The potential impact of the COVID-19 on tuberculosis in high-burden countries

Length of quarantine, movement restrictions and disruption of TB services could spell disaster for hundreds of thousands at risk.

A modeling analysis released by the Stop TB Partnership shows that under a three-month lockdown and a protracted 10-month restoration of services, the world could see an additional 6.3 million cases of TB between 2020 and 2025 and an additional 1.4 million TB deaths during that same period.
The new study was commissioned by the Stop TB Partnership in collaboration with the Imperial College, Avenir Health and Johns Hopkins University, and was supported by USAID. The modeling was constructed on assumptions drawn from a rapid assessment done by The Stop TB Partnership on the impact of the COVID-19 pandemic and related measures on the TB response in 20 high-burden TB countries—representing 54% of the global TB burden.

The modeling focused on three high burden countries—India, Kenya, and Ukraine—and extrapolated estimates from those countries to create global estimates of the impact of COVID-19 on TB.

According to the new study, with a three-month lockdown and a protracted 10-month restoration of services, global TB incidence and deaths in 2021 would increase to levels last seen in between 2013 and 2016 respectively, implying a setback of at least five to eight years in the fight against TB.

To minimize the impact of the COVID-19 pandemic on TB, save millions of lives and get the world back on track in achieving the UNGA targets, national governments need to take immediate measures that ensure the continuity of TB diagnostic, treatment and prevention services during the lockdown period and undertake a massive catch-up effort to actively diagnose, trace, treat and prevent TB.

World Tuberculosis Day 2020

Each year, we commemorate World Tuberculosis (TB) Day on March 24 to raise public awareness about the devastating health, social and economic consequences of TB, and to step up efforts to end the global TB epidemic.

The date marks the day in 1882 when Dr Robert Koch announced that he had discovered the bacterium that causes TB, which opened the way towards diagnosing and curing this disease.

TB remains the world’s deadliest infectious killer. Each day, over 4000 people lose their lives to TB and close to 30,000 people fall ill with this preventable and curable disease. Global efforts to combat TB have saved an estimated 58 million lives since the year 2000. To accelerate the TB response in countries to reach targets – Heads of State came together and made strong commitments to end TB at the first-ever UN High Level Meeting in September 2018.

Countries in the Eastern part of the WHO European Region are most affected by the TB epidemic: 18 high-priority countries for TB control bear 85% of the TB burden, and 99% of the multidrug-resistant TB (MDR-TB) burden. These countries are Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, the Republic of Moldova, Romania, the Russian Federation, Tajikistan, Turkey, Turkmenistan, Ukraine and Uzbekistan. Despite much progress in Eastern Europe, critical challenges remain as regards access to appropriate treatment regimens, patient hospitalisation, scale-up of laboratory capacity, including the use of rapid diagnostics and second-line Drug Susceptibility Testing (DST), vulnerable populations human resources, and financing.

The theme of World TB Day 2020 – ‘It’s time’ – puts the accent on the urgency to act on the commitments made by global leaders to:

  • scale up access to prevention and treatment;
  • build accountability;
  • ensure sufficient and sustainable financing including for research;
  • promote an end to stigma and discrimination, and
  • promote an equitable, rights-based and people-centered TB response.

AFEW Partnership‘s activities are also aimed on ending tuberculosis in Eastern Europe and Central Asia. For 5 last year in Kazakhstan, KNCV and  AFEW-Kazakhstan were developing a model for structural collaboration between public health (TB, HIV, primary health care) and non-public sector. AFEW International was coordinating this project.

Kazakhstan was one of the three countries selected to develop a model to strengthen engagement with non-public sector for improved quality of TB/HIV services. Almaty was chosen for the implementation of the model because it is the largest urban area in the country. The project supported the establishment of a network of NGOs that have the capacity to provide TB and HIV care to the most vulnerable populations, and build a partnership between public and non-public sectors to improve access to TB and HIV care by the development of a referral mechanism. Within the program a TB PhotoVoices Project was developed. 

