ВИЧ/СПИД и туберкулез в Центральной Азии by World Bank Russia

ЕВРОПА И ЦЕНТРАЛЬНАЯ АЗИЯ

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1. http://wwwusaidgov/regions/europe_eurasia/car/briefers/hivaids_prevention.htnil. MapT 2003 r. 2. UNAIDS (2001). OTBeTHbIe MepbI rio 60pb6e c BW{/CrIH,oM, HflfIf 1HHapKOMaHmeg B cTpaHax LfeHTpaAbHofl A3m-iHpH cogeficTBHH UNAIDS. AnMaTbI: UNAIDS - LeHTpanbHaM A3mA. 3. CiivweHie Bpe,a - TaK Ha3biaioTcq riporpaMMbI ayrpH-i, ripe.;ycMaTpHBaiomi-He o6yCeHHe no npHHui]iHfy "paBHbfi paBHOMy", KOHCyJIbTHpOBaHH4e H TeCTHpoBaHHe, o6MeH HrIi H o6ecrie,qeHme BbICoIKo-y33BHMbIx rpyrn. DTH HOprpaMMbI OKa3aIHCb BeCbMa Bipe3epBaTIsaMn 34eICeTHBHbIMH H aKOHOMHqHbIMI B pa3BHBaIOH]HXCK H pa3BMbZI CTpaHax (CM., K ripHMepy, Cogpy)KecTBo ABcTpanmm 2002. OKynaeMocTm HporpaMM o6MeHa Hirn IHpHLsOB mh B ABcTpaJiH [Commonwealth of Australia 2002. Return on Investment in Needle and Syringe Programs in Australia]).

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CTpaTermn, nOJIMTHKa m npasoBan OCHoBa BO BCCX cTpaHax nPHHqT peKOMeH,gYeMbIfi B03 no,gxogZ DOTS (KpaTKocpoqHbIg Kypc nemeHHi Ty6epKy.ie3a riog ripqMbIM Ha6uogeHHeM). OAHaKO, BbI3bIBaeT o6ecrioKoeHHOCTh pWA o6cToSTeVIbCTB, Kacaioauixcs neAeH4H Ty6epKyjie3a B perHoHe: (1) orpaHHqeHHbIi oxBaT H MacmTa6 BHe,peHH DOTS, o qeM rOBOpiT HI3K4fi IoKa3aTeJIb yCner[IHOCTH neqeHmis H BbICOKH14 rpOLXeHT MJIY-Ty6epKyle3a; (2) MacTHqHoe HIH4 HOJIHoe OTCyTCTBHe OxBaTa TiOpeM, CiHTaiOMi4XC5 I CTOxHHKOM 3IH,AeMfHH Ty6epKyjie3a B perHoHe; i (3) B HeKOTOpbIX cTpaHax 4YTH3HaTpbI rOTOBblI HaiaT neqeHHe Ty6epKyne3a npenapaTaMH BToporo p5iga go roIryeHHS yoBeTBOP4TenbHbix pe3ynbTaTOB BHegpeHH4 DOTS. OxBaT HaceiieHHHi nporpammog DOTS 3HaqiTejIbHO pawiwTaeTcq B CTpaHax perHOHa: OT KbIprbI3cTaHa H Ka3axcTaHa, r,ze noxrr 100% HaceIieHH oxBaqeHo nporpaMMofi DOTS, go TypKMeHHCTaHa, rge OXBaT COCTrBaweT 34%, H Y36eKHcTaHa, rie pacniiipeH4e DOTS ui4eT ,OBOnbHO MenIeHHO, H, HaKOHeiA, B Ta,nmKHcTaHe nporpamma DOTS 6bvIa iipHOcTaHOB3IeHa H3-3a rpax<gaHCKOA BOirHbI (Ta6jniua 5). rHoKa3aTeRb ycneInHocTm4 ieqeHHI Ty6epKyjie3a B LeHTpajibHoa3HaTcKHx cTpaHax, peaAH3yioiTHx DOTS, BARTeTcC CKpOMHbIM. KbIprbI3CKaM Pecny6.nHa - cTpaHa, nepBofl BHegp4BmasI DOTS B perHoHe, MmeeT HaHjiyimii4 rioKa3aTeJIb yCCemHOCTHTInexeHHS, KOTOpbIIi, TeM He MeHee, B 1999 ro,gy 6bulI HlDKe yCTaHOBjieHHOfi B03 LenH B 85 ripOUeHTOB H3JIeieHH4A riaUmeHTOB, BriepBbIe 3apeHCTp1 pOBaHHbIXm neeH (Ta6jiHqa 6). BjiHIHHe neKapcTBeHHOfl YCTOfIHBOCTH H BHT-HH4eKLAHH goAXHo 6b1m H3y,qeHO ,VI iiyxmero rIOHHMaHH5I yCHnIHfrno 6opb6e c Ty6epKyJIe3oM B perHoHe.

rioKa He FOTOBbI K BO3MO)KHOMy qaCTHqHOMy nepecexeHIO 3nMeeMHEf B1WI/CHIELa H Ty6epKyTie3a. Ty6epKy.Tie3 ,sBjeTcS OCHOBHOA LIeHTpanbHOa3HaTCKHe CTpaHbI

BVM/CnfgJ

Ka3aXCraH Kblprbl3CraH

TaAWNKHCTaH TypKMeHUCraH Y36eKNcraH

TYEEPKYnE3 B L4EHTPAnbHO1 A3mm

1996

1997

1998

1999

2000

DOTS oTcyTCTByeT 5,3

DOTS oTcyTCTsyeT 5

4 100

100 100

DOTS OTC YTCsyT DOTS OTCyrCTBYeT DOTS OTCyTCTByeT

DOTS OTCYTCTrByeT DOTS OTCyTCTByeT DOTS OTCyTCTByeT

14cmoqHUK: BCeMmpwaR 6opb6a c ly6epKyne3oM, OT9eTbi B03 3a 1998-2002 rr.

oriropTyHHCTHi1eCKO HH4eKUeegipi4 CHIIe C. ,geiiaHHbIe B PoccHH flpOrHO3bI nOKa3bIBaOT, xqTO IpH HaIHqHH- g2amKe CKpOMHoM 11o MacUITa6aM ariMeMHn BHW4/CrIHH a Ty6epKyne3 MoKeT BbIHT H3-rOi KOHTpOjI (BHHOKYp i4 gp., 2001). bI Kiy6epKyie3y u BW4x/CrIHAy B LleHTpaIbHOfi A3IH OAHaKo BePTHKzaTbHbIe nOAXO HOKa He CoegHHHJICb, H oTcyTcTByeTqCHOCTh BBonpoce o6 oTBTCTBeHHOcTH 3a neqeHHe naiHeHTOB Co CHHoM H Ty6epKyie3OM. Ka3axcTaH H KbIprbI3cTaH o6paTmHCb B rI(cTM c npoCb6of 0 p4HaHCHPOBaHHH ANM BHe,peHH5 nporpammbi DOTS Plus, KOTopaArpegyCMaTpBaeT ipOOJDKeHHe neqeHHA no nporpamme DOTS H npHmeHeHiHe npenapaToB BToporo pwga. O,HaKo 3TO MO)KeT OKa3aThCl npexKgeBpeMeHHbIM, IP1EHHMSaR BO BHHIMaHHe, xTO rporpaMMa DOTS He 6bvTaIOIJIHOCTbIO peaIIs3oBaHa, a cHcTeMaTH4ecKoe Ha6jiiogeHHe 3a MJYTy6epKyjie3oM oTcyTcTByeT. KpoMe Toro, HCI1OJIb3yeMbIieBO MHorHX cTpaHax 6CCCP MHo i HeijHCKofi rIpaKT1Ke. ripoToKojibI Tie1eHH5 He OCHOBaHbI Ha AOKa3aTebH CjIegOBaTejbHO, CymecTByeT P14CK C03gaHH5 yCTOfEHMBOCTH K ripenapaTam BToporo p3qa, KaK 3TO HpO330UIAO C nIpenapaTami nIepBoro p5,a H3-3a HX HeIipaBHAbHOrO ipHMeHeHH5H, ITO npHBe,AeT K C03gaHEI0 AOrIOJIHHTeJbHOf irIpO6jieMbI XH o6iiecTBeHHOrO 3gpaBOoxpaHeHEH B perHOHe H B MHpe B UeAIOM.

(OHHaHCtpOBaHHe nporpamm 6opb6bl C Ty6epKyne3oM HIo HMeOIUEHMCc 3gaHHbIM, CpegCTBa, BbieXHAmbie Ha HporpaMMbI 6opb6b c Ty6epKyAIe3oM, cocraBJiHIrO OT 32 MJH. OJo. B Ka3axCTaHe ($640 Ha raLweHTa) B

2001

rOA perncrpaqitN na4Wefros

1995

1996

1997

1998

1999

Ka3axcraH Kbiprbl3craH TaCKHKNcraH

NA NA 87,6

NA 87,5 81,8

74,3 75,6 74,5

79,0 82,0 NA

79,0 83,0 NA

TypKMeHHcraH

73,2 78,1

63,7 NA

58,9 NA

NA 78,0

60,0 79,0

Ya6e.ocram NA - HeT AaHHbix.

lCmO4HUK: BCeMmpHaq 6opb6a C Ty6epKyJle3oM, OT9eTbi B03 3a

1998-2002 rr.

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r. go 1,3 MAH.

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3apa,KeH BUl. 3inHeMHfl B1/H/CrIHAa ocjioxumeTCq paCIIpOCTpaHeHHeM H IIJIOXHM neemeHErem iHHeKumfi, nepegaiouAHxcs rOJIOBbIM nyreM (rIHIrl), cpe,H 3THx rpyrn iE, CJIe,llOBaTeJIbHO, cpegH iniiipoKorO HaceIieHH5. Komnmecmo 6oRbHbIx CHcHJHCoM B03pOCJIO C MeHee 10 Ha 100000 HaceIieHH3 B 1986-1993 roAaxgo 270/100000 B 1997 rojy, 3aTeM B 2000 rogy nocTeiieHHO CHH3HJOCb jo 160/100 Tbic. (UNAIDS 2002).

CornacHo oT'eTaM UNICEF (2002 r.), B 2000 rogy 6buxo BbHBneCHO 320 cziyqaeB UHHH Ha 100000 HaCejieHHS4 (CHcIwIHC H roHope3i), -TO ABnIeTCSi CaMbIM BbICOKHM fIOKa3aTeJIeM B cTpaHax ELtA, H npe,gc'ra eT co6o0 6o0ee qeM 200-rIpoleHTHbIfi pOCT 3a6ojieBaeMocTH CHfqH1HCoM c 1990 roia (Carinfonet 2000). CorilacHo O4)HLHaJIbHbIM ,gaHHbIM, B 2000 rogy c JiHimc 6bur BbiaBeH y 1 npolueHTa AOHOpOB KPOBH, y 1 ripoileHTa 6epeMeHHbIx wKeHIIHH H y 2 rIpoLieHTOB 60JIbHHqHbIX naiWeHToB; B 2001 rogay cH4)H.Ic 6buI o6HapyweH y 5 IIpOiLeHTOB 3aKioqeHHbIX B Kamepax i1pegBapHTeJIbHOrO 3aKioqeHHA. Ho gaHHbIM KOKHO-BeHeponorHqecKHX AHcnaHcepoB, 75 rpoiLeHTOB PKC crpagaeT KaK MHHHMyM O,HHM 3a6oneBaHHeM, nepegaioMHMc31 rojioBbIM nyTeM. B 1999 rogy 6o0ee 19000 naIHeHToB c paHHefi cTagHeti cHC)HAca 6bLDm roCnHTaA13HpoBaHbI, TO CCToaBMHo 6onee 400000 KoAKo-gHefi. rpoiLeHT mnogeft, riOceTHBIIIx I T MeTmHIUHHcKHe yqpexqeH HA HO nIoBO,y 3apa)KeHH cHHHIH4COM, cocTaBHA MeHee 30%, rioCKoJIbKy 60nbIImHHCTBO MoKeT .ietmrbcs 6e3 rocnHTaJIH3aiAHi, XOTH 3aTpaTmI Ha TaKoe iemeHHe BbICOKH. TeM He MeHee, rocniiTajiH3aTLHs no

nOBO)ly cHcEHIHca 3KOHoMHqecKHU

He344eKTHBHa H He HYXKHa npfl

CyleCTBOBaHHH

6o0ee COBpeMCHHbIX MeTO,gOB IieqeHHEi. 11peABaprTeJIbHbIe pe3yJIbTaTbI 03OPHoro 3nHAHag3opa (gaHHble co6paHbI ,epe3 CHCTeMy JIKT) B OT,creJbHbiX rpyrinax HaCeJIeHHs noKa3bIBaiOT, TO paCnpOCTpaHeHHOCTb BUM B KaparaH,ge cocTaBimeT oKono 5 nppOUeHTOB, B r. YpaAbcKe - 2 ipoieiHTa H B AjiMaTI - 0,3 npoiueHTa. O,IHO HCcAe,AOBaHme noKa3ano, xITO B KOHlet 2001 roga 0,5 npoiLeHTa PKC 6bLiH BHI-1HHcPHIHPOBaHHbIMH (H3 4000 PKC, npomIe,giHx

CKPHHHHr), OIAHaKO PeCny6nHKaHCKHA CnHI MHHHMYM 1 npoiUeHT cpe,AH rpynn

PKC. O,HaKo

aTH

IeHTp coo6iiaeT,

rTO HH)HIUMpOBaH KaK

gaHHbIe OTXpairT pacnpocrpaHeHHOCTb

BbICOKOrO pHcKa, a He Cpe,gH HaceiieHH5i.

