Oraz’s Journey Back to Health

Tuberculosis (TB) is a highly contagious bacterial disease that is preventable and curable. But rapid disease spread, antibiotic misuse, and non-adherence to TB treatment regimens have resulted in a proliferation of hard-to-treat cases of multidrug-resistant TB (MDR-TB). In 2019, MDR-TB accounted for 25 percent of the total deaths among communicable, maternal, neonatal, and nutritional diseases in Central Asia. Globally, tuberculosis is now second only to COVID-19 as the world’s most infectious disease killer.

Oraz, a 26-year-old security guard, works at the International Airport in Ashgabat, Turkmenistan. He was first diagnosed with TB in 2016. His doctor prescribed the standard six-month TB treatment regimen of first line twice-daily injectable antibiotic drugs. Oraz’s TB treatment was time-consuming and arduous, and he experienced numerous side effects. After enduring three months of treatment, he started to feel better. Mistakenly thinking he was cured, Oraz stopped treatment and returned to work at the airport.

Two years later, Oraz experienced a fit of violent, uncontrollable coughing while on his way to work. Believing he was cured of TB, Oraz didn’t think anything of it. A few hours into his shift, the coughing fit returned, but this time, he noticed blood in the palm of his hand. Something was terribly wrong. The following day, Oraz visited the clinic where he had been previously treated for TB. An X-ray confirmed what his doctor suspected - Oraz’s TB had relapsed.

The doctor prescribed Oraz the same course of TB medication as when he was first diagnosed in 2016. After two months of treatment, Oraz’s condition did not improve. Further tests revealed that Oraz had developed MDR-TB, an advanced form of TB that is unresponsive to two or more of the most common first-line anti-TB drugs.

Fortunately for Oraz, in 2020, the World Health Organization (WHO), in collaboration with Turkmenistan’s National TB program, introduced modified shorter treatment regimens (mSTR) for TB in Turkmenistan. The new regimens vary by diagnosis but replace the more expensive and harsh injectable drugs with self-administered fully oral medications. The oral tablets are safer, and treatment regimens are generally shorter in duration, making it easier for patients like Oraz to adhere to their prescribed course of treatment.

Oraz has one month of treatment left. “Fighting tuberculosis is not so difficult - there are many more difficult things in life,” Oraz says. “Nowadays, medications are much more tolerable and easy to take as they are only tablets, and so far, I haven’t observed any serious side effects during my treatment. And all will be well,” says Oraz.

Thanks to the new and improved TB treatment regimens, Oraz will soon be cured of TB and able to return to work. In the near future, he hopes to marry and lead a normal life.

Along with other Partners, through this Project the USAID is providing support to implementation of mSTR operational research for MDR/RR-TB in Turkmenistan, Kazakhstan, Uzbekistan and Tajikistan, as part of the regional mSTR operational research initiative, led by WHO Europe in 14 countries of the WHO European Region.  In Turkmenistan, the UNDP through the Global Fund TB Grant in collaboration with Stop TB Partnership/Global Drug Facility ensures uninterrupted procurement of reagents for TB diagnosis and anti TB medicines for treatment of patients with MDR/RR-TB under programmatic and operational research conditions.  To date, more than 100 MDR-TB patients in Turkmenistan have been enrolled and 18 of them completed the full course with 9-month modified fully oral shorter treatment regimens for MDR/RR-TB.