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Background: Tajikistan National TB Control Program
Objective: (1) To identify the main obstacles to increasing TB Detection in Tajikistan. (2) To identify interventions that improve TB detection.
Methods: Review of the available original research data, health normative base, health systems performance and national economic data, following WHO framework for detection of TB cases, which is based on three scenarios of why incident cases of TB may not be notified.
Results: Data analysis revealed that some aspects of TB case detection are more problematic than others and that there are gaps in the knowledge of specific obstacles to TB case detection. The phenomenon of “initial default” in Tajikistan has been documented; however, it needs to be studied further. The laboratory services detect infectious TB cases effectively; however, referrals of appropriate suspects for TB diagnosis may lag behind. The knowledge about TB in the general population has improved. Yet, the problem of TB related stigma persists, thus being an obstacle for effective TB detection. High economic cost of health services driven by under-the-table payments was identified as another barrier for access to health services.
Conclusion: Health system strengthening should become a primary intervention to improve case detection in Tajikistan. More research on reasons contributing to the failure to register TB cases, as well as factors underlying stigma is needed.
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Revised 7/16/2018. Revision Description: Removed outdated link.
National program for tuberculosis protection of the population of the Republic of Tajikistan, 2010-2015. Dushanbe. 2010.
World Bank, Data and Statistic for Tajikistan. 2010. Available from http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/ECAEXT/TAJIKISTANEXTN/0,,menuPK:287273~pagePK:141132~piPK:141109~theSitePK:258744,00.html. Accessed 2011 Jun 15.
Toshmuhammadov M. Civil War in Tajikistan and Post-Conflict Rehabilitation. Hokkaido University Center of Slavic Researches, Sapporo. 2004. Available from http://src-h.slav.hokudai.ac.jp/pdf_seminar/040607tasmuhammadov_eng.pdf. Accessed 2012 Jul 12.
Global Tuberculosis Control: WHO report2011.WHO/HTM/TB/2011.16: 187-211.
Project HOPE, 2009-2010. Routine monitoring reports of the supervisory visits.
Global Tuberculosis Control: WHO report 2010.WHO/HTM/TB/2010.7: 14-5.
Botha E, den Boon S, Verver S, et al. Initial default from tuberculosis treatment: How often does it happen and what are the reasons? Int J Tuberc Lung Dis. 2008; 12:820–3.
Botha E, den Boon S, Lawrence KA, et al. From suspect to patient: Tuberculosis diagnosis and treatment initiation in health facilities in South Africa. Int J Tuberc Lung Dis. 2008; 12:936–41.
SaiBabu B, Satyanarayana VV, Venkateshwaralu G, et al. Initial default among diagnosed sputum smear-positive pulmonary tuberculosis patients in Andhra Pradesh, India. Int J Tuberc Lung Dis. 2008; 12:1055–8.
Harries AD, Rusen ID, Chiang CY, et al. Registering initial defaulters and reporting on their treatment outcomes. Int J Tuberc Lung Dis. 2008; 13(7):801–3.
Korobitsyn A, Rajabov J, Norov O, Shekhov A. Analysis of initial defaulters in selected districts in Tajikistan. 41st IUATLD conference; Berlin. 2010.
World Health Organization. Health Systems Topics. Available from http://www.who.int/healthsystems/topics/en/. Accessed 2012 April 25.
Kosymova S, Ismoilova J, Korobitsyn A, Saifitdinov S. Tuberculosis knowledge, attitudes and practices survey among health care providers, TB patients and general population of Tajikistan. Technical report. Dushanbe. 2009.
World Health Organization. Treatment of tuberculosis. Guidelines for National Programmes, 3rd ed. Geneva, Switzerland. 2003.
Goffman E. Stigma: Notes on the management of spoilt identity. London, UK: Penguin; 1963.
Jones EE, Farina A, Hastorf AH, Markus H, Miller DT, Scott RA. Social stigma: The psychology of marked relationships. New York, NY: Freeman; 1984.
Weiss MG, Ramakrishna J. Stigma interventions and research for international health. Stigma and global health: Developing a research agenda International Conference 2001; Bethesda, Maryland, USA. Available from http://www.stigmaconference.nih.gov/FinalWeissPaper.htm. Accessed 2009 Jan.
Kosymova S, Ismoilova J, Purves M. Tuberculosis knowledge, attitudes and practices survey among health care providers, TB patients and general population of Tajikistan. Technical Report. Dushanbe. 2006.
Salikhov B, Bobokhojaev O, Sirojidinova U. Stigma associated with tuberculosis among Tajikistan labor migrants. 6th Conference of The Union Europe Region; Imperial College, London.
Russell S. The economic burden of illness for households in developing countries: A review of studies focusing on malaria, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome. Am J Trop Med Hyg. 2004; 71(2):147-55.
McIntyre D, Thiede M, Dahlgren G, Whitehead M. What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts? SocSci Med. 2006; 62:858-65.
Feeley FG, Sheiman IM, Shiskin SV. 1999. Health Sector Informal Payments in Russia. Boston University, Boston, Massachusetts.
Feeley FG, Boikov VE, Sheiman IM. 1998. Russian Household Expenditures on Drugs and Medical Care. Boston University, Boston, Massachusetts.
Ayé R, Wyss K, Abdualimova H, Saidaliev S. Household costs of illness during different phases of tuberculosis treatment in Central Asia: A patient survey in Tajikistan. BMC Public Health. 2010; 10:18. Available from http://www.biomedcentral.com/1471-2458/10/18.
Makhmudova M, Rajabov J, Chorgoliani D, Hasker E. TB drug use study in Tajikistan. 39th IUATLD conference; Paris. 2008.
Makhmudova M, Joseph J, Ismoilova J, Norov O, Korobitsyn A. TB patients’ needs and costs study in Tajikistan. 41st IUATLD conference; Berlin, 2010.
World Health Organization. Advocacy, communication and social mobilization (ACSM) for tuberculosis control: A handbook for country programmes. 2007. 4-5.
Luelmo F. World Health Organization. What is the role of case detection in Tuberculosis control? Toman’s Tuberculosis, 2nd Ed, Geneva, 2004.
WHO Expert Committee on Tuberculosis, 9th Report. Geneva, World Health Organization, 1974.
Statistical Agency President of the Republic of Tajikistan Database. Available from http://www.stat.tj/ru/database/real-sector/. Accessed 2012 Aug 26.