Ha,a30p 3a flOBeAeHLeciCKMHm

aCneKTaME BaKeH ,JIS Ha6jnmOeHHR 3a TeM, HaCKOjThKO

pacnpocTpaHeHbI (taKopbI pHcKa nepe,axI BUT. OHpOCbI, npIOBe,eHHbie UNAIDS, HOKa3bIBamOT, xTO HIUH Ha CaMOM geiie 3HaioT o mepax npocHmaKrMci[ BUI: 88

ripOUeHTOB

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O2HOpa3OBbIC mInpHUbI 3a1HiWJaOT OT riepegaqH BUM-

HHcJeKiXHH, a 95 npOLxeHTOB 3HaIoT 0 TOM, xITO npe3epBaTBbI MOryr 3atgHnrmb. HeCMOTpa Ha 9TO, MHorHe no-npexlemy npaKTHIKyIOT He6e3oriaCHoe noTpe6jieHHe HH'beKLAHOHHbIX HapKOTHKOB H BCTryriaOT B MHOrO-u4CjieHHbIe cAyqafiHbie riOAOBbIe KOHTaKTbI, He HOJIb3y3SCb ripe3epBaTHBOM; perynipHoe RCHIOtb3OBaHHIe npe3epBaTHBOB

He npeBbiruaeT 20 ipoieHTOB. 3To coriiacyercsi C npegocCaBMeHHbIM oiponieHHbIMH

AaHHbIMH 0 TOM, Crpa,;aJIH JH OHH

Korga-mi6o

MrIHr

caMimH H (20 ripoUeHToB).

Ho nOnyqeHHbiM ,gaHHbIM, 6onee rIO.IOBHHbI PKC He nOJIb3yioTcI npe3epBaTi BaMH He 3HaIOT O gpyrHx crioco6ax npocHAaKTicKi BUM. Onpoc, npOBegeHHbLf B AnMaThI, noKa3ani, qTo 80 ripoUeHTOB MCM He HCIIOJIb3yioT npe3epBaT4Bbi, 25 npoIeHToB HImeoT UHHH, 10 iipOLeHTOB ynoTpe6jmioT HHbeKUHoHHbIe HapKoTHKH H TOnbKo 30 npoixeHToB HMieoT ,IAOCTaTo'HbIe 3HaHHR o cnoco6ax nepegaM14 BUMLI. HoIzo6Hoe PHCKOBaHHoe nOBegeHHe o6ecrie'IHBaeT pacipocTpaHeHHe BUMQ OT IHUH/PKC Ha mIHpOKme CjiOH HaceiieHHR, eCJHl He HpHHSITb 344oeKrHBHbIX mep ,L.I CHHMKeHHA TaKHX pHCKOB.

BawHo HMeTb xopoIIee npe,gcTaBneHIe O 3HaHHH, oTHOmeHHH, npaKirmKe H y6ex;eHHx MOJIO,gbIX JIio,eiA, 'To6bi fOH5Tb HX yA3B4MoCTh. Onpoc IIIKOJIbHHKOB B AUMaTmI noKa3an, rTO 13% nHmTHaguamneTHHx yKe HMeniH ceICyanbHbIe KoHTaKTmi, 4%

npo6oBaWIH HapKOTHKH, 23% ynoTpe6jmIIT ajiKorojbh H 9% ceKcyanbHo aKTHBHbIX

BM4/CrIMAH TYEEPKYnE3 B LAEHTPAnbHOA A3wm

HMeoT IIHHH. CoriacHo OTTeTy o geMorpacmH H 390pOBbe Ka3axcTaHa, 17% IOHOmefi H 33% geBymeK B BO3pacTe 15-19 JIeT He 3HaIOT O TOM, Kax ripe,OTBpaTHTh npegaaMy BM-HH)eKiei4HH, a 27% MyoKtHH H 65% )KeHII;4H He HIOJTb3yioTTCSI Hpe3pBaTHBaM4 BO BpeM5 rlOJIOBBoro KOHTaKTa C HeIOCTOSHHbIMH4 napTHepaMH.LAaHHbIe UNICEF nogrBepqaioT, YTo 74% MOJIO,ZbIX nmojgef B BO3pacTe 15-29 fieT H 46% MOJIOJgbIX )KeHII;HH TOA))Ke BO3paCTHOfl rpyIInhI OCBegOMjieHbI O rp3epBaTmax KaK O cpejgCBe

BIP-, H 54% Ka3axcTaHueB B BO3pacTe 15-49 .eT 1H3 6eAHefImix cjioeB I OT o6iecmTBa 3HalOT O HeO6xOAHMOcTh HCIIO.Ib3oBaHHI npe3epBaTHBOB giS 3aITb 3apaKeHHa BEHT. B 1999 rogy 17,5% MOJIOAbIX MY>KYHH B BO3pacTe 15-24 1ieT OTBeTnHJI, YTO y HUX HeCKOJhKO napTHepOB, B TO BpCMSA KaK 30% MypC'IHH H 16% KeCHMHH B Bo3pacTe 15-59 nieT cKa3aA ,YTO HMeJIH IlOJIOBbIe KOHTaKThI co cJyrafiHBMH1 npo4wiaKTiiKmi

napTHepaMH; 58% My1C4HH H 19%

KHeHHH B BO3pacTe 15-59 iieT OTBeTMJH,qTO

HCHOJnb3yIOT ripe3epBaTHBbI. (UNICEF 2002). HaceIieHHe TiopeM BbI3bIBaeT oco6yo O3a6o-eHHOCTh KaK Y313BHMaq rpynna, rge

npicyrcTByeT MHOoKeCTBO q4aKTOpOB pHcKa 3apa)KeHHi4 BUM H oTKyga HH43HLHpOBaHHbIe nonaga1OT B o6nyio macCy HaceiieHSI(Ta6nmnia 9). B 2001 rogy 3aKljoqeHHbie cocTaBnLH 25% 3apermCTpHpOBaHHbIX ciyaeB BWI/CrI4a, xqTo rOBOPHT o6 YPOBHe 3a6ohieBaeMocTH BW14/CrHHJOM B TOpbMaX B 0,5 npolneHTOB, MTO HecKOJIbKO Bbime, HeM OcJ)HuHaJbHbIe gaHHbIe. ro

OUeHKaM MHHHCTepCTBa IOCTHLIHH, 3a6oJIeBaeMOCTb

BHM cpex4 rILH B TpbMaX cocTaBjneT 3% (CKPHHHHrnpouuiii 11117 xe,1oBeK). rIpHMepHO 30% 3aKJUoqeHHbIX IpHHiMaIOT HH'beKIHOHHbIe HapKOTHKH, H HapKOTHKH npogojnKaioT ocTaBaThC5L BrIOJIHe OCTYHbIMH B T1OpbMmaX IHCTpyMeHThI NM HHbeKUHA He CTepHH3YOTc Hm HCnOJIb3yIOTC1 ,gOTex riop, rioKa He cTaHyTr rOInHOCTbIO

HenpHrOAHbIMH. B HCCJiegOBaHHH, fIpOBegeHHOM B TIOpbMaX, TOJIbKO 4 npouieHTa 3aKJo,qeHHbIX ,aaAH npaBHJbHbIg OTBeT Ha BOrIpOCbI 0 nyrix nepezaqH B4H H cTepHnA3aIUHH HrJI. KpoMe Toro, B HcCAeROBaHHH rOBOp14TCI, 4To 6oflee riOJIOBHHbI

BCeX 3aKJiiOxiCHHbIX BCTHyalOT B rOMOCeKCYaJIbHbIe KOHTaKTbI 6e3 rlpe3epBaTHBa. TaKHM rFIrIrl BeCbMa 3HaqHTejIbHa. PaHbIue o6pa3oM, cpegH 3aKmioqeHHbIX 3a6ojieBaeMOCTb 3aKnJoseHHbie nogBepranICb o6313aTejIbHOf nIPOBsepKe Ha BUM, HO 3Ta npaKTrKa 6buIa npeKpanueHa. BKpaTqe, anH,emHA BxM/CrIa B Ka3axcTaHe B HaCToqrnmee BpeMA HMeeT cnieAomHe xapaKTepHcTHKH:

T.ope?iMHoe HaceneHme, Y4PemAReHMR m PaCnPOCTPaHeHHOCTb BI4' B Ka3axcTaHe

3aKnlo'eHHbue HocHTenm BM4 PacnpocTpaHeHHocTb

BM4 (%)

Hombue 3ainbo4ernbie Ocso6oXCAeHHMbe

McnpasmTenbHbme Y4peXwAeHMN T.opbMbi,

1990

1995

2000

2001

64490 0 0 51018 23895

65359

58424

67937

0 0

218 0,17

446 0,34

51613 19354

54211 33222

56785 24544

rAe npeAyCMOTpeHO

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C 60nbHn9HblMH

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38 PABOMWr lOKFlAg BCEMHPHOrO SAHKA *

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450 TmIcHi noTpe6iH-

Te.ieI HH'beKUHOHHbIX HapKOTH4KOB; HX nIOJIOBbIe napTHepbI TaioKe nO,ZBepraioTcs oco6eHHO BbICOKOMY pHICKy.

reorpacpH'ecKaA KoHLxeHTpau{5. HaH6oniee nocfpagaBIImHMH IIBM[IOTCSI KaparaH-

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nocne,zHee peM3i ycKopoIInpOBe.AeHHe MeponpH5rg no 6opb6e c BUM.

BbLTIAH rpHHmI HauHoHaRbHaH cTpaTeriiA 60pb6bI c BUM/CHII44oM, pa3pa6oTaHHas ipH nori-

gep,KKe UNAIDS, H iwT=eTH5m nporpaMMa. HagoOHaJbHaA cTpaTerH5 rIpaBHTenbcTBa - 3TO TURaTeJIbHO nogroToBBAeHHbIAi gOKyMeHT, yKa3bIBaiomHA Ha Heo6xogHMocTh I1OBbIIiiHHS OCBegOMJneHHOCH o6igecTBa H BOBieqeHHA mHpOKHX MaCC HaCeiiCHHH, TaK KaK MHOrm'e, BKjiIOqaq ripe1cTaBrTejieA MeCTHbIX opraHOB BjiaCT4, He OCO3HaIoT MacmTa6oB npo6eMbi. C 1995 ro,ia B CTpaHe cyiiecTByeT MeKBegoMcTBeHHbIf KOOp-

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Ty6epKyne3 B TiOpbmax, Ka3axcTaH (a6conloTHoe 4Mcno

u nOKa3aTenb

Ha 1 00 TbIC.)

1997

1998

1999

2000

2001

1302 880 11903

1218 820 12970

345 300 13697

175 140 10061

174 130 8060

HoBble cny4aN ry6epKyne3a

5555

5061

5591

3434

3038

lnoKa3aTenb BblABneHuR

5591

4268

2995

2515

2210

lNcno yMepwHx OT ry6epKyne3a CmepTHocmb OT Ty6epKyne3a

PacnpocrpaHeHhocrb

MCTO4HlUK: CDC (2002) CeTrb opramli3aLm4A no 6opb6e C MHH)eKVMOHHbIMmm 6one3HAMM B L.eHTpanbHOA A3UU.

PAro'-IwrI gOKnAg BCEMHPHOrO SAHKA

ripeBbIuIaeT 5 npoiieHTOB,

,~ W .

rOpR.HMmH TOqKaMH. 1aHHbIe HaiWoHajibHoi CnpaBOHOfi jia6opaTo-

PacnpOCTpaHeHHOCTb Ty6epKyne3OM no o6nacTnM (Ha 100 TbIC. HaceneHI4)

pHH

3a 2000 ro,a noKa3bIBaIoT, xTO ypOBeHb B B o6iiacr5ix KoJIe6JneTcI OT 9 go 22

ripoUeHTOB, rpIH AOCTraTOHbIX 3nmeMmoJIorH'ecKHx gaHHbIX (Ta6Ima 13). CHcTeMa xTo6bI yiyI1MTb Ha,g3opa 6y,geT pacimHpThmc, c6op HHPopMaUHHM B HaLUOHaIbHbIX MacilTa6ax

O6nacTm

2000

AnManHcKaT

121-146

r. AnMaTbm

121-146

Cemepo-Ka3axcTaHcKam

121-146

Cmpamezus, nonumuKa u npasooaR ocHoSa

lONCHo-Ka3aXcTaHcKaA

121-146

BocToHHo-Ka3axcraHcWm

rlpaBHTeJIbcTBo B3SiO Ha ce6si cepbe3HbIe o6Hq3aTejmcrBa no 6opb6e c Ty6epKyrIe3oM, xno

KaparaHAnHCKaM

121-146 121-146

KycTaHaUcKa r. AcauHa

121-146 147-173

AKMOnmHCKaJ

147-173

)KaM6bnmcKaR

147-173

ATbpaycKai

MaHrNcTaycKan

174-200 174-200 174-200 201-226 227-281

K3bmnOPANHcKam

281-308

3anaAHo-Ka3axcTaHcKaca

rlasnoAapcKan AKTio6uHcKam

ioATBepxqaerc3i ciegpoDmH MeporpHMriAMH

rOCygapCTBeHHOM YPOBHe; U Hi4rge B cTpaHe HeT HegOCTaTKa B npenapaTax nepBoro pgga.

Mcmo4Hur CDC (2002) CeTb oPraHM3aL4W no 6opb6e c mHtpeKiomHHbiMm 6one3HRMM B LAeHpanbHoi

Ka3axcTaH ripHHAii HaiWoHavbHyio rporpammy 60pb6bI c Ty6epicynIe3oM, OCHOBaHHYIO Ha peKoMeHAoBaHHo$i B03 crpaTerxnH 60pb6bI c Ty6epKyne3oM (DOTS) H aa,IanTHpoBaHHyIO C yqeToM yCJIOBH2 Ka3axcTaHa, KoTopa5 oxBaTbIBaeT Bce HaceiieHie cTpaHbI; 3aKynKa IIpoTHBo-Ty6epKyJIe3HbIx ripenapaToB lpOH3BO1HTCI ieHTpanI3OBaHO Ha

A3Mm.

