Worldwide, over 14 percent of patients with drug-resistant TB (DR-TB) do not complete their course of anti-TB medication. This, along with other factors, including inappropriate treatment regimens, are contributing to the rise of DR-TB, a form of TB that does not respond to traditional anti-TB drugs. Previously, patients with DR-TB typically have had to take a long course of therapy that was often poorly tolerated and with painful daily injections.
Since 2018, the World Health Organization (WHO) has recommended fully oral treatment regimens for DR-TB with new anti-TB medications, that are proven to be effective and safe, while significantly shortening the duration of treatment to nine months.
The Improved Prevention, Detection and Treatment of Drug-Resistant Tuberculosis in Central Asia Project, funded by USAID and implemented by WHO, scales up the transition to fully oral treatment for DR-TB patients and supports the introduction of modified shorter TB treatment regimens under certain operational research conditions in Tajikistan, similarly to 13 other countries in Europe.
Ekhson is a 25-year-old labourer living in Tajikistan’s Rudaki district. Ekhson dreamed of getting married to his girlfriend, Madina, and starting a family. They decided to build a house. They hired workers for it and Ekhson became good friends with them, chatting with them during the day and lending a hand with the construction. After a while, one of the workers developed a cough. He visited a doctor who diagnosed him with an advanced form of TB, but he hid his illness because he was afraid of losing his job.
Once they got married, Ekhson and Madina moved into their new house. Soon, Madina found out she was pregnant. However, by that time Ekhson was not feeling well. He had a dry cough, was barely eating, and had started losing weight. Ekhson took medicines and vitamins for his cough, but his condition continued to worsen.
Madina eventually persuaded him to consult a doctor, who immediately suspected TB and referred him to a hospital for testing. Ekhson tested positive for a form of TB that is resistant to first-line anti-TB medications. The doctor recommended that Ekhson start treatment with modified fully oral shorter treatment regimen for multidrug-resistant TB (MDR-TB) as part of WHO’s European regional operational research initiative that could treat his TB in nine months, as opposed to previously used regimens that took 20 months and included painful injections.
Ekhson wanted to recover in time for the birth of his child, so he carefully followed his doctor’s recommendations and was fully adherent to the treatment regimen. The pill burden was much less than previous DR-TB treatments, and Ekhson did well with the fully oral shorter regimen.
Ekhson was in the final month of his treatment when his son was born. He was overjoyed at the success of the treatment. “Now I believe and know that TB is treatable,” said Ekhson. He now urges other patients with symptoms of TB to get diagnosed and start treatment without delay, as well as to closely follow the doctor’s recommendations and not miss any doses.
A modified shorter treatment regimen for MDR-TB includes anti-TB medicines that are currently recommended by WHO for treatment, have been proven to be effective and have a good safety profile. Thanks to a shorter and fully oral treatment of DR-TB, patients are cured and return to their normal lives sooner. As of December 2021, 105 DR-TB patients in Tajikistan have been enrolled on treatment with these modified shorter fully oral treatment regimens.
WHO