Uzbekistan

In Karakalpakstan, an autonomous region in western Uzbekistan, Doctors Without Borders/Médecins Sans Frontières (MSF) treats multidrug-resistant tuberculosis (MDR-TB).

The incidence of MDR-TB in the region is one of the highest in the world—estimated at 13 percent among new cases of tuberculosis and 40 percent among people who have been treated previously. Some patients develop strains of TB that are resistant to the second-line drugs designed to treat drug-resistant TB.

In 2008, more than 230 people were admitted to the MSF hospital in Nukus, the regional capital. The number could have been higher but the ministry of health had to restrict admission of new patients due to delayed approval to supply second-line TB drugs. Overall, a total of 830 patients were enrolled in the MSF program.

On average, MDR-TB patients have to stay in hospital for about two months. Afterwards, they must continue treatment outside the hospital for between 18 months and two years. Many, however, for a number of reasons, do not manage to adhere to the treatment once they have left hospital. The treatment success rate is 59 percent; MSF aims to increase this to over 70 percent.

MSF has also equipped and supports a modern laboratory in Nukus, which performs tests for drug sensitivity. The psychosocial component of the MSF program is critical. Here, patients can discuss with their counselors how to handle side effects, and find out about the disease and its treatment, as well as the general implications TB has for their personal lives. MSF supports voluntarily testing and counseling for HIV/AIDS and provides regular training for local staff. Training topics range from infection control and outpatient care, to the management of side-effects, new diagnostic methods, improving adherence to treatment, sputum collection, and transport.

Currently in its second year of handing over treatment to the Uzbek ministry of health, MSF formally handed over patient management for new admissions in July 2008.

MSF has worked in Uzbekistan since 1997.

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