MSF is currently implementing and evaluating a shorter treatment regimen for multidrug-resistant tuberculosis (MDR-TB) in Uzbekistan, lasting nine months instead of the usual two years.
The medical outcomes from this shorter regimen will be published in 2016. MSF also hopes to start a clinical trial in the country in 2016, combining the first new TB drugs available in over 50 years with existing drugs to treat drug-resistant forms of the disease. Both of these initiatives reflect MSF’s drive to develop shorter, more effective and more tolerable treatment regimens for people suffering from TB.
TB programme in Karakalpakstan
In the Autonomous Republic of Karakalpakstan, MSF continues to run the long-standing ‘comprehensive TB care for all’ project with the regional and central health ministries. This project provides access to outpatient care, rapid diagnostic tests and a comprehensive support programme, including education, psychosocial support, and food packages for those on low income or suffering weight loss. The goal is to ensure patients’ adherence to treatment and to help them manage the sometimes severe side effects of their medication, and to prevent the spread of the disease.
HIV treatment in Tashkent
In the capital, Tashkent, MSF supports the Tashkent City AIDS Centre to increase access to diagnosis and treatment for people living with the disease. In 2015, the team started over 700 patients on antiretroviral treatment, and offered counselling and screening for opportunistic infections (infections that occur more frequently and are more severe in individuals with weakened immune systems). In 2016, the project will begin treating patients who are co-infected with hepatitis C.
No. staff in 2015: 214 | Expenditure: €7.8 million | Year MSF first worked in the country: 1997 | msf.org/uzbekistan
“All I need is a metre of rope”
Amrita Ronnachit – Doctor
"Treating TB has some parallels with treating cancer. The treatment can be long and arduous, with toxic medications, which have terrible side effects. Pretty much the same as chemotherapy. And sometimes, it fails and the TB comes back. When it happens, it’s hard not to wonder if there was more that we could have done.
Today I visited a patient whose treatment has failed, and his results show that the TB is coming back. He is a young 19-year-old boy who has studied to become a mechanic. He was almost at the end of his treatment, just one month to go, when he started to have some symptoms again. At first he told himself that it was just the flu – he often gets it. But last week I saw his test results – it’s not the flu. And further testing has showed that his TB, which was the multi-drug resistant form, is becoming more resistant, what we colloquially refer to as ‘pre-XDR’. XDR, or extensively drug-resistant TB, is one of the most resistant forms of TB, and is very, very hard to treat successfully.
I tell him that the regimen we have been giving him is not working, and we will need to switch to another combination of drugs. It also means we will have to start his treatment all over again, a full 20–24 month course. The months of treatment that he has had so far won’t count, and he will have to restart his daily injections again.
“Twenty months of treatment? Fifteen to 16 tablets a day, right? No, I would rather die.”
Through the surgical mask I can hear his strangled breathing. He is trying not to cry but eventually he can’t hold back the tears."