Resource – WHO


It’s TIME to end TB

24 of March – World Tuberculosis (TB) Day. The theme of World TB Day 2020 – ‘It’s TIME’. TIME to put the accent on the urgency to act on the commitments made by global leaders; TIME to scale up access to prevention & treatment; TIME to promote equitable, rights-based & people-centered TB response; TIME to ensure sufficient & sustainable financing including for research; TIME to promote an end to stigma & discrimination.

In support of the global #ItsTimetoEndTB campaign, AFEW International talked to people who faced TB and asked them to reflect on TIME in the context of their life stories.

Saule, volunteer of Sanat Alemi

When I found out about my diagnosis, it was like TIME had stopped for me. During the treatment, I was scared, I thought I was going to die. Fortunately, my roommates were very supportive, they kept saying that TB is curable and that life goes on.

I can not forget the moment when I moved to another department of the hospital for chronic patients. I stayed there for 2 years. It was very scary. It seemed to me that it’s impossible to cure TB since my tests were always positive. Nevertheless, after a hard struggle, I defeated the disease.

They say TIME heals. But it doesn’t. TIME is not able to cure, we cure ourselves by thinking about good things, doing daily routine, trying to distract yourself from bad thoughts, agreeing with what happened, giving ourselves the attitude – to stop suffering, accepting the fact that our life goes on.

I really want to forget those moments, memories that I experienced during my illness. And I am happy that I defeated TB, with the help and support of my parents and my daughter.

 Igor, volunteer of Sanat Alemi

Disease always changes a person. Many things you start to look at in a new way, rethink TIME, your life. When I got sick, I didn’t have any strength or desire to get out of my hospital bed. But I was lucky to have people around who supported me and made me to believe in myself, helped me to cope with the disease.

TIME of TB treatment became special for me. It changed me from the inside. I became stronger, learned to deal with difficulties. When you are ill, you realize that TIME has to be appreciated and spent as effectively as possible. You try not to waste it on trifles. “Yesterday” cannot be returned, so you analyze every moment you have lived and try to use TIME rationally and purposefully in the fight against the disease.

Tuberculosis is my life experience that has taught me to cope with difficulties and achieve my goal. Tuberculosis is curable, the main thing is not to lose heart and to set up yourself to get positive results!

Danat, volunteer of Sanat Alemi

When I found out about my diagnosis, I didn’t believe in that, because I had never complained about my health before. It was like TIME had stopped for me, bad thoughts kept me going. I was thinking I will never survive, and in general, I felt like my life was over. Thank God, there were people around who supported me morally and kept me alive.

The disease changed me a lot. I became stronger, more demanding to myself, I became more religious. Because of the prescribed therapy, I was able to get better. During the treatment TIME, my life values changed: I began to appreciate every moment of my life.

The fears related to the disease are behind me because I now know that TB is curable. People should be more informed about TB. This will help to detect the disease at an early stage and solve the problem of discrimination against people with TB!

Tuberculosis in the WHO European Region

Despite the notable progress achieved in the fight against Tuberculosis (TB), it still poses a public health threat in the WHO European Region. According to the latest estimates, in 2018 about 259 000 people became ill with TB (Fig. 1) and about 23 000 people lost their lives due to TB in the Region, mostly in eastern European and central Asia countries. 

In the past 10 years, the number of new TB patients has been falling at an average rate of 5% per year, which is the fastest decline among all WHO regions. However, the treatment success rate among newly diagnosed and relapsed patients was 77%, which remains one of the lowest among WHO regions.

One in five new TB patients is affected by MDR-TB

Countries in the European Region have the highest rates of multidrug-resistant TB (MDR-TB) globally. Nine European Region countries face a particularly high burden of MDR-TB. In 2018, of estimated 49 000 rifampicin resistant (RR) tuberculosis cases among notified pulmonary tuberculosis patients, 45 400 (93%) were diagnosed. The increase in detection is mainly due to improved access to rapid and quality assured diagnosis. The treatment success rate for TB and MDRTB in the Region remains below the 85% and 75% regional targets respectively (Fig. 2) although data show a slow improvement.

Around 95% of all reported MDR-TB patients were tested for resistance to second-line TB drugs in 2018, which is an increase compared to the previous year. The testing led to the detection of about 6 800 patients with extensively drug-resistant TB (XDR-TB), which accounts for about 19% of patients with MDR-TB.

