Belarus: Standards of care rise, TB disease and deaths decline

Reforms in Belarus to upgrade TB care and control to international levels are having a positive impact with fewer TB deaths and new cases.

Aleksandr, a 24-year old from the Vitebsk region of Belarus, learned he had tuberculosis when he started a new job in 2010. It is a disease that he knows well. His father died from TB and his brother and sister were treated for it and cured. Like his siblings, Aleksandr completed the standard TB drug regimen, but a few months later he fell ill again. Doctors diagnosed multidrug-resistant TB (MDR-TB) and he was admitted to the hospital for a second round of treatment.

MDR-TB is a potentially deadly, hard-to-treat form of TB that is resistant to the most powerful TB drugs, isoniazid and rifampicin. Resistance to the medicines can occur when doctors do not prescribe the right treatment regimens or when patients do not complete the full treatment. It can also occur if medicines are of poor quality.

Belarus is one of 27 countries globally with a high burden of MDR-TB. In 2011, the country had over 9000 TB patients and nearly one out of four patients had MDR-TB.

One of the most effective ways to prevent the spread of MDR-TB is through adequate detection and treatment of drug-susceptible TB.

TB care and control at international standards

In 2008 the country began instituting reforms to upgrade TB care and control to international levels, in line with WHO Stop TB recommendations.

“Significant improvement in the quality of treatment and new diagnosis methods were the major achievements of the reform,” says Valentin Rusovich, WHO TB coordinator in Belarus.

Reforms focused on improving laboratory services to detect all forms of TB; adoption of international treatment protocols in hospitals and clinics; better monitoring of patient data to assess needs for medicines and services, and track results; and roll out of rigorous infection control guidelines, approved by the Ministry of Health and adapted for local conditions.

For example, in hospital settings, patients with drug-susceptible TB are now separated from people with MDR-TB, patients wear masks outside of treatment units, and medical staff use special respirators (a more protective type of mask) when in contact with people ill with TB.

In addition, standardized TB treatment was introduced into outpatient services paired with patient incentives – distribution of food parcels and reimbursement of transportation costs to clinics. This increased the numbers of patients who completed their treatment and were cured.

International support was critical to success: WHO technical advice, financial support from the US Agency for International Development, and grants to procure TB and MDR-TB medicines by The Global Fund to Fight AIDS, Tuberculosis and Malaria.

Reforms impact TB

Initial results (2011) show that new measures are having a positive impact. There are less TB deaths and new cases of TB have dropped 30% compared to peak levels in the early 2000s.

The duration of hospital stays for TB patients is steadily declining. Patients move out of health facilities within 2 months and complete their treatment and care as outpatients.

New TB cases are also down among health personnel due to new infection control measures.

Drug-resistant TB rate remains high

However, rates of drug-resistant TB remain high and have increased. Drug-resistant forms of TB had risen 15% in 2010, compared with earlier data.

Belarus was commended for its significant impact on TB care, in a 2011 programme review by international and national experts. But the health specialists stressed the importance of early diagnosis and treatment for patients suffering from MDR-TB to build on the success.

Aleksandr is positive about his future.

“I’ll soon finish my second year of treatment and I am confident that this time it will work It’s important to know that anyone can be infected with tuberculosis, and if you think you have it, you shouldn’t be afraid to start treatment. You will be cured, but it takes time,” says Aleksandr.