Population: 7 million Total TB cases notified (2009): 5959 Treatment Success Rate for new smear-positive TB cases (2009): 81%
Tajikistan became independent in 1991 following the breakup of the Soviet Union, and experienced a civil war between regional factions from 1992-97. Tajikistan is landlocked with Pamir and Alay Mountains dominating landscape; western Fergana Valley in north, Kofarnihon and Vakhsh Valleys in southwest. Ir is made up of several ethnic groups specifically: Tajik 79.9%, Uzbek, 15.3%, Russian 1.1%, Kyrgyz 1.1%, other 2.6% (2000 census). Less than 7% of the land area is arable. Cotton is the most important crop. It has much in the way of natural resources: hydropower, some petroleum, uranium, mercury, brown coal, lead, zinc, antimony, tungsten, silver and gold, but industry consists only of a large aluminium plant, hydropower facilities and small obsolete factories mostly in light industry and food processing. The country remains the poorest in the former Soviet sphere with the lowest per capita GDPs among the 15 former Soviet republics. Because of a lack of employment opportunities in Tajikistan, as many as a million Tajik citizens work abroad (almost all of them in Russia), and send money back to their families in Tajikistan. Tajikistan's economic situation remains fragile due to uneven implementation of structural reforms, corruption, weak governance, seasonal power shortages, and the external debt burden. Electricity output expanded with the completion of the Sangtuda I hydropower dam - finished in 2009 with Russian investment. The smaller Sangtuda-2, built with Iranian investment, began operating in 2011. The government of Tajikistan is pinning major hopes on the massive Roghun dam which, if finished according to Tajik plans, will be the tallest dam in the world and significantly expand electricity output. Food and fuel prices in 2011 increased to the highest levels seen since 2002 due in part to an increase in rail transport tariffs through Uzbekistan. Tajikistan imports approximately 60% of its food and 90% of that comes by rail. Attention by the international community since the beginning of the NATO intervention in Afghanistan has brought increased economic development and security assistance, which could create jobs and strengthen stability in the long term. Tajikistan is seeking WTO membership and has joined NATO's Partnership for Peace.
There is a steady reduction in TB in Tajikistan, in 2009 the TB notification rate was 85,2 per 100,000 of population which by 2011 has decreased to 78,7 per 100 000 of population. However the TB mortality rate is acutally increasing from 5,4 in 2008 to 6,6 in 2011, which is due to problems accessing MDR-TB treatment in recent years.
According to the Ministry of Health HIV is increasing problem for general population. In 2010 the number of HIV cases notified was 989 which is nearly twice the number reported in 2010. The proportion of TB/HIV positive patients started ART has increased from 17,4% (54 of 310) in 2010 to 55,9% (66 of 310) 2011, and the number of TB patients tested for HIV is increased for the last five years from 306 (4%) in 2007 to 6241 (82%) in 2011. In 2011 the number of HIV patients who died was 190, among them 131 (68,9%) died because of TB/HIV co-infection. A lack of effective coordinating mechanisms for TB and HIV is a key barrier for effective collaboration. A Technical Working Group on TB/HIV exists but is not very active and guidelines for the clinical management of collaborative TB/HIV activities between two programs are absence in the country. Recording and reporting on TB/HIV co-infection exists, however analysis of the data is not regularly conducted at the national levels.
The budget of the NTP has increased yearly from 2006; however, it is far from being sufficient to cover basic needs of TB programme. In 2011, according to the estimates, the governmental contribution to disease control was 29%. Currently, majority of funding is coming from the international organizations, mainly for the GFATM Rounds 3 RCC (Project HOPE as the PIU) and Rounds 6 and 8 consolidated grant (UNDP as the PIU). The NTP is supported also by KfW, USAID (through the CDC, Project HOPE, and KNCV), MSF and other partners. The country has applied to the Transitional Funding Mechanism (TFM), which is expected to begin in October 2013. The TFM application is mainly for management of 1,600 M/XDR-TB patients over 2-years period. This is approximately the needed number of treatments to cover all country with M/XDR-TB treatment.
TB CARE I Strategic Approach
One of the constraints of proper implementation of TB activities is the lack of national strategic documents related to fighting TB (national TB control program, national strategic plans) and inconsistencies between existing regulations and international recommendations and standards. The National TB work plan needs to be revised to become more comprehensive and cover all important aspects of TB/MDR/XDR management including prison system and childhood TB. Another major constraint is lack of management and technical capacities in NTP. Management of TB control program at different levels (national, oblast, rayon) needs further development and coordination with different partners working in TB field should be strengthened. NTP needs to have national strategy on development of HR for TB control program. The aim of the TB CARE I work plan is to contribute to the expansion of equitable access to quality assured early diagnosis and adequate treatment for TB and MDR-TB patients.