One in eight new TB patients is HIV positive 
People living with HIV are 20 to 40 times more likely to develop active TB disease than people without HIV.1 HIV and TB form a deadly combination, each speeding the progress of the other. Because of the increasing trend of new HIV infections in the WHO European Region, HIV coinfection rates among TB patients also increased sharply from 8% to 13% between 2014 and 2018.  Rapid detection and appropriate treatment are vital. However, only 80% (24 365) of the estimated 30 000 TB/HIV coinfected individuals were detected in 2017, and only 73% of those diagnosed were offered antiretroviral treatment.
Strengthening Regional commitments to end TB 

The Tuberculosis Action Plan for the WHO European Region 2016-2020 (European TB Action Plan) was endorsed by the 65th WHO Regional Committee for Europe in 2015. This strategic document sets the regional goal of ending the spread of TB and MDR-TB by achieving universal access to prevention, diagnosis and treatment. Following up on the Regional Committee resolution, the final report of implementation of the European TB Action Plan will be submitted to the 70th Regional Committee in September 2020. The finalized report will be reviewed by all Member States before endorsement along with a suggestion to extend the validity of the European TB Action Plan. This vision aimed to end the TB epidemic and ensure that by 2030, no   family faces catastrophic financial costs due to TB. To monitor progress and ensure that commitments articulated in the UN High Level Political Declaration are met, a Monitoring and Evaluation Framework 2021-2030 with new indicators and targets has been prepared and submitted to all Member States for public consultation. These indicators, while regional in scope, are designed to serve as a guide to the development or adjustment of comprehensive monitoring plans at the country level.

WHO European Region comprehensive technical assistance to Member States includes supporting the development and introduction of innovations and tools, such as digital technologies, rapid molecular diagnosis of TB, new drugs and regimens for DR-TB. The WHO Regional Office for Europe seeks to ensure that all people affected by TB have equal access to the benefits of latest development, including vulnerable populations, such as prisoners, migrants, socially marginalized, children and people living with HIV.

In 2018, WHO’s Regional Office for Europe, collaborating with partners on the issue-based Coalition on Health and wellbeing, launched the United Nations Common Position Paper on Intersectoral Collaboration To End TB, HIV and Viral Hepatitis and is working with civil society, national and international partners to implement it.,-tb-and-viral-hepatitis-through-intersectoral-collaboration2018. Country-level assistance is vital to this process. National processes to strengthen the dialogue and action around these topics are ongoing in Portugal, Tajikistan, Georgia and Belarus. This collaboration and dialogue contributes to developing the first edition of an Operational Framework; guiding concrete action to end HIV, TB and viral hepatitis beyond the healthcare sector. These best practices are being collected at the regional level.

About TB

TB is a contagious disease that spreads when a person breathes in the bacteria breathed out by an infected person. This disease is mainly caused by Mycobacterium tuberculosis. About one fourth of the world’s population is infected with the latent form of the disease, and a tenth of them become ill with active TB during their lifetimes.
The symptoms depend on the organ of the body which is infected. Usually, TB affects the lungs. In this case, the major symptoms are cough with productive sputum (sometimes with blood), shortness of breath and chest pain. There are also general symptoms such as fever, night sweats, loss of weight and appetite, fatigue and general weakness. People living with HIV or other conditions that weaken their immune system (such as diabetes), people on immunosuppressant therapy, and people who use tobacco or use alcohol harmfully are at much higher risk of developing the disease.
MDR-TB is resistant to two of the most potent anti-TB drugs. This is a result of inadequate treatment of TB and/or poor airborne infection control in health care facilities and congregate settings. XDR-TB is resistant to the most important first- and second-line drugs and there are currently very limited chances of people with XDR-TB being cured. TB can affect everyone but is particularly linked to social determinants of health such as migration, imprisonment and social marginalization.


24 of March is a World TB Day 2020.World TB Day is a big moment to sound the alarm, raise attention, and tell world leaders to follow through on their promise to diagnose and treat 40 million people with TB by 2022, as agreed at the UN High-Level Meeting (UNHLM) on TB in September 2018.

We all need to work together now on important activities to make sure that World TB Day 2020 is the biggest and most effective.

