Ensuring Uninterrupted Treatment for Tuberculosis Patients in Kyrgyz Republic during COVID-19
June 5th, 2020 | Story
June 5th, 2020 | Story
When the first cases of coronavirus were registered in Kyrgyzstan in late March, the Kyrgyz Government announced a state of emergency in some parts of the country with strict lockdown measures in order to contain the epidemic. The shutdown of public transportation and restrictions on movement during the state of emergency made it impossible for many tuberculosis patients to receive their daily dose of drugs. TB patients are normally required to travel every day to the health facility to receive their drugs in person, and to take them under direct observation of health care workers in order to ensure compliance. This is because tuberculosis requires a very long and difficult course of treatment, and strict adherence to the full treatment regimen over many months is essential to ensure cure, as well as to prevent the development of much more serious forms of drug-resistant TB which are very difficult to treat. The new COVID-19 emergency situation puts TB patients at high risk of interrupting treatment or being lost to follow-up. In addition, TB patients are particularly vulnerable to COVID-19, so any kind of movement or travel would put them at increased risk of contracting the disease.
In response, our USAID Cure Tuberculosis Project immediately helped draft a decree for the Ministry of Health (MOH) on the provision of TB services under emergency conditions. The decree, which was adopted by the MOH on April 8, allowed TB patients to receive a 14-day supply of drugs at a time in order to avoid going to the health facility every day. It also allowed alternative ways of observing treatment remotely, including new 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. At the same time, the Cure Tuberculosis Project helped publicize the decree and its special instructions through the internet and social media outreach, including targeted messages to TB patients highlighting their vulnerable status and need to stay home.
One of the Cure Tuberculosis Project sub-grantees, the National Red Crescent Society of Kyrgyzstan, used its network of patronage nurses as community-based treatment supporters in Chui and Talas regions to ensure TB patients’ adherence to treatment and to help patients lost to follow-up resume treatment. These treatment supporters work primarily with TB patients who are from very vulnerable groups of the population, who tend to receive insufficient support and care and are at higher risk of treatment interruption.
Patronage nurse Elena Sorokina has 12 patronage patients, and two of them receive treatment through community-based treatment support. One is a very challenging patient with a polyresistant form of TB aggravated by alcohol abuse and psychological problems, which display as aggression towards medical workers. Despite this, Sorokina visits the patient daily to deliver drugs, ensure compliance with the prescribed treatment, and provide psychological support. She informs the TB doctor about any changes in the patient’s behavior and condition and makes sure the patient is examined regularly. She also transports sputum collected from the patient to the health facility for tests. During patronage support, the patient’s adherence to treatment has improved significantly. He feels better and has become calmer.
Red Crescent employs seven patronage nurses and three specialists who help patients return to treatment. During the emergency, patronage nurses took care of 119 TB patients. Eight patients received TB and other drugs on a daily basis. Eleven TB patients who had previously interrupted treatment for various reasons, resumed treatment.
TB patients highly value the help of the patronage nurses and credit their support and direct involvement in treatment as one of the key adherence factors. “If it were not for you…,” says a 46-year old male patient, who experienced severe depression, stopped treatment for three months, and resorted to alcohol before patronage nurse Gulnara Kadyrova took him under patronage. Soon, he started treatment and stopped drinking alcohol. The patient acknowledges that he has found support and is very glad that there are people who give him strength and motivation to improve his life. He has a great desire to heal.
Patronage nurses continue to provide individual and group psychosocial support and motivation to complete TB treatment, for both patients and members of their families, including holding many support groups online during the COVID-19 crisis. Tuberculosis patients, a high-risk group for COVID-19, also received information and recommendations to avoid coronavirus infection. In addition to psychosocial support, Red Crescent also provides material support to some disadvantaged TB patients. Patients receive vouchers that they can use in local shops to buy non-food and food products to improve their diet. Better nutrition improves the tolerance of drugs and increases motivation to continue treatment and be cured.
Constant communication and attention from a Red Crescent patronage nurse, control by medical workers, and the desire to recover helped me to continue treatment. I can take the medicines myself, but you need to keep in touch with medical workers if you need to ask something, consult, take tests, and to just receive attention helps a lot mentally,” says a 37-year old female patient from Alamedin district.
The Cure Tuberculosis project’s prompt response to the COVID-19 crisis through the use of virtual technologies and innovative means of social support helped TB patients continue receiving life-saving treatment without interruption.