Turkmenistan is a high-priority country for tuberculosis (TB) in the WHO European region.  The country has reached the End TB Strategy 2020 milestone in reducing the TB incidence by 20% compared to the 2015. According to the WHO, in 2019 the estimated TB incidence rate in Turkmenistan was 45 per 100,000 which is 36% decline from the 2015 rate 71 per 100,000. The estimated TB mortality declined slower, from 12 per 100,000 in 2015 to 10 per 100,000 in 2019. Despite positive changes тhe speed of the progress is yet slow, due to high prevalence of drug-resistance. The Drug Resistance Surveillance (DRS) survey conducted in 2018 identified 23% of rifampicin-resistance or multiple drug resistance (RR/MDR-TB) among new TB cases and 54% - among previously treated cases. This is a significant increase compared to the 2013 DRS results (13.9% and 37.6%, respectively). The 2018 DRS results also showed a high prevalence of fluoroquinolone (FQ) resistance at 31%. The treatment success rate in MDR-TB patients of 2016 was low at 54% as elsewhere (the WHO Euro regional average 57%).

The Government of Turkmenistan demonstrates significant political commitment to improving the population’s health. Strong stewardship and a governance framework for health care are in place, including those for TB prevention and care. The Government of Turkmenistan has increasingly taken over TB priority interventions that were previously supported by the Global Fund. Starting from 2017, the Government covers 100% needs in the supplies for drug-sensitive TB. Since 2019 the Government has also taken over the financing for second-line TB medicines and reagents for drug resistance TB in accordance with the Plan for Sustainability of the National TB Program of Turkmenistan and preparedness of transition to fully domestic funding by 2021. Only the most programmatically challenging and expensive interventions for extensively drug-resistant TB (XDR-TB) are still under the Global Fund funding as of 2020.

In 2021-2025 the National TB response will be guided by the National Program for Prevention and Control of Tuberculosis in Turkmenistan for years 2021 - 2025. The main goal of the program is to decrease the burden of TB in Turkmenistan by ensuring universal access to timely and quality diagnosis and treatment of all forms of TB. In line with the Global End TB Strategy, the NTP defined the following targets to be met by 2025:

• TB mortality rate (incl. prisons): 5.2 per 100,000 population
• TB incidence rate (incl. prisons): 35.5 per 100,000 population
• MDR-TB treatment coverage rate: 90%
• MDR-TB treatment success rate: 70%

To assist NTP with attainment of the national goals for TB, strengthen the sustainability of the previous achievements and to complete the exit from the Global Fund support, Turkmenistan will implement the Global Fund’s transitional grant.

The goal of the project is to finalize the successful transition and strengthen the sustainability of the Global Fund investments in Turkmenistan through progressive government co-financing of all key interventions by 2024 and reaching sustainability and self-reliance of the National TB Program by 2025.  The project is streamlined around two main Objectives: 1) To sustain the National TB response in the successful and complete transition to domestic funding and to ensure universal access to prevention, diagnosis, treatment, and 2) care services for people with drug-resistant TB leaving no one behind and apply people-centred strategic interventions during the transition period  Additional funding provided by the Global Fund will help Turkmenistan finalize its full transition to self-reliance by 2025. The transitional grant will invest in the activities prioritized by the National Program for Prevention and Control of Tuberculosis in Turkmenistan in 2021-2025, and in line with the Global Fund’s sustainability, transition, and co-financing policy.