Establishing a Platform for Rapid Innovation Uptake: Perspective of

Kyrgyzstan

Kadyrov A.S.

2019, Wolfheze, Netherlands

Goal: To increase the treatment

success rate among patients with

multidrug - and extensively drug-

resistant tuberculosis (M/XDR-TB)

Improvement of treatment success rate requires introduction of effective regimens and methods of

treatment

INTRODUCTION OF A SHORTER TREATMENT REGIMEN FOR NEW MDR-TB CASES

INTRODUCTION OF AN INDIVIDUALIZED TREATMENT REGIMEN FOR M/XDR-TB PATIENTS

DURATIONFROM 9 TO 12MONTHS INSTEAD OF 2 YEARS

THE COST IS2-3 TIMES LESS

NEW ANTI-TUBERCULOSIS DRUGS

LESS ADVERSE EVENTS

Creating a Sustainable Program Capable of Rapid Adaptation of Innovations in Diagnosis and Treatment

• Diagnosis• Treatment regimen design• Safety and efficacy monitoring• Drug management• Patient support• Infection control• Contact evaluation• Recording & reporting• Digital Health

Stages of the Introduction of New M/XDR-TB Treatment Regimens

5

July-Sept2015

Oct-Dec 2015

Jan-March 2016

Apr-June2016

July-Sept2016

• Guidelines and SOPs finalization

• Trainings for clinical and laboratory staff

• Site selection/evaluation

• National Plan development

• Drugs needs estimation

• On-site trainings

• Start of the enrollment

• Approval of manuals

• Development of a diagnostic algorithm and treatment regimens

• Guidelines and SOPs development

• National Plan implementation

Development of guidelines and SOPs

January2017

January2018

• New regimens and new drugs are available all over the country

• Support was provided to all the patients

New Biomaterials and Anti-TB drugs Transportation System

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vel

1 le

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NCT/NRL

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Transport Agent

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Payment of travel expenses to providers for the delivery of sputum specimens from FPG/FOO to CFM/GPC (as per the Order of the Ministry of

Health of the RK)

Diagnosis

• Module-based reference-laboratory of the NCT was launched in 2013.

• Ensured access to rapid molecular TB diagnosis (Xpert, SL-LPA)

• Started implementation of new laboratory TB diagnostic methods (QuantiFERON assay, whole genome sequencing)

• Introduced drug susceptibility tests to Bedaquiline and Delamanid

Treatment 1

• Strengthened capacity of the regional DR-TB consilia

• TB treatment is according to the latest WHOrecommendations:

• New anti-TB drugs (Bedaquiline, Delamanid)

• Shorter and individualized MDR/XDR-TB regimens

• Active adverse events monitoring

throughout the country

Treatment 2

• 100% provision of anti-TB drugs for all patients:

– Since 2016, first line anti-TB drugs have been procuredwith the state budget

– Since 2018, second-line anti-TB drugs (15% of the totalneed) have been procured with the state budget

– Pediatric formulations (suspensions, etc.) are available

The modality of directly supervised treatment

Clinical follow-up, evaluation and monitoring

Treatment adherence: evaluation and monitoring

Psychological and social follow up

Patient-Centered TB ServicesTB

CA

SE M

AN

AG

EMEN

T

To improve individual treatment outcomes and minimize the risk of TB transmission by providing medical services, social and psychological follow up from the moment of diagnosis to the completion of treatment

Development of information products for

TB systems (EMR, LIS, Notification, etc.)

ТB facility

Electronic TB patient card

Drug management

Laboratory information system

TB IS SERVER

Transportation IS

Dashboard

1

2

3

4

5

Information security

Information security

MORE THAN 1,000 PATIENTS ON NEW

TREATMENT REGIMENS

• In all the regions of

Kyrgyzstan

• Treatment is completely

free of charge• Leaders in TB control!

78%

16%

6%

PRELIMENARY TREATMENT OUTCOMES, 2017 (N=119)

Успех лечения Потерянные для наблюдения Неэффективное лечениеTreatment failureTreatment success

Lost to follow up

Slide 3

Text 3PREVIOUS TREATMENT REGIMEN

First cohort, January – March 2017, 31 patients

EXTENSIVELY DRUG-RESISTANT TUBERCULOSIS

INDIVIDUALIZED TREATMENT REGIMEN

ONLY

CURED CURED

Further Steps

• Transition of the country to new, effective TB treatment regimens (injectable-free, new regimens and anti-TB drugs)

• Expansion of the coverage and availability of rapid XDR-TB diagnostic methods by scaling up the implementation of the transportation system in other regions of the country

• Developing mechanisms for effective state procurement of prequalified anti-TB drugs and other materials

• Further expansion of TB Case Management System in PHC facilities across the country

• Building capacity of health professionals in using modern approaches to diagnosis and treatment of TB, DR-TB, and TB Case Management

Acknowledgement

• USAID• Challenge TB/KNCV• Defeat TB/Abt Associates• UNDP/GF• Supranational Reference Laboratory• WHO• MSF• ICRC• NGO• National Red Crescent Society

Thank you for your attention!