MSF was the first organization to implement DOTS strategy for TB treatment in Uzbekistan in 1998. Following the discovery of high levels of drug resistance among TB patients, In 2003 MSF, in collaboration with the local Ministry of Health, started a so-called DOTS-Plus pilot programme, where a total of about 600 patients have received treatment for MDR-TB so far.

The project is located in the autonomous region of Karakalpakstan, home to the infamous dried up Aral sea. The multi-drug resistant (MDR) TB rate in Karakalpakstan is among the highest in the world - 13 percent of all new TB cases and 40 percent of re-treatment cases.

In Nukus, the regional capital, MSF has set up a fully fledged bacteriological reference laboratory capable of performing first and second line drug sensitivity tests. Almost every case of pulmonary TB that comes to the National TB Program is being screened. MSF has refurbished the 75-bed MDR-TB hospital, and maintains an additional 40 beds in the main Ministry of Health tuberculosis hospital for poly-drug resistant and less severe cases of MDR-TB.

MSF provides all drugs, medical and lab materials, as well as highly nutritious food for the patients. There are more than 300 patients currently on treatment; about one third of them are inpatients, the others on ambulatory treatment. In 2007, MSF enrolled 265 patients. In March 2008, MSF is launching a massive information campaign in Karakalpakstan, aiming to improve public awareness about basic TB issues and alleviate TB-related stigma.

In the near future MSF will provide technical support to the local MoH to scale-up DOTS-Plus and gradually handover the existing activities to the MoH. MSF will also focus strongly on local capacity building and advocate with relevant actors at all levels for a sustainable and effective response to the TB epidemic in Karakalpakstan.