A nurse working in the red zone, Bishkek. Photo: Marion Biremon / UNDP Kyrgyzstan

Scientists around the world are warning of disastrous effects of the Covid-19 pandemic on HIV and TB services, possibly erasing years of achievements in these important fights. When it became clear that Kyrgyzstan would, unfortunately, not be exempted from the new global pandemic, the UNDP’s “Effective HIV  and TB Control in the Kyrgyz Republic” Project, funded by the Global Fund to fight AIDS, Tuberculosis and Malaria, together with partners (government institutions and NGOs) started adapting their activities to ensure continued prevention, diagnosis and treatment of HIV and TB in this difficult context and to help the country fight Covid-19

Donating lifesaving medical equipment

With the outburst of the new pandemic, the Global Fund allowed beneficiary countries to reallocate funds to the fight against Covid-19 and change planned activities to adapt them to the new context of isolation, reduced hospital services and limited mobility.

One of the priorities was to help equip medical workers and institutions to strengthen their capacity to respond to the Covid-19 pandemic. When the first cases of Covid-19 were detected in Kyrgyzstan mid-March, the project immediately donated 50,000 surgical masks and 2,000 FFP2 respirators to health care workers in direct contact with patients.

Regardless of difficulties with supplies and logistics around the world, the UNDP / Global Fund was able to purchase ten ventilators for artificial respiration that were distributed to the Ministry of Health and to the State Service for Execution of Sentence. These devices are used to save patients in respiratory distress and are extremely important to help people suffering from severe cases of Covid-19.

In addition, the project made an important donation of 6550 rapid Covid-19 PCR tests, to be used mainly for HIV and TB patients. These innovative tests allow to diagnose Covid-19 in less than one hour using already existing GeneXpert machines and don’t require additional equipment or training for laboratories. The total amount spent on this equipment (ventilators and tests) surpasses 314,000 USD.

The project is also planning to purchase personal protective equipment (PPE) for health care workers in the TB and HIV fields by September in the framework of the Global Fund grant for Covid-19.

The UNDP donates ventilators to the penitentiary system, Bishkek, June 2020. Photo: Chyntemir Kalbaev / UNDP Kyrgyzstan

Adapting HIV services

One of the greatest challenges caused by the new coronavirus pandemic is ensuring continued prevention, diagnosis and treatment of HIV and TB. Due to lack of medical staff, overcrowded hospitals, limited movement, fear of infection, unemployment and necessary isolation, many patients cannot access health services and these had to be rethought.

Concerning HIV, it was decided that patients would receive their treatment for up to three months at a time in order to avoid frequent trips to the health facilities. Preventive treatments (methadone) and medical material (syringes, condoms) are also given out for longer periods of time.

But it’s well known that treatment alone is not enough, and psychological health is just as important. It’s necessary to continue providing support to patients and key population groups during the pandemic, so this, too, had to be readjusted. The projects’ sub recipients, NGOs working with key population groups, are now providing online consultations to their clients and virtual peer-to-peer support groups. The project developed a new algorithm for HIV express testing, so called assisted HIV express testing, allowing in certain cases self-testing under instruction and control of outreach workers or consultants. Mobile brigades teams in all regions of the country provide in-person services to people living with HIV when necessary. To this extent, the UNDP / Global Fund has also increased travel allocations since fees have significantly raised these past months. All staff of partner organizations were equipped with PPE.

The project is also providing food support for clients in difficult financial situations and is re-opening several shelters and centers where people in difficult situations can receive free housing, meals, shower, laundry, social and psychological services.

In the penitentiary system, the UNDP / Global Fund project distributed 1800 leaflets to prisoners and health care workers on Covid-19 prevention measures.  

A TB doctor checks a patient's X-rays. Photo: UNDP Kyrgyzstan

Adapting TB services

TB treatment, which can last up to two years for resistant cases, is traditionally given out on a daily basis to patients in health facilities, under control of a nurse or doctor. This is done to make sure patients take all of their pills every day – which is the only guarantee that the treatment will work and that patients won’t develop further resistance to the medication. Many patients do not take this treatment consistently in normal circumstances, so with the outburst of Covid-19 and the problems it caused (additional stress, isolation, unemployment, uncertainty, limited mobility…), support is even more important.

But of course under the Covid-19 pandemic this has become impossible and even dangerous for the patients, whose immune systems are already weak. The UNDP / Global Fund project encouraged the Ministry of Health to switch patients to at-home treatment, giving out medication for longer periods of time in advance and controlling their intake via video observed treatment. As a result, the number of patients on video observed treatment increased from 123 in February to 386 in April. The project team is providing trainings on how to use video observed treatment for patients and health care workers, and closely monitoring its implementation.

The project also continues to pay for CT (computerized tomography) scans to diagnose children for tuberculosis at an early age, and is now also paying for their transportation to the medical centers. In order to stimulate TB diagnosis, the UNDP / Global Fund project will provide additional payments to nurses for each diagnosed TB case in August 2020.

All patients on treatment for drug-resistant tuberculosis receive monthly financial help from the Global Fund, and were given an additional 500 soms each to buy PPE. Case managers continue to check up on them and their household contacts, provide psychological consultations and TB education, even during the new pandemic. Due to Covid-19, the project is increasing the number of case managers and instauring mobile brigades to deliver consultations at patients’ homes around the country. These measures are meant to ensure there is no decrease in diagnosis or treatment of TB.

More importantly, the project team has invested all of its efforts in ensuring timely and quality delivery of anti-tuberculosis and antiretroviral therapy drugs to the country regardless of all the difficulties now arising with supplies and logistics worldwide. 

Health care workers in the Covid-19 red zone, Bishkek. Photo: Marion Biremon / UNDP Kyrgyzstan

Supporting and training health care workers

In addition to printing and distributing handbooks and educational posters on Covid-19 for staff in AIDS, TB centers and penitentiary system, the UNDP / Global Fund project is providing regular online trainings on Covid-19 and online psychological seminars for health care workers until the end of the year. The project is also financing observation periods for some of the doctors working in red zones.

A study conducted by the project in May 2020 showed that health care workers still lacked basic knowledge on Covid-19 and were facing extra stress due to increased workloads and a tense environment. Since they are on the frontline of the battle with Covid-19, it’s crucial to take good care of them and arm them with all the necessary for this fight.

Continued training and support for health care workers in this complicated period were also included in the new Global Fund grant for Covid-19, along with other activities to guarantee access to TB and HIV services in this unprecedented context.

As Jenty Kirsh-Wood, Deputy Resident Representative of the UNDP in the Kyrgyz Republic, pointed out: “At the UNDP, we are committed to support health services for all, including the most vulnerable groups of the population. No one should be left behind in this global effort to end Covid-19.” Together with the Global Fund to fight AIDS, Tuberculosis and Malaria, the UNDP is doing all it can to minimize the impact of the pandemic on HIV and TB care and continue helping those in need. 

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