6nacTb

AnMaTNNcKaN

nepmwIHan

BTopMIHaR

npenapaT

MJ1YT5

npenapar

Bcero

I MJlYTE

npenapaT

MJ1YTE

r. AnmaTbi

45,9 36,5

9,9 16,2

66,2 39,9

12,3 19,2

58,8 38,9

11,4 18,2

Cemepo-Ka3axcraHcKaR

58,1

9,8

63,6

21,8

61,4

42,3

lOKHo-Ka3axCMaHCKaR

37,1

7,5

37,8

9,2

37,7

8,9

Bocro4mo-Ka3axcraHcKam

44,2

6,3

90,0

27,8

71,3

19,1

KaparaHAHuicKal

56,9

10,I

70,8

22,3

64,5

16,8

KycTaHaAcKai

21,8

5,5

63,4

13,5

50,8

11,0

r. AcTaHa

AThipaycKas.

72,9 39,2 12,6 26,1

13,9 6,7 -

87,7 55,8 82,6 57,4

48,0 10,5 2,0 6,4

39,4 46,7 37,0 33,9

3anaAHo-KaaXcTaHCKaM

86,2

10,3

87,0

14,2

87,2

13,7

namnoAapcKaJ

78,8

12,1

93,7

34,4

91,3

30,8

72,2 33,0 46,2

25,9 16,8 9,7

86,8 21,1 62,7

26,2 34,3 18,3

80,0 73,6

26,1 22,9

AKMOnmHCK8R

)KaM6bincKan

5,5 8,4 1,0 1,9

AwnIo6HHCKaM

MaHrmcraycKan K3binopAnHcxan Ka3axcrau

Ty6epKyne3a (2002). lCmOo4HUK: Ha4UOHanbHbIg Hay4HO-mCCneAOBaTenbCKiU U4HCTMTYT

BMH/Cnfg MTYSEPKYJ1E3 B LAEHTPAJ1bHOI

A3mm

B Mae 1998 roAa ripe3HgeHT Ka3axcTaHa Ha3ap6aeB gwan yKa3,Tpe6yIoMlH4 BHe,peHHs DOTS no BceP Pecny6rniKe H BbeIieHA cpezcTB rocyapCTBeHHOrO 6iopKe'ra Ha 3aKyrucy npoTHBoTy6epKyjie3HbIx rperapaToB.

IoTpe6HOcTb

B npenapaTax

nepBoro pzAa onpegeuieTCA KanxKbIe nonroga nyreM MOHiTOPHHra 3anaCOB B KaKwgOM

ixeMe6HoM yqpe)EaeHIH -iepe3 KOMmBrboTepH3OBaHHM cCHcTeMy,geAcrByiouWo no Bcefi cTpaHe. CornacHo npe3HgeHTCKOMy yKa3y, HpaBHTejIbCTBO Ka3axCTaHa rHiHHmmO DOTS B KaieCTBe OdH4imajIbHOf cTpaTermn cTpaHbI Ho 6opb6e c Ty6epKyne3oM. MHHHcTepCTBO 3gpaBOOXPaHeHH5 oTBeqaeT 3a Bce MeporipHITHAl, CB3aHHbi c Ty6epKyAe3oM, a

HayqHo-Hcc.iejoBaTejIbcKxif HHCTHTyr Ty6epKyne3a peani3yeYT H KOOpgHHHpyeT c-paTeri4io DOTS. Bce iporpammbi DOTS, BMinoqag H Te, KOTOpbIe IpOBO,gHT HrIO, yrnepxcAaioTcs HHCTMTyTOM go HX BHe,peHm5.

nompe6Hocmu f macl3ope u aononHumenbHbIe uccneaoafHuR 3ieKTpOHHOe Ha6JKogeHHe 3a cuyqaAMH Ty6eplcyTie3a no3BojSeT JioDLaM, IpHHHMaio]4MM norioHnTHecK"e pemeHHA, rnoJiy'aTm AOCTOBepHbIe aHHbIe, 6bicrpo aHanJH3HpoBaTL TeHCeHUHH 1 IIpHHHMaTh lHHqOpMHpOBaHHbme peueHms. 3jieKmpOHHa5I CHCTTMa HaA3opa 3a BegeHHeM HHHBH,yaJbHbIX cJyqaeB (3CHHIC-ESCM), pa3pa6oTaHHas IpH cOgefcTBHiH CDC, 6bm1a BBegeHa B AeficTBMe no Bcefi cTpaHe, a 6a3a gaHHbix 6bula co3gaHa B srHBape 2000 ro,a (6onee 65000 c.7y-4aeB Ty6epKyne3a). CHcreMa noinocTsIo coBMec-

THMa Kax C C

eCTeMOA Hag3opa B03, TaK 14 c cH4cTeMoA Hag3opa COBeTcKoro Tmna. OgHa-

KO HeAcHo, ioAepBaeT 3m MHHHcTepcTBo 3ApaBOOXpaHeHH51 3TY CH[CTeMy go CM4X nop, HAM e OHO BepHyJIOCb K iipe)H)e COBeTCKOfi CHCTeMe Hag3opa. 3Ty CH[CTrMy

Heo6xogi4Mo 6ygeeT pacmi4pHb, 'rro6bI OHa TaioKe Biuoqania TeCr Ha .ieKapCTBeHHylO onpe,AejieHH5 BO3MOmKHOCTm rIpHM4eHeHHSH riOXOgOB DOTS-nrnoc EK .neqeHMo ycToxmBb1x qopM Ty6epiynie3a. Heo6xogHMbI orno.niHieremHbie iCcjiejoBaHE11, 4TO6bI oipeguenmT,BSbJioTc5I 31I BbICOKELe roKa3aTeJIH MJIY- Ty6epicyne3a H BEMH4eKLUm npripwHog 7-9 npoiLeHTOB He6JiaronpHErTHbix MCXOgOB neqeHm no crCTeme DOTS, a TaKxce npiwEnHHofi 5-nposleHTHoA CMepTHOCTH OT Ty6epKynTe3a. B pamKax nOninnimrecKoro lmanor-a IHoTpacneBoii pa6oTmi, COBMecTHo qMHaHcMpye-

yCTOfrIMBOCTh A,i

MOfl HpaBHITeJICTBoM H4BaHKOM, B HaCTOqmITee BpeMq npOBO,MTCH yrTly6JieHHoe H3y"eHHe HauWoHaibHofi nporpaMMbI 6Opb6bI c Ty6epKysie3oM. 3'To Mi3yqeHMC BK:1inoqaeT aHaJIH3 3nrugeMHojiorHrqecKHx gaHHbIX, o6cJiegOBaHHe MegmEWHCKErX y"peqeHH1, a

TaioKe

inpoBegeHHe (OKyC-rpynnOBbIX ,MCKyCCII

C laUWeiHTaM-

HaMeHmepa6oTHmKaaMH.

Bonpocba npolunjaKmuKu, 8UGzHOCmUKU u ne.'eHUA Bcneg 3a BBeAeHemM B 1998 ro,y crpaTerim DOTS, K 2000 rogy ee oxBaT 6bIcTpo pacnpoCTpaHmc3i Ha BCIO cTpaHy, xTO 3Ha-nHTeJIbHO IOBJIHSIO Ha 3iaimeMHOnOrHqecKyMO CTyragUHO B Ka3axCTaHe. YpOBeHb CMepTHOCTM cpa3y CHH3HJICS, a pOCT qHcJIa HOBbIX c.y'aeB 3aMeXpm1 cA. OgHaKo noKa3aTenb ycneinHoro niexieHm eige He AOCTH4r

85%, 'TO ABnHeTCH1 uejibio BO3. 3HaxiHTeIbHoe CHHXKeHHe cMepTHOCTM H q4cjia HOBbIX cJIyQaeB B pe3yJIbTaTe BHegpeHHH DOTS B TnOpeMHOA C14CTeMe rogqePK14BaeT BaKHOCTh HenpepbIBHoro CHa6>KeHEi4 npoTHBoTy6epKyne3HbIMHi npenapaTami H ne iienHi oCBo6oxIgaeMbIx 3aKnioqeHHbIx B Ka3axcTaHe. 03a6oxeHHOCTm BbI3bIBaeT BOnpOC 3q4eKTHBHOCTH McnOIb3oBaHEHl MMeIOmMXCA pecypcoB H AOHOpCKOrO cJJHHaHCMpoBaHHR. XOTA HagHOHaJIbHa5I nporpamma 6Opb6bl C Ty6epKyne3oM Ka3axcTaHa 3aHBAHeT o IP4BepeHKIHHOCTMnf CTpaTeC4II DOTS, BKJnoqasi raCCHBHoe BBmiiBeHMe n-yrem 6aKTeepHocKonwmecKoro aHlaH3a MOKpOTM, B CTpaHe no-

npe>KHemy tpe3MepHo H46e3 Heo6xogHMocTR ripMiH1eiTCcA MaCCOBaA peHTreHocKoriHA (Ta6nHiL4a 14). B 2001 rogy npEMmepHO ,Be TpeTH BcerO B3poc.iOrO HacenJeHHA rIpOmnH CKplHHHHr, H46buio cgeiiai-o CBbIIUe 5 M14MHJLOHOB peHTreHOBCKMX CHHMKOB (MMc1), T.e. 517 CHHIMKOB Ha KawKAbIf BbIqBjieHHbIHr c7yMaEr Ty6epKyie3a. B 2001 rogy 6bIno 3aKyri-

gOK:I1Ag BCEMIPHoro EAHKA

PASOL4

Ty64ncnaHcepbi

CaHaTopHm T5-Ka6uHeTmi lnyHKTbI b o6blHHblX ne4e6Hbux y'penmAeHHnx KONKH Ann 6onbHblX Ty6epKyne3oM KOIKH a caHaTopmHNx

Bpa4n-4rTN3naTpbl KOHKO-AHN

(TblC.)

CpeAAHn npoAonflCTenbHocrb rocnwran3san"n Xnpyprn'ecKme nmewaTenbcrBa 0Oniooporpa4n'aecKne annapaTmi L4n¢poBbie 4)niooporpa4)n4ecKme annapTmi PeHreHocKonNqecKoe NccnegosaHme (MM(P) % HaceneHHR,

npoweAwnx peHTreHocKonwio

BaK4AHHai4m N peBaK4HHaa4m

5l14)K (Tbc.)

Ma3KN MOKpOTbl Ha *bulcneHHe

AHanH3

KynbTyp

TS (Tblc.)

MOKpOTbi (Tbmc.)

1990

1995

2000

2001

350

345

341

334

127 19815 5925 1522 5787

136 15733 4541 1280 4674

159 13490 3843 1305 4329

147 13522 4040 1346 4477

128

120

604

199 659

1255 545

1565 601

6965

6803

3892

30 5177

662,8

698,7

404,8

411,3

1046,6 334,9

1016,9 261,1

10001

11107

AHanK3 MOKpOT Ha 4yBCEHTlenbHocrb

K IieKapCTBeHHbIM npenapalmm McmowHuIc MmHmcTepclmo 3ApasooxpaHeHKfl.

JneHo 30 LcIpOBbIX qpnooporpawHmecKHx anrapaToB. rIpH alHla0orHbIX noKa3aTCTLqX ycnIeiiHocI jieqCHH5A B Ka3axCTaHe H KbIprbI3CTaHe, cpeAHAII HpOrOAXGKTeIbHOCTh HaXOxeHHA5I B 60JIbHmlue ogHoro nponeqeHHoro alUHeHTa B Ka3axcTaHe 3aMeTHO BbIIIe, qeM B KbIprbI3CTaHe: 92 iH74 gHI COOTBeTCTBeHHO, 4TO rOBOpHT O 'Ipe3MepHoM iHcIOJIb3OBaHHH 6o0bHIwqHbIX yqpewAeHEI4 B Ka3axcTaHe. B Ka3axcTaHe noKa HeT HaUHOHaJbHO$A nporpaMMbI 60pb6bI c MJIYTB. IAMeIoTcs riojTBepA) eHHbie AaHHaibie o TOM, -rro 60-80 npOUiHTOB 6OmbHbIX MyAbTHpe3HCTeHTHbIM Ty6epKyne3oM Mo)KeT 6bITb H3iieqeHO rIpH npaBHIbHOM BqaeHHm cJiyqaeB, OCHOBaHHOM Ha HCHOJHb3OBaHHH npenapaToB BToporO H Tpembero p3iga (DOTS-runoc). Hagnewcauaq

