National TB Center, Abovian, Armenia
Armenia has one of the highest per-capita rates of drug-resistant tuberculosis (DR-TB) in the world, and, since 2004, Doctors Without Borders/Médecins Sans Frontières (MSF) has been supervising the only program in the former Soviet Union country to treat the disease.
Although it is seen by many in Armenia as a disease that affects only vulnerable populations, DR-TB is spreading into more communities.Today, the MSF-supervised program treats teachers and writers, as well as former prisoners.
In Armenia and other countries in the region, TB has spread widely since the collapse of the Soviet Union. Drug-resistant TB is caused by incorrect drug prescriptions and interuptions in treatment. A person can also catch a drug-resistant TB strain from an infected DR-TB patient.
Once diagnosed with DR-TB, patients are initially treated in the national TB center, where they remain until they are no longer infectious, a period that usually lasts around two months. Further treatment outside the TB center can last anywhere from six months to two years and sometimes longer.
An MSF lab manager points to a TB sample which is showing positive for drug resistance. This more recently developed method, which was introduced in Armenia by MSF, can provide results in one to three weeks.
The injections, pills, and powders DR-TB patients must take are toxic antibiotics, the most recent of which was developed 40 years ago. Most patients suffer side-effects that can sometimes cause more immediate discomfort than the disease.
Polyclinic, Yerevan, Armenia
To combat side-effects, medical staff can prescribe additional drugs, but adherence is difficult for all patients. Of the cohort of patients admitted to the MSF program in 2007, 21 percent were unable to complete the full course of medication. In addition to side effects, other reasons for stopping treatment include the duration of treatment, stigma, or a need to leave the area.
Patients receive treatment free of charge, but the drugs cost MSF thousands of dollars per treatment. The drugs are purchased at a reduced price with assistance from the Green Light Committee, a World Health Organization initiative.
Polyclinic, Dr. Shahidul talks with a patient outside a polyclinic in Yerevan. The patient discharged himself from hospital and Dr. Shahidul is trying to persuade him to return to the national TB center to continue treatment.
MSF nurse Adriana Palomares makes a home visit. If patients are unable to come to receive their medication at one of the five polyclinics around Yerevan, MSF staff take their medication to the patients.
An MSF team visits the home of a patient in the Armenian capital. In addition to medical assistance, MSF provides a package of social and psychological assistance to try to ensure patients can complete treatment.
A DR-TB patient says that stigma against TB patients is strong in Armenia, as people are fearful they might contract the disease, even when patients are no longer contagious. "In Armenia, people prefer socializing with people who have HIV more than those who have TB," he said.
He has another year and four months to go before his treatment is complete. He has had TB since 1998, and was admitted to the DR-TB program last year. "I spend my days on the sofa watching TV and at the polyclinic," he said. "For my grandchildren’s sake I will continue with the medication."
March 23, 2010
MSF is the only organization treating patients with drug-resistant tuberculosis in Armenia.