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MSF in Uzbekistan, 2007
Field Staff: 81
Reason for Intervention:
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The ex-Soviet republic of Uzbekistan has a high tuberculosis (TB ) incidence rate and one of the world’s highest levels of multi-drug resistant (MDR) TB , a strain that is resistant to the most powerful anti-TB drugs. MDR-TB rate accounts for 13 per cent of all new TB cases and 40 per cent of re-treatment cases.
MSF has been treating TB in Uzbekistan since 1998, initially using the directly observed treatment short course (DOTS) and more recently DOTS-Plus for treating MDR-TB in the autonomous region of Karakalpakstan.
Inappropriate and inadequate treatment of common sensitive TB increases drug resistance. MSF has seen many alarming practices in the local healthcare system that fuel this epidemic, from poor infection control in TB facilities and inappropriate use of first and second-line drugs, to self-treatment with anti-TB medicines easily available on the market. MSF is now seeing a number of cases of extensive drug resistant (XDR) TB.
In a joint MSF and Ministry of Health program, MSF has set up a reference laboratory in Nukus where MDR-TB is diagnosed by testing sputum for sensitivity to certain drugs.
Patients from Nukus and Chimbay region receive DOTS-Plus treatment in a renovated MDR-TB hospital. The treatment is complex and lengthy. Some patients suffer unpleasant side effects. After six months in hospital, patients need to continue on medication for another 18 months supported by a mobile DOTS-Plus clinic or home visits from an MSF nurse. In 2007, MSF enrolled 265 patients, compared to 150 in 2006. Since the start of the program in late 2003, MSF has enrolled over 617 patients.
At the end of the year, MSF signed a memorandum of understanding with the Ministry of Health of Karakalpakstan on the gradual handover of the MDR-TB treatment program over the next three years. MSF still has major concerns about the sustainability and future of the project and plans to address these by investing in local capacity-building and advocacy.
MSF has worked in Uzbekistan since 1997.