CTpaTenm DOTS-rnoc B HaLwoHaIbHyIO nporpammy 60pb6bI c Ty6epKynie30M B Ka3axcTaHe ripegCTaBiSeeTIc OnpaBgaHHO0. O6ecnoKoeHHoe MacmTa6oM npo6neI MbIYTB H ee nOcjiegCTBHqmiM, HlpaBiTeJTbCTBo npeAnpHHniO cnIeAyioie MepbI: (1) co3,aaio qeTmipe EioTHbixy'yacTKa xvm peaJM3aLwm DOTS-rbuoc (USAID/IJAP, Mepe3 npoeKT HOPE H CDC, co3,ano gBa AOflOJHTJIbHbIX mwioTHbix y'acTKa); (2) cocTaBHno 3afSBKY B KomHTeTr "3eieHoro cBeTa" B03 Ha 3aKynIKy npenapaTOB BToporo psva no 6onee HH3KHM ilCHaM; H (3) HCrIob30BaJo 3aeM BcemHpHoro 6aHKa Aim npHo6pereHrm npoThBoTy6epKyjie3HbIx npenapaToB, TpaHCnOpTHbIX cpeACTB Avim o6nacTHbIx Ty6,grHcnaHcepOB, jia6opaTOpHOro o6opygoBaH1Hs H pacxojHbix MaTepaHnoB H co3gaHH5 HawHOHaJIbHOA crIpaBo-iHoA nia6opaTopHH no Ty6epKyjie3y C no.iHbIm Ha6opoM o6OpyAOBaHinI AJii HpOBegeHHR aHaHJ13a Ha yBCTBHTejibHOCTb K ripoTHBoTy6epKyjie3HbIM npenapaTaM. Hqemipe mionOTHbIx ytacTKa (CeBepo-Ka3axcTaHcKaA H IOX(HO-Ka3axcTaHcKa3i o6iiaCTH, ropoA AnMiaTbi H HaUHoHajibHbIf iLeHTp 6opb6bI c Ty6epKyAe3OM) B HacToAIree BpeMA npoBoaT ,AHarHOCTKny Hi Iie-ieHHe MIYTB; B 2000 rogy OHH OTcjIexGmB3Am B o6igegi CwioxHocm 300 naiwexirroB. B 2001 rogy, npEI coge2CTBHu USAID, 6bUnI co3,aHbI iiSneeHm MJJYTB (AKTno6miHcKasl H KaparaHAirHCKaA eige ABa uvIOTHbIX y'acmAa o6naCMT) B pe3yjibTaTe iero B 2001 rony KomJI'ecTBo B351TbIX Ha y'eT naWeHToB cocra-

mHmerpauH

BVq/Cnlg1

MTYSEPKYJ1E3

B L4EHTPAflbHOI

A3mm

2002 rogy rIpaB nebcTmo Ka3axcraHa o6ecnewimo ripenIapaTamH BToporO p3wa euie iniecT o6niac-refi (BocrotIHo-Ka3axcTaHcKyo7, )KaM6bIicKyIo, 3aria,qHoBHTo 400 TiejIOBeK B

Ka3axcTaHCKylo, K3bmuiop,mcKyio, MaHrbicraycKyIo E' rIaB.no,apcKyfo) TeM CambIM gono.nHHiTeJbHo oxBaEniB 1300 6oJbHbIx MJIYTB. B 2003 ro,gy IIpaBTeirbcTBo rulaHHpyer pacumpb .neeqeHHe MTYTB ,Aim oxBaTa Bcex perEOHOB cTpaHbI.

3aKynaeT npeIIapaTbi BToporo pla gVH rIIHJIOTHbIX npOeKTOB C ro,za. OAHaKo ,gni 6bicTporo pacripocTpaHeHHA riporpamm JieteH4IA MJIYTB He XBaTaeT ,AOJDKHOfi KJHHHiecKofi riO,rOTOBKH, .na6opaTopHoro noTeHLUHana gui IlpaBHTeJIbcTBo

2000

aHaJUl3a x1yBCTBHTeJIbHOCTH K nperiapaTam H XopoIuHX pe3yJIbTaTOB peaJIH3atWHH cTaH,TapTHbIx HIPOTOKOJIOB DOTS. nIO3TOMY B03MoKHoe pa3BHTHe yCTOfNlHBOCTH K ipenapaTaM BToporo psga BbI3bIBaeT TpeBOry. OAH14M H3 HaH6oAee BaKHbIX BOIIpOCOB 3iBjU1eTCA oTcyTCTBHe B Ka3aXCTaHe HayqHO o6ocHoBaHHbix jiete6HbIx IpOTOKOJIOB, a TaioKe oTcyTCTBHe Ha MeCTaX TexHHxieCKH4X BO3MOHOCTefi Awim 60pb6bI c MJYTB.

AeRmenbHoCmb HnO u napmmepo6 HaLHOHaAbHaA nporpamma 60pb6bI c ry6epKyne3oM 6buIa HaqaTa B KOHue 1999 roga urpH nojgepxcKe BceMHpHOrO 6aHKa. Ee ieIbIo 3iBieTcH ynyImeHie KaxecTBa JIe-eHHA

HiyiperuieMie nojiHEf pecjopMEHpOBaHHR H ocyiecTBwieHHA MeponpTHai no 6opb6e c Ty6epKyAe3oM no Bcefi pecny6n4Ke. BO3 npe,rocTaBana TexHH-IecKoe co,eflCTBme STOMY 4¢HHaHCHpyeMOMy BaHKOM ipoeicy. rIpH 4)HHaHCOBOM H TeXHH-iecKoM cojgeficmmn USAID H ero napTHepoB no peaJII3agHH (CDC B CIIA H rIpoeKT HOPE), K2000 rogy cTpaTerMH DOTS 6bia ycnexIHo pacnpoc'TpaHeHa Ha BceA

TeppHiTOpHH CrpaHbl. rIpaBiTejIbCTBo Ka3axcTaHa BbieJIH.o cpeAcTBa Ha peryJIspHbIlf

MOHHTOpHHr peaJ13aunu cTpaTerHH DOTS. C 1997 roxaa rlpoeKT HOPE npOBO,XT o6yteHHie no DOTS KaK ,WIu qI143HaTpOB, TaK Hiwmi Bpaiefi nepBHqHorO 3BeHa. L_eHTp CDC HpIHHIMmaeT aKTHBHoe yxacTile B o6HoBnIeHHIH na6opaTopHfi H COBepmneHCTBO-

BaHHII HaBbIKOB COTpy,AHHKOB TB-jia6opaTopiHA. CDC TaKe ripOBesi o6yqeHHe MeTo,TaM aHaAH3a ,gaHHbIX SIieKTpOHHOfi CHCTeMbI Hag3opa 3a CT1yqaqHMH Ty6epKyne3a (ESCM) xvu o6AiacmbIx Ty6gHcriaHcepOB no Bcefi CTpaHe.

HIpH3HaBaH cepbe3HOCTh ,aHHO1i npo6JneMbi LeHTpaJIbHoi Am3HH, c 1997 ro,a

USAID/CAR Haqajio OKa3bIBaTb coAeicTmHe peanii3auHH DOTS B 'emipex rHIOTHbIX yqacTmax Ka3axcTaHa. B 1998 ro,Ay no npOCb6e rIpaBHTelibcTBa USAID pacimupmio cBoe TexHH'leCKoe co1AeficTBe Ha 21 HnHOTHblI Ty6AHcnaHcep. rIapTHepaMH USAID no peanji43aLHHi cTpaTermi DOTS ABIIOTC31 rlpoeKT HOPE H4 CDC, KoTopbIe pa6oTaioT no

Bcei eTpaHe. rIpoeKT HOPE nomoraeT CBOHM riapTHepaM B pa3pa6OTKe nIpaBOBOII IH

roJnTHiqeCKoA 6a3bI, a TaioKe B noBbImiieHHH ipOcpeCCCHOHajibHbIX HaBbIKOB Iy3rH3HaT-

pOB H Bpaxiefi nepBWnHOrl MeqiHKo-CaHHTapHOf4 IIOMOIIH. B HacTomiee BpeMAIHpoeKT

HOPE BHegp3ieT CTaHqapTHbIe KOHTpOJIbHbIe JImCTbI IA perynipHoro MOHHTOPHHra H 04eHKH peanm3aug DOTS B TeCHOM COTpyuHmeCCTBe C rIpaBHTejibCTBOM. HeTaBHO ripoeKr HOPE H CDC HaqanIH HOBYIO nporpammy 60pb6bI H npo(pcHaicrHKn Ty6epKynie3a B KaparaH,HHCKO}I TlOpbMe.

rIpogonKcal cqirnaTm cipaTerio DOTS rJIaBHbIM IIpHOpETeTOM B genie 60pb6bI c TB B Ka3axcraHe, USAID/CAR npH3HaeT, tTo M.IYTB npegICTaBnmeT co6o0 cepbe3Hy1o yrpo3y 39tXeKT-BHOCTH peaJU13aLiH CTppaTerHH DOTS B CTpaHe. ,ZII oKa3aHHB nOMOn;H rpaBHTeCjbcTBy Ka3aXCTaHa B ero ycHwEIx rio 6opb6e c MJIYTB, PerHoHanbHoe

npe,zCTaBHTejIbCTBO USAID B LJeHTpanbHofI A3Hinpe,ocTaBnieT TexHHxiecKoM COgeACTBHe Bco3zaH4H Bceo6lbeMjlloigeft MoAeCJi BegeHHA MJYTB. 3Ta MORejib 6yAeT

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HOrO 3,0pOBb5 (HrO), KoTopax nipoBena HCcjiegoBaHHe OCBegoMneHHOCTH H 3HaHHi o BHOM 3,AOpoBbe. 06ecneqeHHocTm rpe3epBaTisaMH HepaBHoMepHa, a penpo,y tPOH,j HapOAOHaceAeHH5I OOH He B COCTOSHHm o6ecnIeiHmb BCIO IIoTpe6HOCTb. B 2002

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H TYrEPKYJ1E3

B LEHTPAnbHOI A3mm

rogy DFID H rlpaBHTej.IbcTBo HHgepnaHAOB o6ecneqHIH 80% rioTpe6HOCTH B npe3epBaTHBax NIH BbICOKO-yI3BHMbIx rpynn, a HpaBI4TeIbcTBO OmcKog o60nacTH

BbigeIHJIo 24000 gojuIJapoB CIIA Ha 3aKynKy npe3epBaTHBoB. PeniirH03Hoe coo6ImecTBo co3gaeT nperpaAbI B aTof pa6oTe. XOTH peiIHrHO3HbIe iHAepbi o6H13aiH4Cb nozgepKHBaTm rpaBa penppOAYirBHoro 3AOPOBbS H HpocpiAaKTHKy BWI/CHa, OHH BbICTYIIaOT HIPOTHB o6CyxqeHHR BOripOCOB 6e3aoIaCHoro ceKca H pa3gaH ripe3epBaTHBOB B IIIKOJIaX. 4)OHg HapogoHace7ieHI4 OOH opraHH3OBaji Kpyrnbir CTOji c yqacTHem peJIHrIO3HbIx iiHgepOB H oxKHgaJI noniy'HT i4X oAo6peHHe 3aKoHa "O penpogyWMBHblX ripaBax". BepxoBHbIH KOMHCcapHaT OOH rIo ,Aeiam 6eceHiLeB (UNHCR) 3aHHMaeTcH nIpo6ieMaMmH penpo,TyKIIBHoro 3.OpOBbq H BHH/CllHaa cpe,H MOjOlobIX 6e)KeHueB, KOTOpbIe B OCHOBHOM rIpH6bIBaloT I43 Tag>EICiiTaHa (HO ABJTAIOTCS 3THw4eCKLHMH KHprH3aMH), OJHaKo cpe,H HHX eCTm TaioKe qeqeHIbI H aqjraHLbI. UNHCR noNIep,HBsaeT

Hp0.oIoHMbIe HrIO KaMnaHHH no HHcJopMIpoBaHHo MOJIO,AbiX 6eMeHIeB, pa3Aa,ay npe3epBaTHBoB H4 co3L7aHHe KnEHHHK gm 6eweHLIeB. MexyHapo,gHaA OpraHM3aqR no npo6AeMaM MHmpaqHiH (MOM) npoBO,HT KaMHaHHIIO o6IIXecTBeHHof4 HH(OpMHpOBaHHOCTH gV5 Tpy.OBbIX MHrpaHTOB. 06bMHO TpygOBbIe MHrpaHThI He HMemOT ,AocTyna K Me,LHgHcKoOf noMomJH H4 6o0iee YH3BIMbI gIm BHH/CrI4Aa. MHormIe )KeHMHHbI OKa3bIBaIOTCq B CHTyalUH4, Kor,Aa HX BbiHyxaaroT oKa3bIBaTh ceKcyalIbHbie ycnyrH, miH6o npHi6eraloT K rIpocTHTyIHH4 B KaqecTBe BpeMeHHoro cnoco6a 3apa6oTaTm,

noKa He HaAgyr nOCTOsHHOA pa6oTbi. JIM oci4iniaRnbHOrO ycTpoiCTBa Ha pa6oTy B KbiprbI3CKOA Pecny6mnKe Heo6xo,HM aHa7IH3 KpOBH, H nO3ToMy 3THEH-eia4e KHprH3bI, BO3BpaigaioWHecH 143 Ta,KnHcraHa, Y36eKHcTaHa H gpyriHx cTpaH, o65I3aHbI nporm TeCT Ha BIlqI, LTo6bI CTaTh rpa)KAaHaMm KbIprbI3CKOfi Pecny6nrHn. IOCAJ, oKa3bIBaeT noggepAucy MeponpH5{HAM no npoc¢waKCrrKe BW/CrIILa B KbIprbI3CKOfi

Pecny6nmKe B KOHTeKCTe peajul3agiH

CBoefl CTpaTerMi B 4eHTpaJTbHOf

A3HH, KoTopaS npeAycMaTpHBaeT Bb1geeieHHe 2 M I40nEIOHOB ,onmapoB CILA Ha npOrpaMMbI CHIDKeHH4A Bpega B TeqeHHe 6m.DKafIiniIx ,gByXneT. IOCAIM TaioKe Co,gefCTByeT MepOnpHITHHM, OCyf;CcTBJieMbIM aMCpHiKaHcKmM LeHTpOM 60pb6bI Hinpo(4HAaKTHKH 3a6oj1eBaHHA (CDC), BKino-iaSI o6yqeHHe COTpygHHKOB MHHHcTepcTBa 3apaBooxpaHCHHAS MeTOgaM Jo3OpHoro 3nHriHa930pa. eienapTaMeHT Mew,4yHapoJHoro pa3BHTm (DFID) BbiCeEji nepBoHatIaJIbHo 2 MJIH. zoiui. ClIIA Ha nporpaMMbi CHmKeHXH5 Bpe,rxa H noggepIcKy peCTpyKTypEH3aLHH cHcTeMbI HCHOJIHeHHH HaKa3aHHE.

