Kazakhstan: turning the TB tide

Published: 22 March 2007 0:00 CET

Sholpan Gabdesh carefully unpacks the heavy parcels that Valentina Syrovyatkina, a Kazakh Red Crescent nurse, has carried up to her fourth floor flat on a bleak estate in the northern Kazakh town of Kokshetau, some 300 km from the Russian border. It is the 59 year-old's last delivery, as Sholpan is coming to the end of her treatment for tuberculosis (TB) and she is worried about how she is going to manage in the future.

“For the past seven months, the food and toiletries from the Red Crescent have been my lifeline. Without them, I don’t know how I am going to survive on my husband's pension,” (nine thousand tengiye (60 US dollars a month) she says. She wipes away a tear and points to her husband, Utegen, who for the past two years has been bed-ridden after suffering a stroke.

Sholpan is one of 50 patients that Valentina and a team of Red Crescent nurses visit in Kokshetau. Three times a week, the team checks that their patients are taking the DOTS medication, which stands for directly observed treatment. Tuberculosis is a disease that flourishes in poor living conditions and the nurses also bring food parcels as a healthy diet is an essential part of the 6- to 8-month treatment programme.

Kazakhstan has one of the European region’s highest rates of tuberculosis – a highly contagious disease that spreads through the air. More than 23,000 Kazakhs have the disease, with 147 registered cases per 100,000 people. Rates are more than double those in Communist times, with the transition period having brought economic recession, declining living standards and the country’s health service to its knees.

“Over the past six years, we have been filling the gap between the services provided by TB institutions and individuals who have no access to them,” explains Dr Erkebek Argymbaev, President of the Kazakh Red Crescent.

Although TB rates peaked in 2002, prevalence and mortality remain high in the west of Kazakhstan and in areas where HIV infections are high.

TB-HIV: the dual epidemic

TB kills up to half of all people with HIV worldwide, as their low immunity increases their vulnerability to the disease. In Central Asia, TB patients are also at higher risk of getting HIV as many of them are in high-risk groups such as former prisoners, drug users and sex workers.

Although HIV is not yet fuelling the TB epidemic to the same extent as in neighbouring Russia, the levels of both diseases are rising.

The Kazakh Red Crescent is pioneering the region’s co-infection work, setting up special teams of doctors, psychologists, lawyers and social workers in the country’s HIV “hotspots” such as the central towns of Temirtau and Karaganda. Most of the 70 TB patients living with HIV are former prisoners, as the region – once infamous for the Gulag archipelago, is still known as the country’s “jail belt”.

One of the most difficult parts of the co-infection work is breaking the news to a TB patient that he or she is HIV-positive, says Kazakh Red Crescent psychologist, Zoya Ruzhnikova. If HIV-positive people develop tuberculosis, and are not immediately treated, they will normally die within two months.

However, if they start taking their TB treatment early enough their life can be prolonged by up to five years, or more, until they can have access to antiretroviral drugs. “Our prisons are rife with TB,” says Zoya. “Once the prisoners are released, many of them default on their TB treatment and risk infecting the local community.”

Alexander, 33, a former drug user, was diagnosed with HIV in 2001 and then developed tuberculosis. He was, however, quickly treated and is now a volunteer with the Red Crescent HIV/TB co-infection programme. Drawing on his own experience, he encourages patients with both infections to continue their treatment, taking them parcels of food, vitamins and hygiene products to ensure that they build up their resistance to the diseases.
Multi Drug Resistance (MDR)

As well as the challenge of co-infection, Kazakhstan is also fighting a rise in what is known as multi-drug resistant TB. There are more than 5,500 cases, mostly as a result of people failing to complete a first-line course of TB drugs.

Klara Espolova first contracted TB from her son when he was released from prison. But poverty, a poor diet and her diabetes left her vulnerable to a second attack.

In May 2005, the Red Crescent began sending its visiting nurses to care for MDR TB sufferers in the former capital, Almaty and, in July last year, began a programme for 50 patients in the eastern city of Taldy Korgan. The treatment, which can last for up to two years, is expensive – $4,500 per patient – and thirty percent of patients do not recover.

In June last year, a few months short of her 50th birthday, Klara's worst fears were realised when she was diagnosed as having multi-drug resistant TB. Her son, Sergei, also has this more lethal strain, but, she says, tears rolling down her weathered face, he is not responding well to treatment.

“The multi resistant TB drugs have painful side effects and I often feel like not taking them,” she sighs. “But I know I have no alternative if I am to finally beat this disease.”