What we together can do?

    Reach out to your political leaders (Mayors, Parliamentarians, Ministers of Health, Heads of State) to request their leadership in the fight to END TB, remind them of the commitments and targets that have to be reached by the end of 2022, and request their engagement for World TB Day. This could include making a public statement, supporting an event, introducing a motion in parliament, or committing to achieve the UNHLM country targets.
    The hashtags for this year’s World TB Day are #ItsTimetoEndTB and #WorldTBDay. Start raising awareness through social media. Share your plans with us on Twitter or Facebook.
    Reach out to celebrities, influencers, TV personalities, and other figures to ask them to join your efforts and raise awareness or wear a red arrow pin ahead of World TB Day. Stop TB partnership has a list of national celebrities, journalists and personalities that we can share with you case by case, so don’t hesitate to get in touch with us to get their contacts.
    Team up with local TB partners to join forces in planning major World TB Day events, public mobilizations, and other activities. Stop TB partnership have a database of partners at country level – so do not hesitate to get in touch with us to be able to identify the partners with whom you want to work for these events.

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Prospects for cooperation in the health sector in Uzbekistan

On January 10, 2020, AFEW International, represented by Anke van Dam, Executive Director, and Daria Alexeeva, Program Director, met with Ambassador of Uzbekistan in Benelux countries Dilier Hakimov.

AFEW International is considering possibilities to implement two projects in Uzbekistan. The first one is to develop and improve the quality of HIV testing and prevention services for key populations and support people living with HIV.

The second project, entitled “Strengthening civil society in inclusive health care in Uzbekistan”, is currently under consideration by the European Commission and is on the reserve list of projects.

At the end of the meeting, the parties agreed on a schedule for the AFEW International delegation to visit Tashkent on 15-16 January 2020. AFEW International’s team will have negotiations with the Republican AIDS Center, as well as with representatives of some international organizations, which may act as donors for the implementation of projects of the non-governmental organization in Uzbekistan.

AFEW International already has experience in working in Uzbekistan: the organization supported several projects in the country through ESF, as well as was involved in preparations for the AIDS2018 conference. In addition, representatives from Uzbekistan participated in AFEW International’s community based research education project.

RADIAN grants are now open for grant seekers

Since the 21 of November RADIAN grants for both the ‘Model Cities’ (Almaty only) and ‘Unmet Need’ funds are open for grant seekers to submit concept notes.

The RADIAN ‘Unmet Need’ fund will support local initiatives across the EECA region and beyond the select ‘Model Cities’. Initiatives selected will focus on prevention and care, education, community empowerment, and novel partnerships. The programme will be implemented locally, working with key stakeholders and partners.

The Fund is welcoming concept notes for evidence-informed solutions implementing in Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Estonia, Georgia, Kosovo, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Montenegro, Republic of Moldova, Russian Federation, North Macedonia, Romania, Serbia, Slovenia, Tajikistan, Turkmenistan, Ukraine, or Uzbekistan. The Fund welcomes concept notes for multi-country projects.

You can join for a webinar on applying for a RADIAN Unmet Need Fund grant. This webinar will guide applicants through the RADIAN Unmet Need Fund Opportunity Announcement and application process, and offer an opportunity for participants to ask questions on the Opportunity Announcement and application process.

The webinar will be held on December 3rd 2019 11:00-12:30 (GMT). Please register for the webinar here.

Applications to implement Model Cities in Almaty are now open as well. The programme will support innovative approaches, including new models of care and expanded prevention and healthcare programmes, led by groups who are on-the-ground and part of the community.

The first RADIAN ‘Model City’ will be Almaty, Kazakhstan’s largest city. The RADIAN Model Cities Fund is looking to support programmes centred around existing health system infrastructure that deliver measurable impact in the response to HIV in Almaty. Organisations who share Radian’s vision of significantly improving the quality of care for PLHIV, addressing new HIV infections and AIDS deaths in Almaty can apply for grant funding. A detailed Opportunity Announcement, including eligibility and selection criteria can be downloaded below. Additional ‘Model Cities’ will be announced in 2020.


RADIAN grants for both the ‘Model Cities’ (Almaty only) and ‘Unmet Need’ funds are now open for grant seekers to submit concept notes. All concept notes must be in English.