lmBeiLxapcKoe COTpy,7HwmecTBy npeg7oCTaBHoIO 160 Tbic. IIIBeiuapcKHX qpaHKOB Ha nporpaMMy HHqopMMHpoBaHHH o6 ynoTpe6JieHHH HapKOTHKOB B OIIcKoE o6nacTH, KOTOpaH paCC'rITaHa Ha cTyAeHTOB H npegycMaTpHBaeT o6y"eHIIe yHTeReA. ArCHTCTBO OTKPbIJIO HHc)opMaLHOHHbIr iUeHTp "Payra", KOTOpbIA noggepAMBaeT 3Ty nporpaMMy AreHTCTBO no

B AwanI-A6aAcKoAG H BaTKeHCKOfi o6nacmmix. ,[JOHOpbI H HHIO yKa3biBa1OT Ha HeO6XOmHMOCTb pacmnpeHm nporpamm cHmvKenmBpe,ga c TeM, ro6bi oxBaTm 60% HaiH6ojLee YS3BHMb1X rpyrm (H1H, PKC) H o6ecneluTm goinocpotnHyio ycmOwnmocm MeponpHHIA no npo4ivaKxrHKe H neiqeHimo BIH/CflI4Aa B KbIprbI3CKOA Pecny6inme; npeAocTaBJH HH4JopMaiwio H4o6y'eHRe no BW{/CIHIHAy TeM, KTo 6poci mIKoly; pemax npo6neMy cHmMbi; npeKpamaq yrOAoBHoe npeciie,oBaHie 3a ynroTpe6neHne HapKoTmKoB; yMeHbmaIi nepeHaceJIeHHe TopeM; H rloNIepKHBaA pacampei-le 3aMeCraTejnbHofl Teparni C IcnoJTb3oBaHI4eM MeTagoHa AJs ILMH. OPuHaHcuposaHue B 2000 roAy B KbiprbI3CKOA Pecny6nHKe Ha 3gpaBooxpaHeHHH 6buIO BbIAejieHO 1,8% BBHI (12% rocygapcTBeHHbIx paCxoAoB), qTO cocTaBJuxeT MeHee 7 AOhaPOB Ha Ayrny

HaceiieHHA. rIpaBHTeCJbcTBo coo6nxwro, AO.TJaPOB CIIIA Ha peaJIH3aiAHio BTopofI

TrrO B 2001 rogy BbqenMO OKOJIO 1 MHJInHOHa iiporpaMMbi no BE IH/ClIMy, OzHaKO B paMKaX

PAro04MlI AOKJ1AA BCEMWPHOrO BAHKA

nepBoi iiporpamMMbI no BHI/CrIHy 6buio noiyreHo nInIIb 18% OT 3aruiaHIPOBaHHoro cEHHaHC11poBaHHA, nO3TOMY ciie,yeT o6paTErrb BHHMmaHHe Ha ocBoeHHC Cpe,gCTB B pamKax BTOpof nporpaMMbI. (P1HaHCHPOBaHHe COBMeCTHOI riPOrPaMMbI FIPOOH H UNAIDS cocTaBluo 250 TbIC. gojIapoB CIIIA rIporpaMMbI cHECeHHA Bpega

nOAz;ePXU1BaioTCS

areHTCTBaMH OOH, cDOH,OM Copoca/IHciuTyroM OTKpbrToro O6MecrBa HIMeCTHbIMH BwiaCTniM ropoga OmI. rDo6aAbHblf (D)oH 60pb6bI co CrlIOM, Ty6epKyjie3oM H MaJipHiefi (oDCIM) ojgo6pHn BbVeJIeHHe rpaHTa B pa3mepe 5 MnH. ,AOuJi. CIMIA Ha 60pb6y c B1I4/CrIHAoM 113 CyMMbI 17 MHiLIHOHOB ,ojnapoB, Ha KoTopypo nIpaBrreJIbcTBo nogaBano 3aqBKY, HO,ZrOTOBieHHYO ripH COgefiCTBmH UNAIDS. 3'To gornoinmir oAcHgaeMoe q)cHaHCH4POBaHHe 113 rocygapcrBeiHHbix H ,gpyrHx HrCTOqHHKOB (Bpa3mepe

iipHMepHo

5 MHUOHOB

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2003-2007

ro,bI.

Ty6epKyne3: 3nHAemmonOrm'ieCKaR CmTrya4Hm rIo pacnpocTpaHeHHOCTm Ty6epKyjie3a KbiprbI3CTaH 3aHMmaeT B'ropoe mecTo cpe, LteHTpaJIbHoa3HaTCKHX pecny6nnHK B Haqajie 1990-X rO,iOB 30-.neTH3vA TeH,reHUHq1 K CHi-DKeHHO 3a6oneBaeMocTH Ty6epKyAe3oM B KbIprII3CKof Pecn6n.Kiiie H3MIeH11iaCb B rIpOT11BOHOJIOXKHylO CTOpOHY, KaK H B gpyrHx crpaHax 6blBmero COBeTcKoro CoIo3a (ra6Hiinia 16). C 1990 no 1999 rogbi excero,iHasi 3a6ojxeBaeMoCTm B KbpruI3CKofi Pecny6JnKeyBCJIHMHnaCbC 53 cniyqaeB Ha 100 TmICV HaceiieHHs Ao 132 CIyqaeB Ha 100 TbICSN. E,KerojgHo BO3HHKaeT 6o0iee 6000 HOBbIX CA"*aeB Ty6epKyjIe3a, H 7000 cTaHoB5TCSA XpoHiimecKuMm rIoKa3aTejm XPOHHMecKHx cTryaeB 10 Ha 10OTIc. crqnTaeTcA KpHTH1ecKHM no cTaH,apTaM B03. B 1996 rO,AY B qemxpex paAoHax ,BXByX o6nacTei cTpaHbi 6bma HaqaTa peaJ43a1A nporpaMMbi DOTS. B CBeTe o6Ha,eAwBa1oUJX pe3yJIbTaTOB 14CrIOJIb3OBaHI

HOBbIX nOUXO,10OB B jieqeHH

HOBbIX ciiyqaeB

Ty6epKyjie3a (ypoBeHb ycneIIIHoro Hcxo,a nieqeHnuA rpynnbi naLHeHToB B 1996 ro,gy COCTaBHJ 88%, a BbNBSJIeMoCTh 6bIna Ha 14% BbIIne, t.eM B gpyrEx pagioHax cTpaHbI), B 1998 roAy DOTS 6bIna BHe,IpeHa no Bcefi cTpaHe. 3To pacmrpeiHEe r1POHI30IIO B pamKax nporpammbI pecpopMbi 3.1paBooxpaHeHi, peaH3yemo MHHHcTepcTBoM 3,gpaBooxpaHeHH5 KbIprbI3CKOl Pecny6m4nam rpH no,gepxKe Kpe,HTa BceMnpHoro eepBHqHO, megHKo-CaHHTapHOf 6aHKa. Boniee OHOfi TpeTH 6ioxKera rio KOMrIOHeHTy Ty6epKynIe3a. noMOIIm 6bIio BbI,AejieHO Ha o6yqeHHe, g1arHHOCThKy H ieqeHi{e BHe,ApeHH-e crpaTeruH DOTS ,AelcrBniTeJIbHO pHBeO KHMemeieHHOMY yiyPImeHIIIO 3nHgeeMHoIorniqecKoAi CHTyaIUH B KbIprbI3CKofi Pecry6niKe. OTqaCM B pe3yJIbTraT yjytIImeHnI BbIS1BJIeHHA nOKa3aTeTI1 3a6oJeBaeMoCTH H CMepTHOCTH Or Ty6epKyjie3a

Ty6epKmyne3 B Kbiprbl3cKoH Pecny6nuKe (Ha HaceneHufl)

1990 CMepTHocmb OT Ty6epKyneaa

PacnpocTpaHeHHocrb Ty6epKynesa

00 TbIC. rpaw.AaHCKoro

1995

2000

2001

7,2

13,4

12,6

13,5

228,5

246,1

363,8

313

31 2306

25 3266

22 5953

24 6274

53 59,3 44,9

72,4 90,1 55,1

121,8

127,3

145,3

146,9

97,9

107,2

20,2

28,3

57,5

%HOSblX *bbsneHHbiX cnyHaes

6aqiunnosbuAenuTeneA (bK+) BbrABneHNe cny4aeB TS noKa3aTenb ablAsneHHN - cpeAu MyYCKHH - cpeAn NCeHU4HH

- cpeAN AeTei MCmo.nUK: MHCTNT)r Ty6epKyjle3a.

BMH/Cnfg

TYbEPKYJlE3 B LEHTPAI1bHOA

A3mm

ipogojDKajni pacm g,Zo 1999 ro,za. B 2000 rogy, BnepBbie c 1993 roAa, KOjIWqecTBo

BbI5BIeMbiX cnyqaeB yMeHbIIIOCb. Ho noKa eue CJWHIUIKOM paHO Cy,HTm 0 TOM, y,aaOCb 1I14 nOBepHyrb 3flH,eMHO BCnRTb. B KOHi-e 2001 ro,ga cHcio naiiieHTOB C aKTHBHOM cIOpMOn Ty6epKyjie3a

cocTaBJiso 15420 - 6onee xeM Ha 50-npoIieHTHoe yBeimiieeHi-e rio CpaBHeHHIO c 1990 ro,oM. B nepHog c 1990 no 2001 rOgbI BbLIBjieHHe yBejn-HqaCb fIOMTH B 3 pa3a, a ypoBeHb cMepTHocTH BbIpOC no,im B,ABOe. XOTH BbIbeiCHeC Ty6epKyne3a, COCTaBjsIIoigee 127/100 ThIC. HaceIieHH5, SBJMIeTCq BTOPbIM nIO BeniHqHHe B EBponeficKoM perHoHe B03, BKiiOqalOIuwM Cpe,H1o1o A3io, io oLueHKaM rjio6aRbHogi rporpaMMbI Hag3opa 3a 6Opb6oEI c Ty6epKyAe3oM B03, B 2000 ro,gy 6bLiO 3aperHCTPHPOBaHO JIIrIIlb 82% Bcex HOBbIX c.iyqaeB Ty6epKy"e3a OQAHaKo c 1999 rogZa fpOH3OaIWO 3aMe,veHHe pocTa narieMmi Ty6epKynIe3a Ha 5% B ro,rno cpaBHeHHIO C 17% B nlepHo, c 1995 no 1998 rotb1. rIoKa3aTenIb cMepTHocTH OT Ty6epKyjie3a HeCKOJIbKO CHH3HACSI: c 16 Ha 100 ThIC. B 1997 rogny zAo 12.6 B 2000 roAy, o,AHaKO B 2002 ro,gy BHOBb no.AH3lCAI zAO YPOBH5 1999 ro,a - 13.6 Ha 100 mc3gq. BbISBJeHHe cjiyxaeB 3a6ojieBaHEiA Ty6epKyjie3OM 3HatmTeabHo pa3nIiiqaeTcq B 3aBlHCH4MOCTH OT perl4oHa CTpaHbI. CaMbrli BbICOKHfl noKa3aTeJIb, jocTHraioagirinoqmTI 150 Ha 100 TbIC. HaceCieHHH, 6bIn oTMeqeH Ha iore cTpaHbI BAwaAa,¶-A6aAcKoA o6niac-m;

giTA cpaBHeHHB, cpegHHIirnoKa3aTejIb no cTpaHe CoCTaBJMeT 127/100 TbIC., B TO BpeMS KaK HainMeHbMII4I - nopf[zKa 70 Ha 100 TbICAm. B HeKoTopEbx pagiioiax oTMeqeH

InOKa3aTeJIb BbIHBjieHHA,

npeBibimaiognp4f 200. O,Hofi H43 1IPHqHH yBeiHqeHHA

YPOBH31

3a6oneBaeMocTn Ty6epKyae3oM cpe,g rpaaHCKoro HacejieHHA B 2001 ro,gy lBHAaCb aMHIICTH 1603 3aKmToqeHHbIX c aKTHBHOA qIOpMOg Ty6epKyjie3a. Cmyagn c Ty6epKy"e3oM B TIOpbMaX TpeBowKHaA (Ta6dHLa 17). B 2001 rogy BbiSBieHHe HOBbIX cjxyaeB Ty6epicyne3a 6bVIo B 60 pa3 Bbiuie, qem cpegi- rpaxqaHcKoro IHaceneHA, a cmepTHocTm 6bvIa BbIIIe IOYTH B 200 pa3. B KOHUie 2001 ro,ga KojIEHqecTBO 6OAbHbIX Ty6epKy.ne3OM B TIopbMax cocTaBEwo 2188, 13 KOTOpbIX 686 ymep.no. XOT51 KOgnwieCTBO 3aKhX)YeHHbIX COCTaBASAeT BCerO OKono 0.5% OT o6u;ero HaceJIeHH, B 2000 H 2001 rojAax oT Ty6epKy.ie3a B TIOpbMaX ymepnio roqTo CTOJTbKO Ke HJI ,gaaKe 6obIbmee Yincnio Iogei, qem cpegi4 rpax~aHcKoro HacenieHiH B 2001 rogayyMHpai O,HH H3 Tpex 3aKIo-ieHHbIX c aKTHBHOP q)OpMOg Ty6epKyjie3a. B nepHo,g c 1995 no 2001 rogZX BbMi3BjeHHe cjiyYaeB B TIOpbMaX BbIpOCjiO 6onee ieM B g7eBqTb pa3, a cMepTHocTb OT Ty6epKyjie3a yBeiiHqJIaCb 6ojiee YeM B gecHAT pa3. 3n9iHgeM4o.norHitecKasI ciTryaiLHi no Ty6epKyae3y B T1OpbMaX cnoco6cTByeT pocTy CMepTHOCTm OT Ty6epKyjie3a. MHOme B rHpaBriTe.IbcTBe KblprbI3CKOf Pecny6AiHKtr

coriIacHbi C TeM, YTO KoAjlHecTBO 3aKECIoYeHHbIX CA1IIIKOM BeJIHKO; OJIOOKCHHiC ycyry6.iueTCs3 TeM, YTO B TIOpbMaX cTpaTerEiA DOTS He npHMeHerTCq, H 6On1bHbIe Ty6epKyjiC3OM B TIOPbMaX OCTaIOTCq rIpaK-ImHeCKH 6e3 hiCieHH5I BBHY HegOCTaTKa q4HaH-

1990 3aKn.O4eHHbme c aKTHXoHi cOpMOi TS 3aKIo'eeHHbie C *HOb sbumnmeHHbiM 3aKnio4eHHbie, ymepwme OT TS

TS npoHmmory6epKyne3Hble 6OnbHHI4bl TiOPeM CMepTHOCTb OT

I 4CmO'IHUK UHc5OpMOtAUU: MiHUcTepCTBo BHYTpeHHI4X Aen.

