O 171102Z APR 09
FM AMEMBASSY ASTANA
TO SECSTATE WASHDC IMMEDIATE 5191
INFO CIS COLLECTIVE 1498
ALL SOUTH AND CENTRAL ASIA COLLECTIVE
EUROPEAN POLITICAL COLLECTIVE
AMEMBASSY BEIJING 
AMEMBASSY TOKYO 
AMEMBASSY SEOUL 
USMISSION USUN NEW YORK 
USMISSION USNATO 
DEPT OF COMMERCE WASHDC
CIA WASHDC
DIA WASHDC
NSC WASHDC 1061
SECDEF WASHDC 0975
JOINT STAFF WASHDC
CDR USCENTCOM MACDILL AFB FL
CDC ATLANTA GA
USOFFICE ALMATY

UNCLAS ASTANA 000661 
 
 
STATE FOR SCA/CEN, EUR/ACE, F, OES/IHB 
STATE PLEASE PASS TO USAID 
 
E.O. 12958: N/A 
TAGS: PGOV PREL EAID EINV TBIO SOCI KZ
SUBJECT:  KAZAKHSTAN:  WORLD TUBERCULOSIS DAY -- INSPIRING STUDENTS 
TO MEET A CRITICAL NEED 
 
REF:  STATE 17303 
 
 
¶1.  SUMMARY:  The DCM addressed a World Tuberculosis Day conference 
for medical students at the Kazakhstan National Medical University 
on April 7.  The conference, entitled "We Can Stop TB," aimed to 
motivate students to get involved in the country's fight against 
tuberculosis (TB) -- a disease that claims the lives of over 2,000 
Kazakhstanis every year -- and to generate awareness among the 
general public.  The event also emphasized the role of primary 
health-care practitioners as a first line of defense in controlling 
the disease.  Approximately 80 students and faculty from the 
Kazakhstan National Medical University attended the event, which 
several national media outlets covered.  END SUMMARY. 
 
¶2.  The conference was co-organized by USAID and the Kazakhstan 
National Medical University, whose rector, Dr. Aikan Akanov, has 
twice served as Kazakhstan's Vice Minister of Health.  Dr. Akanov, a 
respected and proven champion in Kazakhstan's fight to control TB, 
reiterated his appreciation for U.S. Government support and 
recognized the friendship between the two countries.  He expressed 
his interest in U.S. health sector commercial sales and investment 
in Kazakhstan.  Dr. Akanov is a former cardiologist who speaks 
fluent English. 
 
KAZAKHSTAN'S TUBERCULOSIS EPIDEMIC 
 
¶3.  Kazakhstan's TB epidemic compounded by HIV/AIDS could 
potentially impact Kazakhstan's development.  The TB epidemic 
presents a major challenge to the country's health-care system and 
to its economy via decreased workforce productivity.  Kazakhstan 
suffers from one of the world's highest recorded rates of TB.  In 
Kazakhstan, according to the World Health Organization's (WHO) 
latest figures, 139 people per 100,000 have TB, as opposed to six 
per 100,000 in the United States.  Further exacerbating the epidemic 
is the emergence of "multi-drug-resistant" (MDR) TB, a form of TB 
which cannot be treated with a standard course of antibiotics.  WHO 
identifies Kazakhstan as one of the world's 22 highest-burden 
countries faced with the prevalence of this deadlier version of TB. 
Factors that contribute to the spread of MDR TB include deviation 
from international treatment standards, interruptions in drug 
supply, poor patient compliance with treatment, and poor infection 
control in TB and penitentiary facilities. 
 
CHALLENGES IN TREATMENT: TB VERSUS MDR TB 
 
¶4.  It is far easier to treat "normal" TB than drug-resistant forms. 
 Patients infected with "normal" TB face treatment regimens lasting 
between six and 12 months with a standard course of antibiotics that 
are affordable ($40) and readily available.  However, to cure MDR 
TB, the patient must undergo at least two years of treatment with a 
more complex regimen of drugs that are up to 1,000 times more 
expensive than the standard course of antibiotics.  Drug-resistant 
TB is a concern because treatment can be debilitating -- not just 
due to duration of treatment, but also due to the side effects 
caused by the more sophisticated antibiotics.  Further, all who are 
infected by a drug-resistant TB carrier also acquire a resistant 
form of the infection. 
 
