Georgia

Latest Operational Update: December 2007

Field Staff: 202

Reason for Intervention:

Endemic/Epidemic disease
Social Violence/Healthcare exclusion

In Sukhumi (Abkhazia) and Zugdidi (West Georgia), MSF treats multi-drug resistant (MDR) tuberculosis (TB). The estimated prevalence is over 10 per cent of new TB cases and 57 per cent of re-treatment cases. The daily intake of dozens of medicines and the extremely prolonged treatment are difficult to endure and patients’ adherence to the treatment course is generally poor.

Patients find it hard to stay isolated in hospital for several months. Many are from poor families and cannot afford to stay too long in hospital when their dependents are relying on them for financial support. MSF has tackled this problem by reducing the period in hospital from between six and eight months to an average of just two. In this pilot project, as soon as the sputum smear test shows a patient negative for active TB bacilli, he or she can leave hospital and be cared for through a mobile service that provides follow-up treatment and support.

MSF also helps to improve patients’ homes, which often do not provide good enough infection control or comfort. Mental health support is another integral part of the program, as is the additional resources provided to families to help fill the economic gap caused by the patient’s incapacity.

In 2007, 78 MDR-TB patients were enrolled on the program in Zugdidi. Since the start of the program in November 2006, no patient has dropped out of the treatment. MSF renovated the TB facility and provides a constant supply of drugs and medical materials. MSF has also been working closely with the Georgian national TB control services providing technical assistance and training in the management of MDR-TB. The Zugdidi project is expected to be used as a model for the Georgian national TB program.

In Abkhazia, MSF has supported the local TB control service since 1999. MSF rehabilitated a TB hospital near Sukhumi and supplies it with drugs, materials and laboratory equipment. Since 2001, the program has focused on drug-resistant tuberculosis and by end of 2007, 166 drug resistant TB patients had been started on treatment. MSF also introduced the life-prolonging antiretroviral treatment for TB/HIV co-infected patients.

In early 2007, MSF handed over its regular TB program to the health authorities of Abkhazia but continued to support TB activities in Dranda. The health access program for vulnerable people has also been considerably downsized, although MSF mobile teams in Sokhumi and Tkwarchili continue to provide care to a group of vulnerable elderly patients who have no means or access to basic healthcare.

MSF has worked in Georgia since 1993.