1995

2000

2001

174

2580

2188

1422

1992

56 262,2 I

542 1887,4 3

686 2635,9 3

PArO'Mom ViOKJ1Ag BCEMHPHOrO EAHKA

CHPOBaHH, OTcyTcTByeT 3I4)eKTIUBHbIA MexaHI3M HaripawieHHfl nawLeHTOB 13 TlOpbMbI B Ty6epKyne3HIIe gHcnaHcepbI.

Ty6epKyAe3HbIx

CmpamezuA, nonumuKa u npasoaA ocCHoSe rIpaBHTerJbcTBo TBep.Ao HamepeHo 6opoTmcs c Ty6epIcye3oM, xTO niOgTBepxaeTcq riocAeiAoBaTejibHbIM rpEHHTHeM ,gByX HanOHaJIbHbix rIporpaMM 60pb6bI c Ty6epKy-

JIe3OM (HrUT). E)KerogHo npOBOARTCI HaUHOHanbHbIe Me)KBegoMcUBeHHbIe coBei4aHH no Ty6epKyJIe3y, a c He,gaBHHx nop no Ty6epKy.7e3y H BHHT/CfIIELy, no,i npe,cejgaTe.ibCTBOM npe3HgeHTa KbiprbI3cKoA Pecny6mum, npeMbep-MHmIcTpa l BiuLe-ipeMbepMHHHcTpa. B 1998 ro,zy nprHHrr 3aKoH o npo43maKrHKe Ty6epKyjie3a B KuprbI3CKOh HeKOTOpbiX

Pecry6JuiKe. rIpaBHTenbcTBo paccmaTpBaeT B03MO)KHOCTL npHHITHS nOIIOJIHEHTenbHbIX Mep, KOTOpbIe MOrni 6b oKa3aTh

lOJIO)KHTeJIbHOe

Bo3g1eAcTBHe Ha

60pb6y c Ty6epKyule3oM, B TOM mHcjie: geKpHMHHaII3aLmS HoTpe6JIeHHA HapKOTHKOB ,1II

CHDKeHHA nepeniOJIHeHHA TIopeM; coKpaEReHne BpeMeHH npe6biBaHHl B cne,-

CTBeHHbIX H3ojSTOpaX (CI430); H HepacrpocTpaHeHHe aMHHCTHH Ha3aKMloqeHHbjX, 60obHbIX Ty6epKyjie3oM OMAHaKo npaBHTiebCTBO nnaHnpyeT BHegpeHit npOrpaMMbI

DOTS-rfLoc g,i gHmHOcTKH H qie-eHHH MyyJIbTHpe3HCTeHTHbIX qopM Ty6epKyJIe3a, IBSeTc3i npHEnmioi o6ecnoKoeHHOcm HrIO H ,AOHOPOB. Trro Ko.iuqeCTBO 3amino1eHHbix (20 TbIC3m) BeiHKO OTHOCE1TenbHO qHcjieHHoC-nm HaceJIeHH3I, OgHaKO 3TOT nIOKa3aTeJIb ZBJMeTCS CpeAHHM AmHCTpaH CHF. [*enbIo MmHicTepcrBa ioCTHLuHH ABwmeTcq coKpaureHme KoJHMecTBa 3aKmoIeHHbIX Ha 12001300 qeJIOBeKBrog 3To 6ygeT AOCTHrHyI'O iyTeM BBegeHHq aibTepHaTHBHbrx 43opM HaKa3aHIHA, nepexo0a K 6onee KpaTKOCpOqHbIM

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PaHHee npone4eHHble

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TecimpomatHble 3SoHHa3HNy PesucreHTHbie K peCpaMnNHHY Pe3NcreKTHbme K

MilY %

Bcero

Henamecmbue

141 33

100 23,4

81 43

100 53,1

96 39

100 40,6

318 115

18 9

12,8 6,4

36 30

44,4 37,0

24 20

25,0 20,8

78 59

* AHaJIU3 4yBCTBUTeibHOcTM K nieKapcTBeHHbIM npenapaTam;

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1997

1998

1999

2000

2001

72,3 10,3

78,8 12,4

84,1 13,6

82,3 14,2

78,7 14,0

MeI4LIMHCKMA mHCTMTyT, OTrAeleHme Ty6epKyne3a.

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2000

2001

2000

2001

2000

2001

2000

2001

amuoryp

1174 530 353 740 692 478 3967

103 3876 3583 1087 112,6 662 91,8 114,2 1817 1944 376 89,9 95,0 1182 1163 73,7 59,1 2753 2862 601 62,0 66,4 2884 3048 751 356 69,9 51,4 1659 1685 3833 82,3 78,7 14171 14285

372 315 301 274 258 243 294

339 335 294 282 270 243 293

141 130 75 133 135 71 685

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2000

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ctuHTaeT-,To PICK 3apawKeHH BENx oTcyrcTByeT, a Apyrie40 npolAeHTOB He HMeioT gaxe rHio THTI 0 TaKoM picKe. B oTiere UNICEF (2002) rOBOpHTCH, qTO o6 HCHOlbBI4H-HH4eKWHH 3HaIOT 43 3OBaHHH npe3epBaTrBa KaK o cnoco6e ripeAoTBpamteHr cpegm xeHIIHH 30-49 OAHaKo neiT. 17 go 14 OT BO3pacTe B npoLeHTa MoAoJbix iiioAef OT 15 Ao 29 KeHUHH Mojiogbix cpeMn a npoiAeHToB, 35 Jo iieT 3Taz on CcHmKaeTcq onponieHipoieHTOB 90 03HY, AaHHbIM Ho 26%. HHDKe: eige iAH4q)pa COOTBeTcTBysioii HOJIHIHb Me, CHI O CJIbImaiHm MY)KqHH oipOifeHIHHbIX HbIX >KeHuiHH Hi95 IpOLeHTOB oKojio 60 npoLeeHT0r )KeHII4H 14 80 IpoiLeHTOB MyAK1HH nojiaraioT, xTO eCTb cnoco6

y6epe-bcA OT CnIIa. Cmpameauw,

nonumuKa u npasosaR ocHosa

CBi4AeTejIbCTBOM TBepgorO HaMepeHHH ipe.oTBpaThT JajibHeflmee pacipocrpaHeHHe BIlM/CFIlaBa IBJIoTcSI: yBepveHe 3aKoHa o CrI14Ae H HaLU4oHaabHofi rlporpaMMbi 60pb6bI c BHx/CrIH4OM; rpmHHITHe ipaBiHTejbCTBOM cooTBeTcTByionueEr CTpaTerHHll", noIroToBneHHa. npIH

coAeHcTBHH UNAIDS; gecTByioAa3i TeMaTirqecKas rpynna OOH;

co3AaHHe 6onee 200 rlyHKTOB qOBepi no Bcefi cTpaHe; H 32aBKH Ha rpaHI FDCTM H MAP (IDA) H NMrIOMo01H B ,anbHefimerI 6opb6e C Ha3peBalon4eii 3alHAeMHe. IpaBiTeejbCTBO TamcKe fI1HBepeKCHO 60pb6e c iH-HbeKIUIOHHbIM ynoTpe6iieH4eM 60pb6y HapKOTHKOB HnHO1AHCaJO BCe mexyHapoAHbIe KOHBeHUH14, HanpaBneHHbie Ha C He3aKoHHbIM o6opoToM HapKOTH4KOB. Co3JAaHa CneiwvIbHaA roCyyapcTBeHHaSq HapKOTE4KOB; KOMHCCHI BO rniaBe c npeMbep-MIHHHCTpOM ,aRuu 60pb6bI c KoHTpa6aHgOg cocTaB B KoMHcCHA UiMeeT cne&4EaTbHbIe oT,ejmbl B MHH3,ApaBe i4 MBJIl. e.AI, o6opOHbI, CTBeHHOA KOMHCCHH BXO)ffT npegcTaBi4Tei MiHHHCTePCTB BHyrpeHHH4X

MeeKBe,oM-

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o6pa3oBaHI,

KoHTpa6aHAbI HaPKOTHKOB H HapKoMaHHH.

inaHlpOBsaHHe no BHH/CrHIMy HaqalioCb no HHHLqHmTHBe CTpaTerinecKoe BceMHpTeMaTHWIecKof rpynnrl UNAIDS, r,Ae B HacTomilee BpeMSi npegcegLaTe-JbcTByeT npaBHTejibCTBa. CTOPOHbI co rogAepmKe HbI$i 6aHY, H ocyigecTBmseTCm npEI nOnHOEi KpoMe TOrO, MHHHcTepCTBO 3,paBooxpaHeHH5 nOJIHOCTbiO COTpy,AHHqaeT c areHTCTBano BW/CrI4y. MHHHcTepcTBo MH OOH Hi AoHopaMH B peanMa4vm meponpHwrr B npOBe.1xeHHH meponpHsrr4 Copoca DOHgOM c BHyTpeHHH1X ,eJI TaioKe corpygHnqaeT CTpaTerHS 60pb6bI c HeeAaBHO npHiHrras no 6opb6e c BW-I/CnmZOM B TlOpbMax. BHH/CrIM4OM HanpaBneHa Ha: ,

CTHMyJInpOBaHHe MexBmeoMcTBeHHorO noAxora K peaCJIH3aHH CTpaTerHH no BWI/CrI4Ay c yqaCTHeM cooTBeTCTBywouHX MHHHCTepCTB, TaKICX KaK MH-HHcTepcTBo 3,ApaBooxpaHeHHA, MBJIl, MHHHcTepcTBo o6pa3oBaHmA HI MHHHcTepcTBo cIJHHaHCoB, a TaiOKe areHTcTB OOH H HrIO. YcHmeHHe TejneBOrO BMeiuaTeJIbCTBa Ai5 rpynn BbIcoKoro pHCKa, KoTopoe i4rpaeT KpTrrw4ecKEI BaXKlO pOmb B coKparmeHHH MacmTa6oB 3nHgeMHi B Y36eKHcTaHe. YKpenieHHe cTpyKTypbi ynpaBJIeHHA HinoTeHgi4aAa peanA3aLH4H HaIAHOHa7bHOf rlporpaMMbi no BWI/CHrIMy H 14U11H c ueIbO o6ecneieHHR ee ycTOfPlHBOrO H noCJIeroBaTeJIbHoro BHe1peH4a.

11. Mex<BegoMcTBeHHas pa6o'asi rpynna no BW/CrIMIy (2002 r.). CTpaTerwSecKas nporpaMMa npOTHBog1eficTBHA pacipocrpaHeHHIo 3anHeMHH BHH/CrIHAa B Pecny6mHKe

Y36eKHcraH. TauIKeHT: IIpaBITeJrbCTBO Y36eIcrTaiia.

PAso'wA gOKvA, BCEMIPHOrO SAHKA

Ilpoeicr CTpaTerHH paccMaTpHBaeT c.neAyIoowe cjaKTopbI KaK cnoco6cTBylouIwe pacripocTpaHeHwro BH4-iHHeKUaM B Y36eicraHe: (1) He,oCTaTomHO CHAbHOe pyKOBoACTBO yCH]InMMI no 60pb6e c 3iHAeMHeie; (2) cnia6oe MexKe,AoMcrBeHHoe

M3aHMo,eficTBHe; (3) BbICOKaA IIOABep-KeHH0CTb 3apa)KeHHIO B rpynriax HaceiieHHiq, B KOTOpbIX cocpe,AoTo0eHa HH(PeKum; (4) HenonHoe co6mio,geHHe nipaB H cBo6o,

qejioBeKa, CBs3aHHbIx c npo6fleMaMH BHI/CHI4Aa; a TamoKe (5) He,AocTaTo:Hoe BHHmaHMie K nIpo4pHJiaKTH1ecKHM MepoiipH5TM, yxo.y H nieqeHMo H noggepwKe miog7eI, xKHyBYUmx c BMI/CrIJ1M. Ha Ajene KoopAHHaqFm5 ycwIi4 MHHH4cTepcTB HeylAoBIeTBopHTeJIbHa, ripasBTreAbCTBo He cnxemino yrBep,im CTpaTerHio rio BWI/CrIlMy H 3a3BKH Ha pH4HaHCHpOBaHHe B rFDCM B cHjJy peIHrHo3HbIX H KYJIbTypHbIX coo6paxeHHf.

