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UzbekistanUzbekistan has one of the world’s highest rates of multi drug-resistant tuberculosis, defined as resistance to the main anti-tubercular drugs, isoniazid and rifampicin. Rates of multi drug-resistant tuberculosis (MDR-TB) are 13 percent among newly diagnosed TB patients and 40 percent in re-treated TB cases. MSF has also witnessed people with extremely drug-resistant TB (XDR-TB), which has even less chance of being cured. With lack of adequate healthcare and unfavorable socioeconomic factors, the situation looks particularly grim for patients in the Karakalpakstan autonomous region, where the environmental disaster of the shrinking Aral MDR-TB requires a lengthy treatment of up to 24 months, with a daily cocktail of highly toxic and expensive secondline TB drugs. By June 2007, 468 patients in Karakalpakstan had been enrolled, with 260 on treatment, in the first “DOTS-Plus” program for TB treatment in Uzbekistan, run by MSF in cooperation with the Ministry of Health (MoH). This project followed the first regional DOTS program (Directly Observed Treatment Short course for uncomplicated TB), which MSF opened in 1998. MSF has rehabilitated a 75-bed hospital and a mycobacteriology laboratory in Nukus, the regional capital. Forty additional beds for MDR-TB have also been provided by MSF in the main MoH tuberculosis hospital. Despite best efforts to include more patients, there is a growing waiting list of detected TB patients, reflecting the high unmet needs in the region. Patients start taking treatment in the TB hospital until they stop spreading the infection, which can take two to four months, then continue their treatment through ambulatory care at DOTS-Plus corners located in smaller health centers in Nukus and the adjacent Chimbai district. Besides quality clinical care, the multidisciplinary MSF team provides prevention measures as well as health education and psychosocial support for patients, their families, and the community. The project does cutting edge operational research that will enhance understanding of MDR-TB. The four-year long DOTS-Plus Pilot Project of MSF has been advocating with the MoH, the UN’s Green Light Committee and the Global Fund to expand the availability of DOTS-Plus in the region, which will allow MSF to hand over this intervention to the MoH in the near future. MSF has worked in Uzbekistan since 1997. |
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