Kazakhstan: Assuring the Quality of TB Drugs

Dressed in worn clothing, a woman with a child in her arms opens the door of her rundown apartment to welcome in a nurse bringing tuberculosis (TB) medication for her family. The woman, a widow and mother of five, is unemployed and can not afford to travel to the local clinic. It is essential to take TB medication regularly, therefore, a nurse visits the family three times a week to bring them medication and to make sure they take it.

This approach of trying to ensure compliance among TB patients [Directly Observed Treatment, Short-course (DOTS) strategy] has been implemented in Kazakhstan since 1998; however, multi-drug resistant (MDR)-TB has been increasing during recent years.

There are many essential components to the DOTS strategy, including ensuring access to an uninterrupted supply of quality TB pharmaceuticals. The Government of Kazakhstan, which supplies TB drugs, understands that TB drugs of substandard quality can affect treatment outcomes and contribute to an increase in drug resistance.

As a result, Management Sciences for Health (MSH) has been working with the Kazakhstan Ministry of Health since 1998 to streamline their drug procurement process. The technical assistance provided helps the government purchase TB drugs from reputable manufacturers at lower prices and higher quality.

In 2003, at the request of the Kazakhstan Ministry of Health, MSH's Rational Pharmaceutical Management Plus (RPM Plus) Program, in collaboration with the United States Pharmacopeia and national counterparts, collected and tested TB drug samples from Kazakhstan. Results were positive and are an indication that the Government continues to follow Standard Operating Procedures established with assistance from MSH.

Compliance with international standards of drug quality, and specifically the quality of TB drugs, will enable Kazakhstan to procure high-quality TB drugs and therefore, can ultimately contribute to the control of MDR-TB and DOTS sustainability in the country.