He3aKOHHoe npHo6peTeHHe H xpaHeHHe HapKOTHKOB npecnie,yercA KaK yronJoBHoe ripecTyriueHHfe, a 3aMeCTHTeIbHaH TepanrA B Y36eKncraHe noKa He y3aKoHeHa. PKC npeciieCyIOTC51 3aKOHOM, a MCM TaioKe nojgBepraioTcq YronoBHOMY rIpecIie,oBaHHio. 3aKoH 0 CrIlZe crioco6cTByeT eue 6oflbmeefi cTHEMraTH3aiH BHtI-HH(pHLHP0BaHHbix, C03|gaBafS J0oronH1HTejIbHbIi nOBo, ,JIS HaH6o)iee yI3BHMbIX rpynn yiKOHSIThC51 OT TeCTHpOBaHHI. nompe6Hocmu * Haebope u aononHumenbHbie uccneao.aHUw B Y36eKHcTaHe cyiecTByeT 14 L]eHTpOB "CrIG" H 90 ia6opaTopHA nio jHariiocmxKe BWI. LleHTp "CrI114" ny6nHKyeT e7)eKBapTaIbHbie orieTmi IIo BIxI/CIIH4y.

C 1998 roAa UNAIDS flpOBeCjO HecKOJnbK sKcnpecc-aHaJiH3oB cHyaLH B TauIKeHTe. B HacTo3ngee BpeMA ODCCP [Biopo OOH rio KOHTpOJIIO HapKoTKo0B H ripeAoTBpaii;eHRio ripecTynHOCTH] IIpOBog/rT HCciiegoBaHme HapKoMaHHH B Y36eIcTaHe. Lferlrp 6opb6bl H npoc)mIaKTrHI 3a6oJIeBaHHA (CDC) npoBo,WT HccnelgoBaHHe pacnpocrpaHeHHocTH BUIN B TaILuKeHTe, H pe3yJIbTaThi AOJDKHbi 6bITb H3BeCTHbI B 2003 rogy. AMepHKaHcKoe AreHTcifBo MexRyHapo,Horo pa3BsTHT (USAID) BO B3aHmoAieACTBHH C CDC ripe.AocraBi5AeT o6opy.AoBaHHe ,ins na6opaTopiiA CrIHa, a Taioe o6y-ieHHe MeTogaM KOHTpO.IbHo-Bbi6opOqHoro (go3OpHOrO) 3iiHgeMHojiorHqecKoro Hag3opa.

B na6opaTopHH HaiwoHaAbHoro LfeHTpa "CrIE4" 6bM.IH BbBSneHbI TmicAqE cnyqaeB nojioxKHTeJIbHoi pealUwt Ha BUM (Tecr ELISA), KoTopbIle HyJalOTCA B noATBepae-

HHH HMMyHo6jioToM [Western Blot]. 3KCripeCC-aHaJI3bI cpeAH IlHH 6bMII

HpOBegeHbl

B riHTh o6nacTrx (r. TaInxeHT, CypxaHAapbHHCKaq, CaMapKaH,cKaq, A,KH3aKCKaI H1

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YA3suMbie U sbiCOKO-yi36UMbe

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ripegorCTaBaHT

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BHe,peHHIO fnyHKTOB .zOBepH51 Ha TeppHTOpHIH BceA CTpaHbI. MHH3ApaB coo6maeT,

n'qo

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Bl4/CnfAW TYFEPKYJ1E3 B L3EHTPAnbHoi MHm

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TIOpbMax. B TlOpbMax BN-xiHH4mHUHpoBaHHbie

3aK3IIOxiHHbIC O6bIqHO H30IHP)IOTC3 OT

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He noceugaxourix

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ClIA, rge

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HbIMH nperiapaTaMxi.

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npoeicra); "AHm-CrIHH,"

a 3aHHMaioTc3i MHoroqHcjIeHHbIe HIIO: "Ca6ox" H TEnanvi Asno," pa6oTaioT c PKC (2

pa6oTaeT c MCM; a "Maxanna" pa6oTaeT c IThH (2 ripoeKTa).

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y-tacTByeT B MeporipHTH5ix no CHHIKeHHI1O Bpe,ga H npoc)maKTHKe

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BWI/CHIH,a HpEH

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B Ka3aXcTaHe H ,JaIKe npu 3HHTurenbHo 6o0iee H43KHX oqHUwaabHbIX qi4)pax, MeM camoe Y36eKIccTaHe B Ty6epKylIe3oM KbIprbI3CKoi Pecny6nHKe, KOJmieCTBO 6onbHbIx

jjeroq6onbIIoe B perHoHe. O0IeHb HH3KRA npoieHT 3aper CcPHPOBaHHbIX CyqaeB

g7omicno Horo Ty6epKyrie3a c no.IoxKHTeJIbHbIM aHIaH3oM Ma3Ka (oxH,gaeMoe 3HaqeHHe MacmUTa6bi HcTHHHbIe qTO nollaraTb, OCHOBaHHe 6brrb Bbime 50 npoieHToB) gaeT coo6uAae-r npo6neMbl Ty6epKyne3a MoryT 6bITb npiMepHO B JABa pa3a Bbiime, meM 29): 3a (Ta6nrLHa yxyi1IaeTcAI ry6epKyAe3oM c cramcruna. B Y36eKHcTaHe cuTyauusi yBeTjLHIHnoCb cAymaeB HOBbIX 3apermCTPHP0BaHHbIX nocnegeHH 10 neT KOjiHxCTBO BbIpOCJIO noxTH Ha Be TpeTH (65 npoqeHToB), a 3a npomeguHe 5 ineTr qmcno yMeplnHx B 2000 Ty6epKyrie3a BBwieHHI floKa3aTenJb BbICOKRA CaMbIli Ha TpeTb (30 npoueHToB). B Ba pa3a npeBbiIIaer rogzy 6buI oTMeqeH B KapaKa7rnaKcTaHe (128 Ha 1 00 TMICs), MTO 72,4/100 Tbic. cocTraBH 3a6ojieBaeMocTH YPOBeHb r. 2001 B - 65.

cpegmHHfrno cTpaHe

cocTaBHJI npu o61geM KojmiecTBe HOBbIX ciyqaeB 18106, a YPOBeHb CMepTHOCTH

12,5/100 Tmcam. flpo6neMa Ty6epKyne3a B TIOpbMaX OMeHb cepbe3Ha. 3a6oAeBaeMocTm

Ty6epKyjne3OM B TiOpbMaX no oiAeHKaM cocraBimer CBbiie 3000 Ha 100 TmIc3m rog gmarHO3 "Ty6epKyne3" cTaBHTc5i 2000 naineHTaM H3 64000 HaceiieHs (KI<awicj B03MO)KHO, 3aKimioteHHbX). ,ao rO.IIOBHHbI BceX cTy'aeB Ty6epKyjie3a B CTpaHe, HaxogHTCA oKoJIo TIOpbMax B BpeMH Hacmoqinee B TiopeM. o6muaTeneA Ha npHxoiHTCH 10- 12 Kax<Abie 30 TbICRl, 3aKJmo'eHHbIX c aKTHBHofi 4popMOA Ty6epKyrre3a: OT1HH Ha cIOpMO9 aKTHBHOAi c 3aKnio'eHHbIx. B 2001 ro,gy npH6.jH3HTejbHo 6000 3aKmio'eHHbIx 65bin neieHm, Kypc Ty6epKy.7e3a BbInAH Ha CBo6ogy no aMHmCTHH. Te, KTO 3aBepIHIu MeCTy no BbIyrUieHbI no, HaA3OP cJywK6 nepB1'Horo 3BeHa 3,ApaBOoxpaHeHHSi h ,D;O B 6OJIbH XMcTeJIbcTBa, a Te, ICrO He 3aBepmIHI ieieHHe, 6bmIH noMeiLeHbI

3aBepmieHH5I Jle-IeHHS.

B Y36eKHIcTaHe

HamecmHhlecny4am nomararenb

BblABneHNX

1994

1992

1993

9370

9774 14890

2000

2001

9866 11919 13352 14558 15080 15750

18106

72,4

1995

1996

1997

1998

NA*

7487

2735

3350

3388

3504

3977

3825

4664

9,6

11,1

10,7

1 1,5

12,5

18,08

19,45

HoBbe cny'au nero-Horo

TS,

Ma3oK+

noKa3aTenb BbmnBneHNR cny4aes neroqHoro TS, ma3OK+ % cnyuaes nero4Horo

TB, Ma3OK+ 3apermcTpup. noKa3arenb CmepTHOCTH

CTaHAapTH3Hp. noKa3aTenb

cMepTHocTm

1999

12,57

14,59

14,57

16,25

17,94

6a3a AaHHbMX WHO HFA Hcmo'Hwum: BceMmpHaM 6opb6a c Ty6epKyne3oM, B03 2002 r. [WHO Global TB control 2002]; Central Asia Infectious [CDC A3uu iAeHTpan1bHOU B CDC 2002; L1H4opMaL4MoHHaR CeTb no MHc0eKILIoHHbIM 3a6oneBaHlnm

disease network 2002]. *NA - meT AaHHbDK

PAroq"I ,OKJ1A, BCEMHPHOrO BAHKA

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gapCTBeHHOg rIpOrpaMMbI 6opb6bi c Ty6epiy.ne3oM. MHHHcrepcTBo 3gpaBooxpaHeHwA Y36eKHc'raHa ioggvepBcuaeT crpaTerHio 60pb6bi c y6epiynie3oM DOTS BcemipHoi OpraHI3aqvH 3WpaBOOXpaHeHH. BbTI TameKC Co3aH KOOpgUHaIi1HOHHbII COBeT no BHe,ipeHHio DOTS B Y36eKHcTaHe. COBeT geflcTByeT rio, npegcegaTeebcTBoM nepBoro

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IiuX genapTame-rOB MHH3ApaBa, rOCygapCTBeHHorO HayqHo-HccJiegoBaTejIbcKoro 1HHCTHTyTa Ty6epKyjie3a, o6AIacrHbIX Ty6epKyjIe3HbIX Me,14HHHCKHX yqpeA;LeHHA, a TamKeK MeyHapOAHBIX H ,OHOpCKHX opraHI3aIA. rIpH rOcygapcTBeHHOM HayqHOHCciegzOBaTeJIbCKOM inHcTrryre Ty6epKyjie3a 6bum co3,aH HaqHoHanbHblg LjeHTp DOTS, ripI CO,geAICTBHIH rlpoeKTa HOPE. rIJmoTHbIe nipoeKTbi DOTS HaiaTbI IIpEI noAz;epmKe BO3, 6aHKa KfW, USAID, rlpoeKTa HOPE H OpraHM3aL "BpaqE 6e3 rpaHln" (MSF). Leenb rocy,apcrTBeHHOn iPOrPaMMbI - KKOHLXY nepBOrO KBapTana 2003 rog7a BHegpHTh no,gxoA DOTS Ha 6OAlbIIIef qaCTH TeppiHTOpH CTPaHbI (KpOMe )D3aKCKOi H1 HaBOHECKOi O66lacTrei). MHHHICTepCTBO 3gpaBOOXPaHeHiH Be,geT IIOHCK riOTeHLIHaJIbHblX ,1OHOpOB H HnOArOTOBHJO 3aMBKY Ha rpaHT ,1A5nO,gaqHi B rDCTM gin pacrpoc'paHeHHA riporpaMMbI Ha ABe HeOxBaqeHHbIe o6iiacT.

nompe6Mocmu c HaB3ope u

onoinHumenbHble uccne8oeaHuA

B HacTo3injee BpeMH KBapTaAbHbi4 aHalIH3 pe3yniBTaTOB JiexeHIHA Ha OCHOBe onpeAe,ieHHS B03 orpaHnIenH JIHMb iHHAOTHbIMH4 paEOHaMm, rAe gefEcTByeT DOTS. FOcygapcTBeHHa,

nIporpamma 60pb6bI c Ty6epKyxWe3oM ripegycMaTpHBaeT c03gaHHe

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rpenapaTOB,

npoBeAeHlioro MSF B KapaKalriaKcTaHe H Xope3Me, YKa3bIBaEOT Ha TO, iTo CTeriCHb IieKapcTBeHHOfi ycTOfiMMBOCTH, Bwiioqa3 MHO)KwCTBeHHyEO AeKapCTBCHHYIO

YCTOfIBOCTb (MTb YM,SIBJSIeTCI OgHOI1i H3

CaMbIX

i 2: i1na resn1 Ty6epKyne3 (%)

BbICOKHX B

MPpe (Ta6Huma 30).

Bonpocba npo4unOKmuKu, OUOZHOCmUKU

B Y36euciTaHe

U ne4eHUA

MHHHcrepcTBo 3,paBooxpaHeHH4A

HaMepeHO BHeApHTb cipaTermio DOTS BTopwiHam

kapaKannaxc_ra__

lCm4aoHuK:

nepmNMHan

MnY Cny4aM

MJnY HoBble cnyfam (%)

ne4eHHN(%)

nosTopHoro

I140

Heony6nwKoBaiHbie AaHHbie

MSF, 2002.

