Tackling Multi-Drug Resistant Tuberculosis in Tajikistan
When Farangis knocked on the door of her parents’ house she had tears in her eyes and was clutching her daughter very tightly.
“I was so weak. The last words of my husband had broken my heart. He had said that he was going to get a divorce, as he didn’t want to get TB from me. He and my mother-in-law just kicked me out. My father took me to the Dushanbe TB center where they did tests and told me that I had extensively-drug resistant TB (XDR-TB) which means it is resistant to most TB drugs. My mother could not believe it and broke down.”
Tajikistan has a high prevalence of multi-drug resistant TB, and has growing numbers of patients with XDR-TB, which is resistant to the most effective treatment regimens available ― making it the most dangerous form of the disease. It has a survival rate of just 30 to 50 percent, and that’s for those who receive treatment. Just prior to Farangis receiving her diagnosis there was no effective treatment for XDR-TB available in Tajikistan.
“The doctors told me two things, one to my great relief that my daughter was not infected and two that there was a chance to get treated with new TB drugs that had recently been introduced in only two districts, and Dushanbe was a one of those districts. I felt like I had been born under a lucky star.”
“There are dozens of similar TB patients’ stories in Tajikistan, we see them far too often”, said Dr. Khursheda Murodova, manager of Dushanbe TB Center. “We know Farangis had previously received TB treatment, but somehow she got XDR-TB. Luckily by the time she was found, we could enroll her in one of the two Challenge TB pilots for the new TB drug Bedaquiline. She is one of the first patients to receive Bedaquiline in Dushanbe City TB Center, and so far, has made a good progress. We have just received the result of an interim laboratory test that is smear negative, so we have high hopes that she will be cured.”
In 2015, the USAID-funded Challenge TB project started activities to ensure the necessary conditions and capacities were available to provide treatment under the new regimens containing Bedaquiline.
There was extensive work done in preparation stage prior to the introduction of new treatment regimens. In close collaboration with the Tajikistan National TB Control Program, Challenge TB supported the development of key policy and technical documents, procured equipment, established a sample transportation system, and implemented drug safety procedures. All the TB specialists from pilot districts and those who involved from primary health care were trained on new regimens and drug-resistant TB management.
Bedaquiline offers a chance to cure patients with XDR-TB and will help reduce the transmission of drug-resistant TB in the community. With Challenge TB support, enrolment of the first patients on the new drug started in December 2016 in two pilots in the cities of Dushanbe and Rudaki.
USAID has donated doses of Bedaquiline for the first 50 patients, and there are currently 24 patients with XDR-TB enrolled on individual regimens containing the drug.
Farangis is now feeling much better, her treatment is progressing well, and she is non-infectious. She has even gained some weight and perhaps best of all, she is back at home with her daughter.
In the coming months the new treatments will be expanded to five more sites in Tajikistan, which means that more and more patients like Farangis will finally have the chance of a cure.
For more information visit www.challengetb.org