The prevalence of drug-resistant tuberculosis (DR-TB) in Uzbekistan is one of the highest in the world, but fewer than ten per cent of the population has access to adequate DR-TB treatment. There is an urgent need to expand comprehensive TB care so that everyone in need can be properly diagnosed and treated.

In May 2010, Médecins Sans Frontières began extending its programme in the Autonomous Republic of Karakalpakstan, northwestern Uzbekistan, from the capital Nukus and the district of Chimbay. By the end of 2010, our team was working to provide TB care in four districts.

In 2010, 385 patients started treatment and a new test, which diagnoses drug resistance faster, was introduced. The aim of this test is to speed up the beginning of treatment and the isolation of DR-TB patients, helping to prevent transmission. The first patients to take the new test began treatment in October 2010.

Social and psychological support

The provision of support to the patient as well as to family members before and during treatment has been at the centre of the project. The majority of DR-TB patients suffer from side effects of their medication. Some of these, such as nausea, headaches and sleep disturbances, are quite powerful and long term, presenting a major obstacle to treatment adherence. Our staff hold individual, group and family counselling sessions to help patients manage these side effects and the social effects of the disease, and to improve their adherence. We continue to promote new approaches in diagnostics and treatment to Uzbekistan’s Ministry of Health, including outpatient care options and psychological and social support, and will continue to lobby the ministry to integrate these services into its structure.

Expanding the TB programme

In 2011, Médecins Sans Frontières will enrol its 1,500th patient in the DR-TB programme in Karakalpakstan and further expand its comprehensive TB care programme to another three districts. We will improve infection control mechanisms and improve TB drug supply management practices, as well as train health staff.

Assisting refugees

In June 2010 approximately 100,000 people crossed the border from Kyrgyzstan to Uzbekistan in search of refuge from civil conflict. The relief operations for the refugees were strictly controlled by the government of Uzbekistan, but our staff managed to visit almost all the camps. The team provided relief items, including washing and cooking kits, and offered counselling to traumatised refugees.