Photo: Misha Friedman
Photo: Misha Friedman
Multidrug-resistant TB: Fighting airborne infection in Uzbekistan and Tajikistan

Multidrug-resistant TB: Fighting airborne infection in Uzbekistan and Tajikistan

February 14, 2017

The fight against tuberculosis (TB) has taken Thomas Albuquerque from Mumbai to Uzbekistan. He tells us what it’s like to battle the deadly disease in households and health facilities, and why Doctors Without Borders/Médecins Sans Frontières (MSF) goes the extra mile.

MSF teams also work to strengthen infection control measures in the hospital. Here, a team rehabilitates the XDR TB ward.
MSF teams work to strengthen infection control measures in the
hospitals. Here, a team rehabilitates the XDR TB ward of a hospital in
Kyrgyzstan. Photo: Pierre-Yves Bernard/MSF

Medicines alone cannot defeat TB. Because TB-causing bacteria can be passed from person to person in air, infection control cannot be ignored in the fight against this deadly disease. As an infection control officer, Thomas Albuquerque is on the frontlines of this fight.

After three years with MSF in Mumbai, Thomas went to Uzbekistan and Tajikistan in March 2015 as a regional infection control officer. These countries are among the 27 highest multidrug-resistant tuberculosis (MDR-TB) burden countries in the world. MSF, in collaboration with their Ministries of Health (MoH), provides comprehensive, patient-centric care to adults and children living with MDR-TB.

“Comprehensive care means we fight TB from all sides,” explains Thomas. “We reach out to patients to plug the gaps in their treatment. In addition to their medication, we provide psycho-social support so they remain motivated to continue treatment and take steps to prevent the transmission of TB.”

He tells the story of an elderly MDR-TB patient in Nukus, Uzbekistan, to illustrate his point. The patient’s son and daughter-in-law were suspected to be infected, and their two children were also coughing. After resisting treatment initially, the elderly patient realised his attitude was putting the whole family at risk. After the psychosocial support team convinced the patient, the medical team initiated his treatment and the infection control team took measures to improve natural ventilation.



Infection control and other challenges

Infection control is an important component of a comprehensive TB care programme. After a patient is diagnosed with TB, MSF and MoH infection control teams typically carry out an assessment in the patient’s house and recommend appropriate environmental and personal protective measures to reduce further transmission of TB. In addition to providing surgical masks and UV lamps to patients, MSF installs fans and air extractors and carries out minor infrastructural adjustments to improve natural ventilation. At the same time, MSF teams sensitise health workers about the need for personal protection and implement infection control measures in health facilities.

While the protocols are the same at MSF’s TB project in Mumbai, the challenges of carrying out infection control are different. “In Mumbai we dealt with patients living in slum settings, which is very challenging because the space they live in is very small. Segregation is difficult in such settings,” recalls Thomas. “In Tajikistan and Uzbekistan on the other hand, space isn’t a constraint as much as the weather is. In the extreme winter, it is a challenge to ensure ventilation.”


Photo: George Butler
Cramped living spaces in Mumbai make infection control a difficult exercise. Illustration: George Butler



A shorter regimen

Adherence is another challenge. Because the treatment for MDR-TB is long and arduous, patients often drop out, unable to bear the side effects. To make TB treatment less painful for patients, MSF is now carrying out a study with the Ministry of Health (MoH) for a nine-month regimen for MDR-TB instead of the standard two years. This regimen has the potential to improve adherence to treatment, and the preliminary results of the study have been encouraging.

MSF’s fight against TB will carry on, Thomas assures, and health workers like him will continue to go the extra mile to alleviate the pain and suffering of people living with this deadly disease.

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