Paul Sommerfeld and Daniel Kashnitsky sit at a table togetherIn mid May, Daniel Kashnitsky and I joined with Tsira Chakaia and a Tajikistan member of parliament (MP), Jamshed Murtazaqulov, in a joint TBEC and Global TB Caucus (GTBC) visit to Belarus. Our intentions were to explore possible initiatives in Belarus under TB REP2 and also whether there is interest in creating a local MP caucus on TB.

Over 3 days we had a fascinating series of meetings with parliamentarians, national health bodies, civil society, the WHO country office, and the British Embassy. The overall picture is very encouraging.

Ten years ago, Belarus had some of the worst MDR rates in the world together with poor treatment success rates. Today a combination of improvements in the national programme and the introduction of new drugs, especially Bedaquiline (BDQ), have had a very positive impact. From this year onwards, BDQ is being made available in all parts of the country although there is still work to be done to ensure access to it for all.

New case incidence is down from 58 in 2009 to 32 per 100 000 in 2017. Treatment success is up to an impressive 83%. Mortality is going down by around 10% per annum. New cases have dropped from a total of 6729 in 1999 to 1916 in 2018.

Nonetheless, 37% of individuals newly diagnosed in 2017 had MDR TB. Bed numbers are being reduced but were still at just under 3000 at the start of 2019 with a consequent tendency to holding individuals with TB in hospital more often and longer than necessary.

A controversial aspect of Belarus practice is the use of enforced isolation and treatment for individuals with a poor record of taking their TB medications. Numbers have been steadily dropping, from 1253 in 2010 to 260 individuals in 2018 held in secure units across the country. The NTP believes that this practice has had a positive impact, helping to achieve the country’s improvement in treatment success rates. We were taken to visit one of these units, on the edge of Minsk. Conditions inside were reasonable but it was disconcerting to see the walls and guards. This is an issue we will continue to focus on. In particular we want to learn more of the experience of MSF which has an impressive programme in Belarus working closely with those who have difficulty maintaining good drugs compliance, including people in the isolation units.

We met a group of 5 MPs, all members of the parliamentary Health Committee. They were interested, clearly wanted to help, and indicated that they are willing to create some kind of TB caucus. They encouraged local stakeholders including civil society to call on them as necessary.

Several stakeholders including the NTP said they wanted greater engagement by CSOs especially to help with detection and support during treatment. Thus all whom we spoke to including the Deputy Minister of Health, ministry officials, and CSOs themselves were enthusiastic about holding a National Dialogue as proposed under TB REP2. Active planning for that is now in progress, with early August being looked at for dates.

Paul Sommerfeld and Daniel Kashnitsky surrounded by members of the Belarus AIDS networkOur last day started with a group of organisations convened by the Belorussian NGO AIDS Network. Their willingness to get involved in TB matters and to pass on their experiences were encouraging; plus our main partner in Belarus, Defeat TB Together, has been a member since last year.   

After the Network, we had a good session with Defeat,talking in depth with Natalya Krishtafovich who is well-known to TBEC members, and also several other activists, notably Anna Tkachova who spoke of her work counselling individuals with TB and helping them with complaints. It was evident that Defeat could easily grow and undertake much more in support of people undergoing treatment, across the whole country, if there were more funding available.  Through our many conversations, we did pick up hints that some social contracting routes might be built on to provide TB funds.

We left with a real sense that TB action in Belarus is moving forward and that there is a desire to build a bigger role for civil society.

Paul Sommerfeld


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