TB REACH Spotlight: Strengthened case detection at government health facilities leads to significant treatment initiation increases in Tajikistan

01 September - Tajikistan has the lowest GDP per capita in Central Asia, as well as in the former Soviet Union, and suffers from high rates of TB (estimated prevalence of 382 TB patients per 100,000 populations). Though the Republican TB Control Center (NTP) currently notifies 75% of the estimated cases in Tajikistan, TB detection and treatment services are still uneven across the country and drug-resistant TB infections are common (17% of new patients and up to 62% of retreatment patients), making the reversal of TB as an epidemic an immense challenge for this low resource setting. Innovative and impactful solutions are needed to quickly link patients to appropriate treatment.

The NTP established a systematic screening initiative based in 3 districts, covering a population of 1.36 million. Community health workers were trained to verbally screen every person visiting government health facilities (polyclinics) in these three districts for symptoms of TB using a standardized questionnaire. Symptomatic individuals were then asked to provide sputum for testing first with smear microscopy and then with the Xpert MTB/RIF assay if smear results were negative. Symptomatic identification, sputum submission, result provision and treatment initiation were all monitored using electronic data collected on mobile phones to limit pre-treatment loss to follow-up. The initiative also established systematic verbal screening and specimen referral networks at a high-volume diabetes clinics and a pre-trail detention facility (SIZO) in the capital, Dushanbe.

During the first year of implementation, over 785,000 individuals were verbally screened for symptoms of TB, resulting in the identification of over 9,250 symptomatic individuals and the treatment of over 1,250 new bacteriologically-positive (Bac+) and a further 410 all forms TB patients. Of these patients, 333 were detected as having infections which were resistant to rifampicin using the Xpert MTB/RIF assay and were sent to specialist clinics for further evaluation and second line treatment initiation. These newly detected and treated patients represent a +244% increase in the treatment of New Bac+ TB notifications compared with historical trends.