Cure Tuberculosis Project Supports Naryn Oblast as a Model for TB Service Reform

USAID has long worked with the government of the Kyrgyz Republic on tuberculosis (TB) epidemic control. The USAID Cure Tuberculosis Project developed a comprehensive package of reforms that work at all levels of the health system to optimize TB service delivery and improve care for patients. This package is being rolled out gradually in all oblasts nationwide. In 2021, these reform efforts were championed by the Naryn Oblast TB Center (NOTC), which has implemented the full package and is now a destination for other OTCs to observe these best practices first-hand.

Cure Tuberculosis provided support to the NOTC to optimize the oblast laboratory network for greater efficiency, implement a quality management system (QMS) to improve diagnostic processes, and build a system to transport patient sputum from remote health centers to central laboratories for testing and to distribute drugs to health centers. The project mapped all rayon laboratories and health care facilities and developed clearer transportation routes so that samples can be received and tested faster. The project also partnered with the Mandatory Health Insurance Fund to transfer financing of the transportation system to the state budget to ensure long-term sustainability.

USAID has also led the way in developing a set of information systems that streamline the work of doctors and laboratory staff. The Laboratory Data Management Information System (LDMIS) captures and shares data between laboratories that perform TB diagnostic tests and health centers that prescribe treatment in real time. The e-TB Register stores all individual TB patient records and test results with easy access to information from any device at any time, and the electronic medical record houses patient data at the hospital level. Cure Tuberculosis also installed an X-ray connector in the NOTC—the first-ever in TB services—that can digitize and transfer X-ray images.

The NOTC can now use the e-TB Register at its full capacity, allowing clinicians to access patient data on demand and decide on the course and initiation of treatment. Today, all TB cases submitted to NOTC’s Concilium for discussion are presented through the e-TB Register, with full access to patient clinical data and x-rays. The LDMIS, e-TB Register, and other clinical information systems, together with revised recording and reporting forms, helped reduce data errors and improve the quality of TB treatment.

“The [LDMIS] and the clinical module [e-TB Register] improved the quality of work, the timeliness of prescriptions, and the ability to monitor treatment,” says Nurjamal Mamytova, the head of the NOTC. “[We obtained tools] to correctly prescribe TB examinations, choose the right treatment tactics.”

USAID initiatives helped increase diagnosis of TB cases partially because of increased GeneXpert testing coverage in Naryn Oblast from 70 percent in 2018 to 100 percent in 2021. The QMS, the TB transportation, and the clinical information systems also helped decrease the turn-around time for critical laboratory tests significantly; results can now be received in as few as five days, compared to as many as 90 in 2017. For patients, this means faster diagnosis, earlier start of treatment, and a better chance of being cured.

Beyond fast and accurate diagnosis of TB, the management of patients while on treatment is critical to success. Cure Tuberculosis strengthened the TB case management approach in Naryn Oblast by improving and simplifying clinical processes and procedures and implementing a reformed TB Concilium model. The NOTC Concilium, which now has the capacity to convene virtually, is much more effective. Every member has been fully trained and has clear roles and responsibilities, decision-making capacity, and access to patients’ test results and records. Rayon TB doctors participate in the Concilium each week and benefit from the knowledge and expertise of their peers when evaluating the initiation, adjustment, and completion of treatment for patients.

At the primary health care (PHC) level, Cure Tuberculosis implemented the TB case management approach to strengthen the quality of outpatient care and ensure health workers’ commitment to treatment completion for TB patients. This includes an incentive payment system for health workers for successfully treated cases, and the engagement of local government and civil society organizations to support people with presumptive TB to test and those with TB to complete the full course of treatment. This psychosocial and financial support is extremely important for TB patients, who often face stigma and discrimination and incur financial difficulties when on treatment.

A strengthened contact investigation model implemented in Naryn Oblast was also a success; the number of TB contacts identified and examined in 2021 doubled since 2020. In addition to the work at the PHC level, the project implemented an active TB case-finding approach in general TB hospitals and implemented infection prevention and control improvements in the NOTC.

These and other achievements of the NOTC in complex TB reforms were recognized by colleagues from Batken and Talas OTCs who visited Naryn in November 2021. They participated in concilium meetings and witnessed the various processes and systems at work – an important step in TB service reforms thanks to USAID Cure Tuberculosis’ support.