Drug resistance survey to be implemented in Turkmenistan

According to two recent reports published by WHO/Europe, only 39 cases of multidrug-resistant tuberculosis (MDR-TB) were detected in 2009 out of an estimated 160 patients with MDR-TB in Turkmenistan. Considering the need for a national TB control programme on the prevalence of MDR-TB in the country, a drug-resistance prevalence survey will be conducted in 2011-2012 by the National TB reference laboratory with the support from experts from the Netherlands (the National Institute for Public Health and the Environment (RIVM)).

A mission facilitated by WHO/Europe from 5-7 April 2011 was conducted and had the following aims:

  • to discuss the concept of providing a countrywide drug-resistance survey;
  • assess the capacity of the national TB programme for the countrywide drug resistance survey; and
  • identify field laboratories to be enrolled in the survey.

A standardized methodology, as recommended in the WHO publication “Guidelines for surveillance of drug resistance in tuberculosis" (2009), was applied to ensure representativeness of the study. The methodology will be adopted to the local circumstances and health system structure.

During the mission, district and regional TB laboratories in the Balkan region of Turkmenistan were visited and a series of consultations with national experts from the national TB reference laboratory on the quality performance of smear microscopy culture and drug-susceptibility testing were held.

The first nationwide anti-tuberculosis drug resistance survey will be implemented by the national TB control programme of the Ministry of Health of the Turkmenistan, in cooperation with the penitentiary system of the Ministry of Justice of Turkmenistan.

The survey will be managed overall by a team at the National TB programme and WHO/Europe and the Supranational Reference Laboratory at the RIVM will provide technical assistance in the development of a survey protocol, survey planning and monitoring, provision of quality assurance of laboratory processes, and data analysis.

Prior to launch of the survey, the following will be conducted to ensure quality implementation and accuracy of results:

  • On-site refresher microscopy training at each of the five regional TB dispensaries, conducted by specialists of the national reference laboratories.
  • Comprehensive training of specialists in use of rapid line probe assay technology. A coded panel of strains will be sent from the partner Supranational Reference Laboratory for proficiency testing of the technology.
  • Training of clinicians from diagnostic centres in Turkmenistan on how to fill out clinical information forms and interview patients in order to ensure proper classification of a patient’s history of previous treatment.

Funding for most aspects of the survey is expected to be covered by phase 1 of the round 9 Global Fund grant.