Applicants whose Concept Notes are selected to move forward to the Application stage will be notified by the Foundation and will be requested to submit an Application with further details on their solution. A detailed Opportunity Announcement for each fund, including eligibility and selection criteria, can be downloaded below.


The 3rd regional autumn school in Bishkek

On October 29, AFEW partners came together in Bishkek, the capital of Kyrgyzstan, for 3 days to take part in the annual Autumn School, which is organized within the project “Bridging the Gaps: health and rights of key populations“.

The great energy of the participants and amazing nature gave a chance to everyone to enjoy the event and to discuss important issues on prevention and treatment of #HIV, harm reduction, migration, and financing in the region of Eastern Europe and Central Asia. Participants in the Autumn School included representatives of AFEW partners from Kazakhstan, Kyrgyzstan, Ukraine, Russia, and the Netherlands, sub-recipients of the project “Bridging the Gaps”, as well as other partners and experts including those from Great Britain and the USA.

Active space

The Autumn School quickly became an active space for discussion: about strategy, barriers, innovations, and partnership opportunities between the participating organizations. During the first day, participants shared updates on the “Bridging the Gaps” project and activities in their countries – Georgia, Kyrgyzstan, Ukraine, and Tajikistan. The afternoon session was devoted to a World Café, in which partners exchanged ideas and developed specific actions to overcome challenges that they often encounter in their work.

The second day was devoted to the topic “Stimulant use and chemsex”. Benjamin Collins, director of International HIV Partnership (IHP), which partners with medical and community activists across Europe and the Middle East for successful responses to HIV and viral hepatitis, joined the Autumn School in Bishkek to share his experience on chemsex . The topic of (problematic) chemsex was further elaborated in the presentations of Monty Moncrieff, Chief Executive of London Friend, a London charity working to promote the health and well-being of lesbian, gay, bisexual and trans (LGBT) people, and Daria Alexeeva, program director of AFEW International. Monty spoke about the London experience in harm reduction, while Daria presented materials of Nikolay Lyuchenkov, an infectious disease doctor and expert on sexual health issues from Russia, which were focused on trends and responses to chemsex in Russia and EECA region.


The third and final day of the conference was devoted to workshops on migration, rehabilitation and financial sustainability. Evgeniya Alekseeva, director of Public Health and Social Development Foundation “FOCUS-MEDIA”, presented analysis of NGOs funding situation in EECA region; Elena Zhirnova, manager of the project “Our Choice: Empowering Vulnerable Women in Kyrgyzstan” (AFEW-Kyrgyzstan) told about challenges and opportunities of social entrepreneurship in the country; and Fatima Yakupbayeva, co-founder of law firm “PRECEDENT” and publisher of the book “From Grant to Business Project”, shared auditing resources for launching a business model and recommendations on how to implement business ideas.


The session on migration started with a presentation by Rukhshona Kurbonova, coordinator of the Migrant Health Programs at International Organization for Migration in Tajikistan. She talked about labor migration in Central Asia, while Zulaika Esentaeva (IOM Kyrgyzstan) shared their experience on service-delivery by IOM Kyrgyzstan for vulnerable migrants.

The session on rehabilitation was devoted to building information campaigns. During the session, Marina Govorukhina, specialist on strategic communications and branding, author of the books “Communications in Public Organizations”, “Strategic Communications in Public Organizations”, demonstrated specific techniques of developing informational marketing campaigns for rehabilitation centers to the participants from Georgia, Kyrgyzstan and Ukraine.

Moreover, the School included a 2-day training for AFEW communication managers, during which participants focused on learning about storytelling and SMM in the context of NGOs.



Natalya Shumskaya, director of AFEW-Kyrgyzstan

I especially noted the session on new psychoactive substances. This topic is relevant for our country, as sexual ways of HIV transmission keep growing in Kyrgyzstan, and new psychoactive substance use impacts sexual behavior. For us it is a wonderful opportunity to take on the experience of those countries that have already faced similar problems, and elaborate effective strategies for preventative measures in our country.

