Amsterdam - Médecins Sans Frontières (MSF) has started a pilot project for the treatment of multi-drug resistant tuberculosis in Karalpakstan, Uzbekistan. The official opening was conducted by Dr. Lee Jong-wook, Director General of the World Health Organisation (WHO).

He praised the project, in which MSF and the Ministry of Health of Uzbekistan work closely together, as an "opportunity for patients to get treatment and prove that it can be done here so that the programme can be expanded throughout Central Asia in the future." The first patients already started treatment.

A total of 100 patients will be enrolled in the programme. They are suffering from a form of tuberculosis that cannot be cured effectively with the first line medicines currently used. A hospital and a laboratory have been equipped by MSF for the pilot project.

Treating multi-drug resistant tuberculosis (MDR-TB) is difficult and expensive. Treatment takes from 18 to 24 months. The other major problem is that the drugs required are much more expensive than those used in standard treatment and have severe side effects.

There is also the danger that super resistant strains of TB could develop if MDR-TB treatment is not conducted properly. For these reasons, there has been a reluctance to initiate treatment in poor countries. Instead many argue for solely focusing on treating drug susceptible cases. MSF feels it is time to work towards overcoming this reluctance. MSF has worked in Uzbekistan since 1998 to combat tuberculosis using the so-called DOTS strategy (or Directly Observed Treatment Short course).

Unfortunately some patients didn’t respond to the first line drugs used in the DOTS programme. So in 2002 MSF conducted a survey into the drug resistance profile of the tuberculosis. The results show that levels of multi-drug resistant TB in Karakalpakstan are the highest in the region; of patients who have never been treated for tuberculosis before 13% are infected with a multi-drug resistance strain.

Of those who report previous tuberculosis treatment, 40% have MDR-TB. Drug resistance arises from improper use of antibiotics in treatment of drug-susceptible TB patients including prescription of improper treatment regimens and/or patient failure to adhere to a full course of treatment.