25 July 2014 - Baku/Geneva - Azerbaijan was one of the first countries in the region to introduce DOTS (in 1995); however, early implementation had been flawed and country-wide coverage was reached only 10 years later. The Ministry of Health (MOH) has the overall responsibility for TB control in the country. The latest (for 2010) WHO-estimated TB incidence in the country is 110 per 100,000 population, which is 7th highest rate among 54 countries of the WHO European Region. The first Drug Resistance Survey, conducted in June 2007 in Baku city revealed MDR-TB in 22.3% of new cases and 55.9% of previously treated cases. This was presented in the 4th Global Report on Anti-TB Drug Resistance in the World.
Prison populations usually contain a high prevalence of people with serious and often life-threatening conditions. Sooner or later most prisoners return to the community, carrying back with them various diseases, like tuberculosis, HIV, etc and often pose a threat to community health and add to the burden of tuberculosis and other devastating infections in the community.
Treatment success was only 55% among new smear-positive drug-susceptible TB patients in 2008. By 2010 it used to be not more than 63% every year, prison population in Azerbaijan. Nearly 25% of the patients failed to continue treatment after release each year.
In order to solve the problem of TB treatment after discharge from prison, a grant was sought from The Global Fund. Thus, in March 2011, our NGO, ‘Saglamliga Khidmat’ (translated as Support to Health) launched the project for ex-prisoner TB patients within the frame of The Global Fund Round 9 TB grant. As a result of active involvement of ‘Saglamliga Khidmat’, currently, the rate of loss to follow-up after release has been reduced to almost zero and the treatment success rate for new sputum smear-positive drug-susceptible TB patients has increased to 88%.
Through involving civil society organization in the follow-up of TB treatment after discharge from prison, treatment adherence and success rates among released prisoners drastically improved in Azerbaijan. The civil society organization play a valuable role in providing psychosocial care, working closely with patients and their family members and providing incentives and enablers.
Monthly food packages and daily transport fees motivate patients to arrive at DOT centres to take their medication. Incentives are given to DOT supporters, in recognition that these patients need more attention from medical personnel.
The impact of the project has been periodically evaluated by the Project Implementation Unit of the Ministry of Justice, by the oversight committee of the Country Coordination Mechanism, and at international level by WHO and the GFATM Office of Inspection General (October 2012). Through the project, Saglamliga Khidmat was able to follow up 99% of released patients with psychosocial and counseling sessions and provide incentives for them to attend DOT centers every day, and thus to strengthen adherence to treatment.
By comparison, treatment follow-up was only 10% in previous years. Since the NGO’s involvement (March 2011-July 2014), 394 patients (260 people with drug-susceptible TB and 134 people with drug-resistant TB) have been discharged from penal institution and all except 6 cases (2%) continued treatment after release.
Psychosocial and emotional counselling by adherence counsellors in prison and also whilst on treatment after discharge from prison and providing incentives has helped to achieve good results. Our follow up coordinators meet each patient once a month and listen to his problems and concerns and provide psycho-social support, incentives and enablers to keep him on the treatment.
This project demonstrates that working in an innovative manner to engage communities meaningfully in the fight against TB, early case detection, early enrolment to treatment and following up treatment continuation and preventing treatment interruption can significantly improve TB treatment adherence and success rates among released prisoners.
The project was evaluated as a best practice by the WHO for European Region in 2013 and is intended to be used as a resource for stakeholders at all levels of health systems for the continued implementation of the Consolidated Action Plan in European Region.
Compiled by Mukhtarli Elchin, Director, Support to Health, Azerbaijan