The third day was remarkable due to the acute topic of sustainability of civil society organizations. We all see the tendency of decreasing donor support in our countries. That means that civil society should aim to ensure financial sustainability independently, and one of the opportunities is the development of social entrepreneurship. During this meeting we shared the experience of creating our own social enterprise – a beauty salon. I would like to especially point out the session by Fatima Yakupbayeva from the “Precedent” company. She gave us specific business-ideas, which could be developed by an NGO in order to earn money independently and further direct it to realization of our statutory goals.

The importance of this event is in sharing and exchange of experience. When the financial support for our organizations is not that high, it is important to avoid duplication of activities, and, on the other hand, to consolidate our efforts in order to realize our main strategic goals. For instance, the past regional meetings allowed us to bring good practices of working with youth at risk from Ukraine to our country. We are very grateful that we didn’t have to be the pioneers in this, but rather adapt and use their experience. Also, I think that the experience of Kyrgyzstan will be useful to some of our colleagues, and they will be able to apply it in their countries.

Monty Moncrieff MBE, Chief Executive of London Friend

It’s important for people working in the region on the same issues to have the opportunity to come together and share their knowledge and experience. It helps build the data on important topics, and enables participants to share what they’re seeing locally, as well as share tips on how to address new and emerging trends. It also helps build relationships, which spark ideas for new partnerships. Even though the internet gives us great opportunities to connect and work together online it’s difficult to get that richness of connection without bringing people together in person, and doing so for a number of days provides lots of opportunities for conversations outside the formal sessions.

We can always learn from one another, and hopefully by inviting people who have been working on issues for some time in other countries we can bring the benefit of that experience. We can share leaning about what’s worked and what hasn’t for us, and hopefully that can benefit people who are only starting to see these issues emerge locally.

Evgeniya Alekseeva, PHD in medical sciences, Director of Public Health and Social Development Foundation “FOCUS-MEDIA”

Meetings such as the Autumn School are important, because they bring together people from different countries and cities, create space for discussing acute issues and situations in our field, allow to form alliances, agree about partnerships, as well as have informal conversations and take a break from the daily routine.

At the Autumn School in Bishkek, I especially noted a very interesting session on chemsex, sessions on business projects for NGOs, and on migration. I will certainly use this knowledge further while writing proposals, developing new projects and creating new ideas.

Zarina Siyakova, program coordinator of the Tajik Network of Women Living with HIV

This meeting provided me with a great opportunity to learn more about what is happening in other countries in regards to promoting prevention and treatment of HIV. I especially noted the session on chemsex, as I hadn’t had a chance to encounter this issue before. I was particularly interested in the presentation by Monty Moncrieff, as well as the presentation of Nikolay Luchenkov from Russia on chemsex in EECA.

Also, I received answers to many questions on migration that I’m interested in, and most importantly, exchanged contacts with almost all the participants. It is well known that nowadays there is a very large stream of migrants from Tajikistan to Russia, and many of them lack information about services for migrants and d existing organizations in Russia. Now our organization will be able to refer our clients to these organizations, and we won’t lose them out of sight.

If you are interested in specific presentations of the Autumn School, please send your request to

New UNAIDS Strategic Information Hub for Eastern Europe and Central Asia

UNAIDS Strategic Information Hub for Eastern Europe and Central Asia (UNAIDS SI Hub) has been launched on the Internet.

The purpose of this resource is to provide an online one-stop-shop for data, publications and strategic information about HIV (and related health issues) in EECA. It is publicly accessible to anyone online, but it aims to make information accessible and easy to find for specialists and policymakers working on HIV in governmental, non-governmental organizations and partners across EECA.

The address of the hub is and it’s managed by UNAIDS RST  in Moscow, with support from UNAIDS HQ. It currently features HIV data from the latest GAM reports, as well as published reports and presentations related to HIV in EECA. It’s possible to access the country-specific data and reports as well as reports and publications from the various menus. By selecting “data” and “factsheets”, you can generate and print Regional and Country factsheets as PDFs as well access as epidemiology slides with global and regional statistics.

The hub works in two official UN languages – English and Russian, but most of the publications will only be available in the language they are produced (and not translated into other languages by UNAIDS).

For contribution to the UNAIDS SI Hub please send your suggestions, data, publications and other materials to