WHO IS AT RISK? 
 
¶5.  Populations most at risk of becoming infected with TB are 
prisoners and people living with HIV, which is predominantly spread 
via injected drug use in Kazakhstan.  TB is the leading cause of 
death among HIV patients worldwide and in Kazakhstan.  The 
Kazakhstan National AIDS Center reported that 40 percent of HIV 
patients died from TB in 2008.  The challenge for prisoners is not 
only contracting TB and/or HIV in prison, but also defaulting from 
treatment upon release. 
 
HISTORY IS PARTLY TO BLAME 
 
¶6.  A legacy of Soviet times, Kazakhstan's health-care system relies 
on many "vertical" structures -- that is, highly independent, 
stand-alone facilities charged with diagnosing and treating specific 
diseases or conditions.  The TB and HIV/AIDS systems of care are 
typical vertical structures, operating separate databases and using 
different protocols that allow for little interaction or 
collaboration outside the disease-specific facilities.  These 
vertical structures present an obstacle for HIV-positive patients in 
need of TB diagnosis, counselling, and treatment, and vice-versa for 
TB patients.  Prisoners participate in yet another vertical system 
of care that is not connected to civil health-care systems, 
presenting problems for newly-released prisoners who are suffering 
from TB and/or HIV. 
 
THE RESPONSE IN KAZAKHSTAN 
 
¶7.  In 1998, Kazakhstan adopted the "DOTS" strategy, the 
internationally-recognized approach to controlling TB.  One year 
later, Kazakhstan reported 100% DOTS coverage in the civilian 
system, and models have since been developed for TB management in 
prisons.  This "success" is deceptive:  the quality of DOTS 
implementation has been questionable, with good detection rates, but 
low treatment-success rates.  Although the Government has drafted a 
number of TB-control decrees (e.g., a 2008-2012 national TB plan, 
and TB and MDR TB management guidelines), there remains a dearth of 
specialists who can interpret and analyze data, conduct operational 
research, test interventions, design evidence-based action plans, 
and monitor impact. 
 
¶8.  Despite shortages of trained TB specialists and inadequate 
technical capacity to treat MDR TB, the Government of Kazakhstan 
would like to rapidly scale up MDR TB case management nationwide. 
To guard against resistance to MDR TB drugs, TB medical staff must 
be well-trained to monitor treatment and resistance, and  MDR TB 
drugs are made available consistently and affordably throughout 
Kazakhstan. 
 
¶9.  In concert with the World Bank; the Global Fund to Fight AIDS, 
TB, and Malaria; and other donors, the U.S. Government -- through 
USAID -- has responded by providing support to Kazakhstan's national 
TB program.  Activities include expanding social support services to 
increase patients' adherence to treatment; providing better 
information to high-risk groups to increase care-seeking and early 
diagnosis; providing training to improve diagnosis, treatment, and 
support for those infected with TB; and improving the collection and 
use of data to make sound policy decisions. 
 
THE WAY FORWARD 
 
¶10.  Some efforts have demonstrated progress in the fight to control 
TB, such as enhancing laboratories' capacity to correctly diagnose 
the infection, and a pilot MDR TB treatment project in Almaty that 
had a treatment success rate of 84 percent compared to the national 
average of 76 percent.  However, given the high rates of TB, MDR TB, 
and TB/HIV co-infection, it is clear that much more needs to be done 
to prevent the further spread of this disease in Kazakhstan.  For 
example, although TB mortality rates were reduced by half in 2008, 
18,000 new TB cases were registered -- of which 14 percent had a 
drug-resistant strain -- and 2,500 people died of TB. 
 
¶11.  COMMENT:  The "We Can Stop TB" conference is just one of many 
activities to encourage Kazakhstan's medical students -- the 
prospective leaders of the country's uphill battle against TB -- to 
focus on this important disease.  TB is not only a threat to 
Kazakhstan, but to the greater region and the world.  END COMMENT. 
 
HOAGLAND