Turkmenistan made significant strides in reducing tuberculosis (TB) incidence, achieving a decrease from 71 to 47 cases per 100 000 people between 2013 and 2021.[1] This decline has enabled the country to meet the 2020 regional target of a 20 percent reduction in TB incidence from 2015 levels. Despite this progress, Turkmenistan continues to face challenges with drug-resistant TB (DR-TB), including multidrug-resistant TB (MDR-TB) and rifampicin-resistant TB (RR-TB). The incidence of MDR/RR-TB has increased from 21 percent to 45 percent among new cases, and from 47 percent to 59 percent among previously treated cases.[2] Although the treatment success rates for new and relapsed TB cases remain high at 83 percent, the success rate for DR-TB dropped to 55 percent in 2019, which is below the regional average.[3] To address this, WHO provided technical assistance to Turkmenistan's National TB Program to support the introduction of shorter treatment regimens for DR-TB, lasting 6 months and 9 months, benefitting 602 patients between February 2021 and December 2023. As part of this analysis of the 9-month fully oral, modified, shorter, treatment regimens (mSTR) for RR-TB was conducted in a cohort of 108 patients enrolled between February 2021 and January 2022. This analysis demonstrated a 92 percent effectiveness rate, confirming the benefit of continuing with these shorter regimens. These advancements have significantly enhanced patient outcomes and contributed to health system cost reductions, while aligning with WHO’s 13th General Programme of Work for 2019-2023 (GPW-13) and its visionary “first-billion target” which aims to contribute to the achievement of the 2030 Sustainable Development Agenda.[4] They are a clear example of implementing “Delivering United Action for Better Health – a strategy for collaboration between the WHO Regional Office for Europe and Member States in the WHO European Region,” through mobilizing WHO’s skill, knowledge and expertise to improve health outcomes for all.

Specifically, the GPW-13’s objective to extend Universal Health Coverage (UHC) to an additional billion people is in harmony with Target 3.8 of the United Nations Sustainable Development Goal 3 (SDG-3), which is dedicated to ensuring universal access to healthcare services and fostering good health and well-being for all. Furthermore, the commitment to combat the epidemics of tuberculosis (TB) and other communicable diseases is reflected in Target 3.3 of SDG-3, emphasizing the global effort to eradicate infectious diseases and improve public health outcomes.[5]

To facilitate implementation of the protocol, the United States Agency for International Development (USAID) and Global Fund (GF) contributed vital resources, including funding for WHO international and local consultants, and ensuring a steady supply of TB drugs and laboratory consumables. WHO Turkmenistan and the WHO Regional Office for Europe provided technical support to customize regional training materials for the local context, provided facilitators, covered training expenses, and oversaw the training process. The National TB Program staff’s comprehensive training covered aspects like new treatment regimens, criteria for patient enrolment and exclusion, clinical monitoring procedures, management of adverse drug events, and the use of case reporting forms and data management systems.

After the new regimen was approved and staff were fully trained. A total of 602 MDR/RR-TB patients, were enrolled in the two studies, implemented by the National TB Programme.

-Oraz, patient who recovered from TB

The implementation of these shorter 6- and 9-month treatment regimens was monitored and evaluated under operational research conditions. To coordinate this multi-country study, the WHO Regional Office of Europe organized meetings between multiple countries and coordinated data analyses.

The change in the treatment regimen had a significant impact. The shorter treatments improved patient compliance and reduced the adverse effects associated with long-term medication use. Furthermore, the new treatment regimen lessened the burden on healthcare resources. In the case of the 9-month regimens, analysis was conducted in a cohort of 108 patients enrolled between February 2021 and January 2022. This analysis demonstrated a 92 percent effectiveness rate, confirming the benefit of continuing with shorter regimens. Based on evidence of increased effectiveness, the National TB Program is preparing to expand the implementation of this regimen across the country.[6]

-Lachin, patient who recovered from TB

Through the support of WHO, Turkmenistan has taken a ground-breaking step in the fight against DR-TB. The introduction of these shorter, more effective treatment regimens represents a stride in reducing the DR-TB burden and improving public health outcomes in Turkmenistan.