Uzbekistan

Background

With a population of 30 million people, tuberculosis (TB) is a critical problem in the landlocked Central Asian country of Uzbekistan. Uzbekistan is one of the five countries in the European region with the highest incidence of TB—79 per 100,000 population as of 2016 and a mortality rate of 9.8 per 100,000 population.[1],[2]

Almost a quarter (24%) of new TB cases has MDR-TB, and this rate increases three-fold to 63% in retreatment cases.1 Uzbekistan is also one of the top five countries in the WHO European region with the highest number of TB/HIV coinfection cases.2

High rates of MDR-TB likely result from a number of underlying causes, including improper prescribing practices, misuse of medicines, and inadequate quantification and supply planning resulting in stock-outs of anti-TB medicines. Decision making and managerial interventions aimed at overcoming these challenges are limited by a lack of reliable data, often due to weak information systems.

Project highlights

Strengthen pharmaceutical sector governance

SIAPS facilitated the creation of the Ministry of Health’s (MOH) TB Pharmaceutical Management Working Group (TBPWG), with representatives from the MOH, National TB Program (NTP), Drug Regulatory Authority, and the Republican Directly Observed Treatment, Short-course (DOTS) Center.

Strengthen pharmaceutical services for the NTP of Uzbekistan

SIAPS addressed the safety of anti-TB medicines and appropriate prescriber adherence to national standard treatment guidelines and dispensing to preserve the effectiveness of anti-TB medicines and contain the development of drug-resistant TB.

Strengthen supply system of anti-TB medicines

SIAPS built capacity for the consistent and efficient use of a Logistics Management Information System (LMIS) by having pharmaceutical management staff provide TB services. SIAPS also supported setting up an early warning system to address the problems in quantification and supply of anti-TB medicines.

Results

  • The TBPWG continued to operate in Uzbekistan to support the nationwide scale-up of QuanTB to improve TB program management. The TBPWG developed pharmaceutical management guidelines and standard operating procedures for organizing the reporting, collecting, and processing of data for QuanTB.
  • Results of an assessment of the TB pharmaceutical management system revealed problems in the rational use of anti-TB medicines. In 16% of cases, first-line treatment did not conform to standard treatment guidelines; in 46% of cases, second-line regimens used for treatment of MDR-TB patients were different from what was prescribed by the MDR-TB consilium. A drug use review (DUR) was conducted in all of Uzbekistan’s 14 oblasts between June 2016 and February 2017. Uzbekistan plans to implement the DUR program on a regular basis to assess the current status of the rational use of TB medicines within their facility and to plan interventions.
  • SIAPS developed the electronic LMIS in Uzbekistan to monitor reports for on-time submission and improved accuracy and to dramatically reduce the time needed to aggregate the data received from the different facilities.
  • SIAPS built the capacity of Uzbekistan’s 34 TB facility staff members (6 at the central and 28 at the oblast levels) responsible for medicines management and use of the LMIS. Feedback from the NTP’s supportive supervisory teams has also been very positive, with health professionals detailing how the knowledge acquired during the training is used daily in the TB facilities.
  • Results of the assessment of TB pharmaceutical management system showed that 71% of facilities visited (20 out of 28) reported stock-outs of TB medicines over the last 12 months. Nine of those 20 (45%) reported that the reason for stock-outs was incorrect quantification of medicines. Another nine facilities (45%) reported that the reason was delayed supply of medicines. To address this, SIAPS worked with the NTP to pilot and roll out QuanTB. To-date, QuanTB is used in all 14 oblasts in the Republic of Uzbekistan.
  • From June to December 2016, the proportion of oblast warehouses with at least one TB medicine stock-out decreased by 32% on average (ranging from 0% to 83% decrease in stock-outs) across the oblasts.

Legacy

SIAPS has played a crucial role in strengthening the pharmaceutical system by building capacity in using pharmaceutical information for decision making and better forecasting and for stock monitoring of pharmaceuticals at health facilities. Regular quantifications and the early warning feature of QuanTB were used to make decisions about when and what quantities to order for the regional and district levels. This approach has significantly improved the supply of anti-TB medicines in the country. QuanTB was institutionalized and incorporated into an amendment to ministerial order #383 to endorse use of QuanTB for TB medicine quantification and supply planning at all levels in Uzbekistan. As a result of SIAPS capacity building, the TBPWG has the ability collect DUR data, generate reports, and plan appropriate actions to solve identified problems and prevent the spread of MDR-TB.


[1] WHO. WHO Global tuberculosis report 2016. WHO/HTM/TB/2016.13. World Health Organization, Geneva; 2016
[2] European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2017. http://www.euro.who.int/__data/assets/pdf_file/0020/334703/tuberculosis-surveillance-and-monitoring-in-europe-2017.pdf?ua=1