Cure Tuberculosis Project Strengthens Kyrgyz Republic Response to TB during COVID-19
June 3rd, 2020 | Story
June 3rd, 2020 | Story
The first cases of coronavirus infection in Kyrgyzstan were registered on March 18. The Kyrgyz health care system was not prepared to effectively respond to the novel coronavirus, with poor infection control in health facilities, lack of personal protective equipment, and the increased workload on medical workers. To control the epidemic, the Government announced a state of emergency in some parts of the country with strict lockdown measures and restrictions on movement. On March 23, the Ministry of Health (MOH) issued a decree to convert the specialized 30-bed ward for treatment of patients with multi-drug resistant TB (MDR-TB) at the National Tuberculosis Center (NTC) to host COVID-19 patients, as well as the main building of the NTC with 196 additional beds as a reserve. State laboratories were also assigned to test for the new virus.
The decision to treat COVID-19 patients at the NTC posed serious challenges for infection control and put health workers at high risk of contracting the disease. For TB patients who are particularly vulnerable to COVID-19, it also posed a new risk of TB/COVID co-infection. USAID, as a longstanding partner of the National TB Program (NTP), immediately provided assistance to contain the risk of infection. The USAID Cure Tuberculosis Project assisted the NTP in revising and strengthening infection control protocols and conducted a full-day training for 50 NTP staff on the new measures. The strengthened infection control measures increased the capacity of medical personnel working on the frontlines of the epidemic, minimized the risk to their health, and reduced the risk of infection among TB patients.
When you put on personal protective equipment, your life instinct kicks in and you try to remember all you’ve learned. Instead of panicking it’s better to receive reliable information and learn how to behave in different situations. Emergency situation! What do we do? Like astronauts, we need new information, because there is always new knowledge on the topic,” says Elena Zhdanova, the head of the MDR-TB Unit of the NTC and the First Anti-COVID-19 Brigade Leader.
Special brigades were established to work in 14-day shifts alternating with 14 days of self-isolation. Together with her team, she applied the strengthened infection control measures during their shifts in the Red Zone – the re-purposed MDR-TB Unit and the adjacent areas within the NTC.
In addition to the direct impacts on the MDR-TB ward of the NTC, the COVID-19 epidemic and emergency situation affected the TB service system as a whole. Restrictions on movement during lockdown made it difficult for TB doctors from the regions to travel regularly to the meetings of the central Conciliums, the medical councils that make decisions on diagnosis and treatment of individual DR-TB cases. Tuberculosis patients also could not travel to health facilities to receive their daily dose of drugs. The Cure Tuberculosis Project promptly helped draft a decree for the Ministry of Health on the provision of TB services under emergency conditions. The decree allowed the Conciliums to transition their weekly meetings online, and the Project provided support to set up regular videoconferencing with district TB doctors. The decree also allowed TB patients to receive a 14-day supply of drugs at a time, and the Project developed guidelines for providing video-observed treatment using the internet, mobile communications, and the help of community-based treatment supporters in order to ensure patients continued to take their drugs as prescribed. The decree was adopted by the MOH on April 8, allowing doctors to make critical decisions about diagnosis remotely and to continue providing life-saving treatment to TB patients without interruption.
The new need to test for COVID-19 placed additional strains on the national laboratory system. Testing for COVID-19 was rolled out in 12 laboratories using PCR technology, including the National Reference Laboratory (NRL) at the NTC. As this was a new disease and diagnostic procedure, there was no system for tracking these test results or mapping cases. The Cure Tuberculosis Project modified its Laboratory Data Management Information System (LDMIS), which had been previously developed for tracking TB test results, to include new categories for COVID-19 test results. The upgraded system was installed in all 12 laboratories that provide testing for COVID-19 nationwide. The Cure Tuberculosis Project trained all laboratory staff to enter test results accurately and continues to monitor the system to ensure data quality and patient confidentiality.
Since April, 150,000 test results for COVID-19 have been entered into the system. The system allows sharing of test results between labs and health facilities and real-time tracking and mapping of cases. The system also allows laboratory specialists to save time on paper-based data entry, and it makes data exchange safer thanks to fewer personal contacts and need for physical documentation. The LDMIS system has been so successful that the Government of the Kyrgyz Republic is considering rolling it out nationwide in all state laboratories to capture lab results for diagnosis and monitoring of all diseases.
USAID’s prompt response to the COVID-19 epidemic through the introduction of new policies, new technology, and capacity-building helped ensure remote diagnosis and treatment of tuberculosis patients, safer working conditions for health workers responding to COVID-19, and a system for tracking COVID-19 results to map the emerging epidemic and contain the spread of infection.