Successful Multi-Drug Resistant TB Treatment in Tajikistan Turns a Life Around

Tuberculosis (TB) is a wide-spread and lethal disease in Tajikistan. Increasingly Multi-Drug Resistant (MDR) TB is developing and challenging health system and peoples’ lives. MDR-TB develops during TB when the normal course of antibiotics is interrupted and the levels of drug in the body are insufficient to kill all bacteria. This can happen when treatment is improperly administered or when people stop taking their medicines early. Unfortunately MDR-TB is hard to treat, and full treatment can take up to two years and is complex, expensive, and dangerous.

Highlights:

  • Extensive technical and financial support in management of MDR-TB patients provided
  • Training of 82 MDR health providers

In June 2009, with UNDP support, the National TB Centre of the Tajikistan Ministry of Health launched a pilot MDR-TB programme in Dushanbe and nearby Rudaki district for a limited cohort of 52 patients. By 2012 the pilot project was expanded to 18 districts for treatment of about 1000 MDR-TB patients. The treatment course consists of two years of further second-line drugs, with the first 6 months in-patient treatment and the remaining year and a half outpatient.  UNDP has provided extensive technical and financial support in management of MDR-TB patients required for the establishment of the pilot. Support includes the procurement and delivery of the second line TB drugs (the cost of a treatment course for one MDR-TB patient is 5,400 Euros); the training of 82 MDR health providers; provision of health and non-health equipment, and furniture for MDR-wards; allowances for about 40 MDR health staff; and the provision of hot meals for MDR in-patients. The expense of the drugs and complex nature of the treatment has meant UNDP support is critical, and no other health programme provides the needed treatment.

Nosirov Perviziz, 30, was one of the first patients. Though MDR-TB threatened his life and severely reduced his quality of life, the challenging treatment was nearly too much for him and he would have left, if it wasn’t for his mothers dedication and the thorough medical support. Nosirov was first treated for TB in 2007. His mother, Mehry, remembers, “when we found out that he had TB, we immediately sent him to the hospital. After 10 days of his treatment he was feeling better. We made a mistake and didn’t complete treatment, and he got MDR-TB.” In 2009 Nosirov was pronounced as having MDR-TB. He says “it was really a shock for me and for my family. It was a psychological injury as well. I didn’t want to talk to anybody, I didn’t want to work, my life lost its sense. It was really a hard time for me and for my family.” Nosirov’s health then was very bad. He was addicted to heroin, physically unable to work and weighing a dangerously low 53kg. Now, though, after two years of treatment, he is cured of TB and has “started living again”.

The MDR-TB treatment has been a big success. Preliminary tests in November 2009 during the treatment were very positive, with about 74% MDR-TB patients having negative culture results, and the pilot was expanded to 16 districts and a national prison. At the end of June 2011, there were 381 MDR-TB treatment patients in Tajikistan: 266 MDR-TB patients in Dushanbe and Rudaki, 28 in prison and 87 in other districts. Of the first cohort of 52 patients, 22 were cured including Nosirov, seven died, two defaulted, for two the treatment failed, and 19 are still under treatment.

Further, the MDR-TB programme and UNDP support is increasing to scale up this vital treatment in the fight against TB to be available nationwide, to change lives like it did for Nosirov.