B 6oJmmHHcTBe perHOHOB CTpaHbI K

KOHUy 2003 r., HO ,AH 9Toro MHHHIcTepcTBo gOmmHO b3bICKaTh gOnOJIHHTeJbHbIe cpegcmBa. CTpaTernm DOTS BHepAPSeTC3 B Y36eKHCTaHe C 1998 r. IIpH nogAep<KKe B03, MSF, USAID, rlpoeKTa HOPE, CDC H KfW

OgHaKo nporpamma pacmipsiemci c Ty6epKy.ue3oM. a npoieeHr ycneIUHOrO

Me,xieHHO H flO3TOMY BpS,g nJH oKaxKeT oa1iHMoe snBJIqHHe Ha 6opb6y B 2000 r. Bcero 7 npoLIeHTOB HaceiieHH5 6buIo oxBaqeHo DOTS,

BWL4'/CnlIMJ

m TyrEPKYnE3

B LAEHTPAJ1bHOI A:w

(nNnOTHbIR npOeKT DOTS)

KaTeropmn

K-eO

naa4HeHTOB

HoBble cny4aH sieromHoro TS C nononTenbHbIM Ma3KOM

nOKasaTenb ypoeBHb ycnewuCMepTHOCTH HOCTIE" ne4eHNRI*

C oTPNLaTenbHbIM Ma3KOM

BHenero'Hrie 47opMbi Ty6epKyne3a

npepBaHHoe nemeHme

4H**'II

9.1

287

3.8

11.1

397

1.5

2.3

330

13.9

15.2

10.6

388 107

86 92

3.6 0.9

2.8 0

7.5 7.5

HoBble cny'iam neroqHoro TS CoTpN4aTenbHbIM MaIKOM noBTopHoe neeieHHe nero4Horo TS C nonocMHTenbHblM Ma3KoM nouTopHoe ne4eHne siero4Horo TS

noKa3aTenb HeyAa-

oTeeT o ne4eHmm Ty6epKyne3a U pe3ynbTaTax nporpamMbl 6opb6bi CTy6epKyne3OM B TB program]. "Bpa4m 6e3 rpaHuL4" npmapanbe [Summary of tuberculosis treatment and outcomes for the Aral Sea Area

1lcmo4HuK: MSF (2002). KparKm

[Medecins Sans Frontieres] - ronnaHAMA, nlporpaMMa ASA. ne4eHwe. * floKa3aTenb ycneWHocTu - 3To npoL4eHT Bcex naL4meiToB, KOTopble6 H3ne4InMcb U 3aBepLuI4n neHeH4R. XO/e B lpUHUMHbI oA nlo OT ymepLUwX naLmeHToB, nlpOLeHT 3TO CMepTHOCTH * YpoBeHb nocne 5 unm *** floKa3aTenb HeyAa4w - 3TO npoL&eHT naLlmeHToB, 4erh ma3oK ocTaeTcR unu cTaHoBuTcR nonoNwwTenbHbim npoBeAeH10 o HeyAoBneTBop4TenbHoM cBIAeTenbcTBoBaTh MowKeT HeyAaw4 noKa3aTenb 60nee meciLAeB nCeHI4e. BbICOKU

Ty6epKyne3a, ycT0'4iHBoro nporpammbi DOTS, KorAa nnoxo co6nK7oaeTcq pewKMm, ju6o0 LutpOKOgi pacnpocTpaHeHHocTM nepsoro pRBa. npenapaTaMw npoTwBoTy6epKyne3HblHm Bbule'4ioTb K neKapCTBeHHbiM npenapaTam, KOTOpblCi TpyAHO KaK MUHHMyM ABYX Mec4CeB npOT)KeHUH4 Ha npoBOAunocb He ne4eHwe ecim ne4eHmme, Mm npepBaBu c4mTaeTclr a** nlawieHT

no4ApRA

jIe,CHHiJ rialHeHTOB, 3aperHCTpHpOBaHHbIX B 1998 m 1999 rr. 6bui HHXe yCTaHoBJIeHAoJDKeH HOfl B03 Leiim B 85% (Ta6.i14bI 31 H 32). OIeHb BbICOKHiA npoueHT HeygalI KaK 4)aKTOpOB, TaKHX BJIHAHHe BbI3bIBaTh o3a6oqeHHocT, Hi Heo6xo,HMo H33yqETb rpaHHU" 6e3 "BpaMH OpraHH43aLx JIeKapCTBeHHa, YCTOEPSHBOCrb H BWI-4HH eeKLH. B KapaKaJlliaKcTaHe, a (MSF) OKa3bIBaeT rO,lep)KKy B cO3gaHHH nHOTHbIX ripoeKTOB B 10 OnrOTIHHTeJIbHOPE rlpoeKTa pacnmpeHMe DOTS yCKOPIHIOCb rpH CcoJgeWcTBHH HbIX mviHOTHbIX pa$iOHax. BaHK

KfW npeCocTaB

nperiapaToB H Jna6opaTopHoro

o6opyA0BaHHR.

Ir ' ULStnll.OJI

4 [

a('

|*[4~[a1 U I@X<[.61-i1U

rpaHT Ha 3aKYIKy Ty6epKyJIe3HbIX

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-;I

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i(sJ

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MUne-

3asep-

nemeHme

'MnHCb

WHnm

nepeYmepnz

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BeAeHbi

4mRcno roA

1998 1999

Ycnex*

nal4eHTOB

135 74

73 65

6 14

7 7

7 14

7 1

79 78

*W3ne4mntucb + 3aBepwmnm Kypc neIeHmm Mcmo'HuK: B03 (1999-2002). BCeMHpHaR

6opb6a c Ty6epKyle3OM [Global TB Control].

PA5OqMI AOKJAL BCEMWPHOrO SAHKA

B rOCylaapCTBeHHOA rporpamme 6opb6bI c Ty6epKycjie3oM IiogqepKtIBaeTCq oTXog OT MaccoBbix cpA ooporpaqH-qecKHx HCCTe,lOBaHEI Ha Ty6epKyne3 H anpoKoro ripHMeHeHHA CTrLaHOHaPHOrO iie4eHHH. B nporpamme OT,gaeTCi nIpHopHTeT HaCCHBHOMY BbISIBjiCHHIO ciyqaeB (BbIHBjieHHe Ty6epKy.ne3a MeTOgOM MHKpOCKOiHH Ma3Ka y riaLJHeHTOB C CHMHiTOMaMEI 3a6ojieBaHHIH, KOTOpbIe camx o6paTmHIlCb B Aeqe6Hbie y'qpexqeHm); aKIHBHoe BbI5IBJeHHe cyqaeB orpaHHXBaeTc OCMOTpOM qJIeHOB 1goMoxo3AsCTBa, rge Haxo,wTCq 6oJmHof Ty6epKyjie3oM c iOIO)oH're.TbHbIM Ma3IoM.

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c4y"aeB Ty6epKyjie3a Ha npoTslenm

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JIeqeeH-e Ty6epKyne3a OCHOBaHO Ha peKoMeHgyeMblx B03 craH,apT1431poBaHHbIX pe,KMaX KpaTKocpoqHoro Kypca xM4moTepaiH. B niuoTHbix paioHax DOTS iieqei-me Ty6epKynie3a (BKmoqa3 neKapcTBa) BsizeTca gim nalxHeHToB 6ecnuaTHbIM. B MecTax, He ox3aqeHHbix DOTS, oPEmWambHO IeqeHie 6ecnnaTHo, HO cpaKrHcmecKH 6ojibHbIM 3aqacryio npi4xo,gIrc5 nioKynaTb IeKapcTBa. Onpege.neHHbIe BO3MOKHOCTM ,zTs pacinuIpeHEI DOTS cynmecTBymo npH FOCygapCTBeHHOM Hay4HO-HCCiiegOBaTejibcKOM HCTHTyTr Ty6epKyJIe3a, LJeHTp DOTS, r,ge pa6o'ralT npeno,gaBaTeJIm, o6y-eHrnbIe cnewluaIcTaMiHBKmiOaMq rlpoexTa HOPE, a TamoKe ceT Ty6epKiyne3HbIx MmegLEHHCKEX yqpexqeHEi4 (,gHcnaHcepoB, caHaTopHeB, iia6opaTopu4) nIo Bceg cTpaHe. B Y36e1cIcTaHe HmeeTcq 256

Ty6epKyfle3HbIx 6onbHrU, r,ge o6igee xmCjio KoeK npeBbImaeT 15000; B crpaHe HaC'lHTbIBaeTcs 1500 YTr43i4aTpoB. TeM He MeHee, npHHHnIIaM crpaTerHw DOTS

HeO6xOgMo o6y"mHTb 6ombee 'Hcno MegHHHCIKHX pa6oTHHKOB giu pacmpeH4

MaCIlITa6a ee BHegpeH1A. CyT1ecTByeT OrpOMHaA1 HeXBaTKa cpe,gCTB Ha 3aKyfKy Ty6epKy.ne3HbIx riperapaTOB, jia6opaTopHoro o6opy,oBaHsH1 n paCXOgHbix maTepHajiOB, a TaioKe Ha Hy6JIHKauHIo yqe6Hb1x noco6xlI4 H o6pa3oBaTeAbHbIx MaTepHaIOB ,gJuI naLIeHTOB. TiopbMbI B Y36eIMcTaHe HaXO0JHTCq B BegCHHH MHHHcTepcTBa BHyipeHHHX geni. 1433a OTCyrCTBHA cPHHaHCHpOBaHHN nporpamma DOTS B T1OpbMaX noKa He BHegp3eTTcq. O.HaKo npe,gcTaBmTein TiOpeMHOg a,gMHH4HcTpaLH BbIpa3HAHi McejiaHHe BeCTh 60pb6y c Ty6epKyjie3OM Ha OCHOBe npHHuHriOB DOTS. TIopeMHbIe wiacTm pa3pa6oTau4 gooKyMeHT-KOHLerii4o 60pb6bI c Ty6epKynie3OM B TOpbMaX H flIOanAi 3aqBKY B (DOHg Copoca/lOO Ha peaHI43aiO uwioTHoro npoeKTa DOTS B O,9HOA 143 KOJIOHHE. AeJmenbHocmb HnO u napmHepos

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c Ty6epKyne3oM B Y36eKHcTaHe (Ta6minnia 33). HaimnaA c 2002 ro,ga KfW npegocTaBMI. na6opaTOpHoe o6opy,gOBaH4e, a IlpoecKT HOPE ocynIeCTBaieT nOCTaBKy 100 6HHOKyUIpHbIx MI4KpOCKonOB, gipyroro .ia6opaTopHoro o6opygoBaHmH H peaKrH-

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C Ty6epKyJ1e3oM B Y36eKiUcTaHe OxBaT HaceneH"mn

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Cc)epa AenrrenbHocrM

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no sceA cTpaHe

NA*

O6ecne4eHme KaHecTBa pa6oTbi T5-

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npoewr HOPE

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HaMaHraH

TE npenapaTamm u na6opaTopHblM

4PepraHa

USAID KfW

CaMapKaHA

o6opyAoBaHmeM (ne4eHme 1250

YpryT

na4meHToB); KoHTpoJlb Ka9ecrsa

CbIpAapbR 5IHrmep

na6opaTopmi; MOHuTopIHr_ nporpamMbi DOTS

TaWKeHT

BpaHn 6e3

SIDA

Xope3M

"rpamgu"

ronnaHAHR KfW

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(MSF)

2,211,675

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npuIHLAnaM DOTS (o6y4eHo 2000

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u na6opaTopHblM

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DOTS; Ann npoeKTa HOPE u CDC, MeHeQANep npoeira

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BJInHSHRH CIIma Ha pOCT 3KOHOMHKHI MaiaBH. Ka,ruHr=oH ,ZJJK, X3HKOK, 1994. OiLeHKa >KypHaji. BW1/CfrI4Ba B HIAp. (Heony6nHKoBaHHaA1 pyKorIHcb). MogeflHpoBaH1ie lapHeTr

Poccim. 3KoHoMH1qecKoe BnJIHHHe CrIHAa B KaM6y r., J1eBapaAxcaH C. 14 OyBep M. (1992). o6umero paBHOBeCHS1 KaMepoHa. aq)pHKaHCKohr cTpaHe: 4CnOJIb3OBaHHe MoQeiiH )KypHali "DKoHoMm,Ka CTpaH AcpHpi4" B TIOpbMaX Pecny6iniE KbIprbI3CTaH: KoKKo C., 2002. Ty6epKiyne3 IH BI4'1/CnIT

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Y36eKmcTaH. c BIN cpeA MCM B OcTrcorenbc R, Mm.KCenbceH X. (1998). O1ieHKa CnTYaijim TamKeHTe, Y36eKI4cTaH.

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IlUBehmapcKas 3KCnepTHaq KOMHCCiHH PeKOMeH,YeT ynoTpe6.neHHR HaPKOTHKOB (1996). KaHa,gCKHSi ,geKpHMHHaRH3auio BioJIeCTeHb no rIoimKe BHT-I/CrII4a H 3aKOHODaTeCIbCTBY. BCeMHpHHbri 6aHI, 1997. BOPb6a Co CrIMoM. ---.

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(2001). Pa6oTa YAP3 c Mo.noIaemIO Ha mecrax no npocpwaKTIIKe B{/CGH1ia B Y36eEI4cTaHe. TamIKeHT. MexceAoMcTBeHHa3i pa6oYas rpynna Y36emHcTaHa no BW4I/CrIHy (2002). CTpaTerHtecKasI nporpamma 60pb6bI c pacnpocTpaHeHuem 3BnHeMH BH14t/CrIfHa B Pecny6AHKe Y36eKEHcTaH. TamIIKeHT: rIlpaBTEJbCTBo Y36eKcraHa. BaH xeT JIo H gp., 200 1. AexpHmiEHaJH3aL ynoTpe6leHMn HaPKOTHKOB B rlopTyranHH: BbIpa6oTKa nomnRm. HEwepAaHgbI. BHHoKyp, rognmbo, ,AaA H HarenbKepKe (2001). 3nEriHgemHr Ty6epKyne3a HIBHY/CfIma B PoccicKoI (DPe,gepaumH. BaUHHrrOH: BCeMHpHbIf 6aHK B03, 2001. PerHOHajibHaA cTpaTerma B03 no ceKcyanbHoMy H pepogyBHoMy 3.0pOBbMO. KoneHrareH. 200 1. PacnpocTpaHeHHocT HHbeKUHOHHOfi HiapKoMaHHH H BHHH43eKiMH B CaMapKaH,e. CaMapKaHA: MHH3gpaB, LleHTp C11a

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