Racing Against Tuberculosis

Improved transportation system helps combat tuberculosis in the Kyrgyz Republic

The improved transportation system helps to diagnose tuberculosis faster and start treatment earlier in the Kyrgyz Republic. And the full transfer of the transportation system from international donors to the government ensures sustainability — after all, curing tuberculosis is a marathon, not a sprint.

Patient Ishen Koldoev is receiving his daily medication at Beisheke village health care facility. He had to take 5 to 6 different medications every day for 24 months to complete his tuberculosis treatment. / Aibek Chakiev for USAID

After battling tuberculosis (TB) for two years, Ishen Koldoev, 61, knows what it takes to fight the disease.

“First of all, it is patience,” says Ishen, “Then, you need to take your medication every day. Only this gives a result.”

He had a drug-resistant form of TB (DR-TB), which is particularly difficult to manage because it’s resistant to basic drugs and can only be diagnosed in specialized laboratories.

The course of treatment for (DR-TB) is also long and complex, often with side effects, making it difficult for individuals to adhere to treatment. Medical and psychological support from health care workers and his family helped Ishen recover.

Nurjamal Mamytkazieva is the only nurse in Beisheke village. USAID has trained hundreds of nurses like Nurjamal so that they can provide quality care to TB patients. / Aibek Chakiev for USAID

In addition to daily treatment, Ishen had to do monthly tests to check progress and make adjustments to treatment if needed. These tests are performed in a specialized TB laboratory or the National Reference Laboratory (NRL) in the capital city of Bishkek, a more than two-hour drive from Ishen’s village.

Timely delivery of sputum samples is vital for fast diagnosis and effective treatment.

Ishen couldn’t travel that far, so the village nurse, Nurzhamal Mamytkazieva, collected his and other people’s sputum samples and delivered them to the nearest district medical center, from which samples are picked up by a transportation agent and taken to the laboratory.

Aida Abytalieva, a lab nurse from Kemin district Family Medicine Center, is loading sputum samples collected from village medical facilities in a special thermos container to ensure they are delivered to the National Reference Lab in Bishkek city safely. / Aibek Chakiev for USAID

“We collect sputum here and deliver it within two to three days. Then in special boxes, I take it to the district Family Medicine Center,” explains Nurzhamal. The special box is a cooler bag for the transportation of sputum samples. It has rechargeable batteries and can store up to 10 to 12 samples of sputum.

There are 104 state-run laboratories in the Kyrgyz Republic that can run tests for TB. USAID helped to develop and introduce a transportation system in Chui and Talas regions. New algorithms, safety measures, and financing mechanisms ensure the safe and timely delivery of patients’ biological material. In other regions, it was rolled out with financial support from the United Nations Development Programme. The same system helps to distribute drugs from TB centers to local medical facilities.

Once the transportation system was tested with USAID’s support, the Kyrgyz government implemented this system across the country with public funding. / Aibek Chakiev for USAID

Test results are almost immediately accessible to lab specialists and district-level TB doctors through the online data management system developed with USAID’s support. This enables doctors to make treatment decisions quicker.

These improvements over the last several years helped to reduce the time for diagnosis of tuberculosis from over 90 days to less than a week, saving precious time to start treatment. Regular and rapid testing also enabled doctors to adjust treatment promptly based on test results.

USAID trained dozens of lab workers like Zamirbek kyzy Adina across the Kyrgyz Republic to make sure that TB tests are accurate and timely. / Aibek Chakiev for USAID

At first, the transportation system was mainly funded by international donors, including USAID and the Global Fund, but as of January 2023, the Kyrgyz Government has fully adopted this system. USAID has worked with the Kyrgyz Mandatory Health Insurance Fund to enable a fully state-funded national transportation system.

During the COVID-19 lockdowns, the state-backed transportation system continued to work without detrimental delays. “Because of COVID, all private companies stopped operation, but the state-run enterprises continued to deliver with unfailing regularity. The TB transportation system showed its self-reliance,” says Gulmira Kalmambetova, former head of the National Reference Lab.

USAID partnered with the National Reference Laboratory to implement international quality management and safety systems. / Aibek Chakiev for USAID

Ishen Koldoev received the results of his final tests from the NRL with good news — he was cured of TB. His commitment and adherence helped him to successfully complete the two-year treatment and overcome the disease.

“I wouldn’t wish this disease on anyone. To those who are being treated, I want to say — take the medicine on time, you will definitely be cured,” Ishen advises.

Nurzhamal, who has been working as a nurse for over 30 years, witnessed first-hand all of the changes in the fight against TB thanks to sustainable funding, innovation, and new treatments. “It is only thanks to international TB interventions that we were able to cure him,” says Nurzhamal about her patient.

Connection between a doctor and a patient is critical for the successful treatment of TB. / Aibek Chakiev for USAID

About the Authors

Communicators with the USAID Cure TB Activity team and USAID’s Mission in the Kyrgyz Republic.