Abkhazia Institute for Social and Economic Research

Medics from AISER  has been confronted with tuberculosis since 2005. In the past few years, AISER has expanded TB treatment to include patients in a growing number of projects, and the focus has shifted from disease control to patient care.

For example, between years 2003- 2005 ASER treated patients for Tuberculoses in 14 projects in 7 countries, including breakaway province of Georgia- Abkhazia (it should be noted that Abkhazia is located just 20 miles from Sochi, a host city of 2014 Winter Olympics Approximately 214 new TB patients were admitted in programs supported by AISER, and many more were diagnosed by medical teams and referred to local TB services, some of them supported by MSF.
AISER shares experience of MSF to provide TB care:
•    Chronic conflicts: MSF projects treat TB patients in chronic conflicts, including work in Abkhazia and in South Sudan, and refugee camps in Chad and in Thailand.
•    Primary health care: An increasing number of patients receive TB care from MSF in health centers, for example in South Sudan, Congo, DRC, and Angola.
•    Prisons: Two MSF projects offer treatment in prison settings: in Abkhazia and Abidjan/Ivory Cost.
•    Multi-drug resistant TB: MSF is treating multi-drug resistant tuberculosis in Ivory Coast, Abkhazia, Thailand, and Uzbekistan.
Steps towards improving TB care recently taken in MSF projects include:
•    HIV/AIDS co-infection: As TB is a major threat to people with HIV/AIDS, MSF provides TB treatment in its AIDS programs in several countries, including China, Cambodia, Kenya, Malawi, South Africa, and Zambia, and is working on integrating treatment of the two diseases in some countries in order to improve the follow up and care of co-infected patients.
•    Alternative models: MSF has sought to find ways to treat patients who are difficult to follow, such as migrants or nomadic people, by reducing their need to come to a clinic. These efforts include home-based care in Cambodia and factory-based treatment in Thailand.
•    Improving adherence to treatment: MSF is introducing strategies offering more flexibility to patients and at the same time guaranteeing good adherence. Self-administered treatment models have been begun with selected patients in Somalia, among co-infected patients in South Africa, and among pediatric patients in Angola. Community- or family-based direct observation has recently been introduced in Cambodia and Mozambique.
•    Increasing the use of easy-to-use, pre-qualified fixed-dose combinations of TB drugs.
•    Increasing the use of the WHO-recommended six-month treatment regimen (instead of eight months) within MSF projects.
•    MSF is also upgrading diagnostic facilities in some countries, including introducing culture in Sudan and enhanced (fluorescence) microscopy in Cambodia and Angola, and improving follow-up of diagnosis with the use of culture, drug sensitivity testing and x-rays in Thailand, Ivory Coast, and Abkhazia.
Anticipating World TB Day on March 24, 2007, the Subcommittee on Africa and Global Health of the Foreign Affairs Committee in the U.S. House of Representatives held a hearing earlier this week on the global threat of drug-resistant tuberculosis (TB).  Julie L. Gerberding, M.D., Director of the Centers for Disease Control and Prevention (CDC) within the U.S. Department of Health and Human Services (HHS), testified on behalf of HHS.  
Tuberculosis is an airborne, infectious disease spread from person to person, usually through coughing.  While the World Health Organization (WHO) estimates that approximately one-third of the people in world are infected with dormant TB germs, people only fall ill when the disease becomes active.  Persons whose immune systems are compromised, such as by HIV, are more likely to see the bacteria become active.  While doctors can treat most types of TB through a six-to-nine month course of treatment with “first-line” drugs, there has been a surge of TB strains, know as multi-drug-resistant TB (MRD-TB), that are resistant to these treatments.  While other drugs exist to address these more resistant strains, the treatment is much longer, more expensive and less effective.  In a growing number of cases, some strains of bacteria – called extensively drug-resistant TB, or XDR-TB – do not respond to the most effective drugs currently available.  
“HHS/CDC, WHO, and [the U.S. Agency for International Development (USAID)] have taken critical steps toward characterizing and controlling the threat of XDR-TB,” Dr. Gerberding told Committee members.  “To provide guidance on TB infection control, HHS/CDC, in collaboration with the WHO, [the Office of the U.S. Global AIDS Coordinator], and the International Union Against TB and Lung Disease, has recently published a guidance document titled TB Infection Control in the Era of Expanding HIV Care and Treatment, now available on the HHS/CDC website.”