The tuberculosis (TB) control strategy in the Republic of Karakalpakstan, Uzbekistan, is being changed to decentralised out-patient care for most TB patients by the Government of Uzbekistan, in collaboration with the international medical humanitarian organisation Médecins Sans Frontières. Ambulatory treatment of both drug-susceptible and drug-resistant TB from the first day of treatment has be...

Multidrug-resistant tuberculosis (MDR-TB) has emerged as a major threat to TB control, particularly in the former Soviet Union. To determine levels of drug resistance within a directly observed treatment strategy (DOTS) program supported by Médecins Sans Frontières in two regions in Uzbekistan and Turkmenistan, Central Asia, we conducted a cross-sectional survey of smear-positive TB patients in...

A 1999 study heightened long-standing concerns over persistent organic pollutant contamination in the Aral Sea area, detecting elevated levels in breast milk and cord blood of women in Karakalpakstan (western Uzbekistan). These findings prompted a collaborative research study aimed at linking such human findings with evidence of food chain contamination in the area. An international team carrie...

ral Sea, Karakalpakstan — It's another punishingly hot day as I make my way to the project sites for a routine supervisory visit. Médecins sans Frontières is in this remote , semi-autonomous region of Uzbekistan to help the local Ministry of Health combat a frightening tuberculosis epidemic. By training local health care workers and providing drugs, laboratories , and water and sanitation upgra...

2234 www.thelancet.com Vol 388 November 5, 2016 3 Casas EC. Experiences with short MDR-TB regimen in unstable settings. The 46th Union World Conference on Lung Health; Cape Town, South Africa; Dec 2–6, 2015. http://capetown. worldlunghealth.org/programme/ programme-by-type/sponsored-satellitesymposia/pdf/12-Sponsored-satellitesymposium.pdf (accessed June 18, 2016). 4 Casas E, Gashu T, Greig J, ...

SETTING After the collapse of the Soviet Union, countries in the region faced a dramatic increase in tuberculosis cases and the emergence of drug resistance. OBJECTIVE To discuss the relevance of the DOTS strategy in settings with a high prevalence of drug resistance. DESIGN Retrospective analysis of one-year treatment outcomes of short-course chemotherapy (SCC) and results of drug suscepti...

The people of Karakalpakstan, along with those of the entire Aral Sea region, are facing a multitude of health problems corresponding to the drying of the Aral Sea and accompanying ecological consequences. In case studies of other environmental disasters, research has shown that environmental exposures may impact not only the physiological but also the psychosocial health of individuals. This r...

SETTING The joint Médecins Sans Frontières/Ministry of Health Multidrug-Resistant Tuberculosis (MDR-TB) Programme, Karakalpakstan, Uzbekistan. OBJECTIVE Uzbekistan has high rates of MDR-TB. We aimed to understand patients' and prescribers' attitudes to anti-tuberculosis drug prescription, regulation and drug-taking behaviour. METHODS Participants (12 patients, 12 practitioners) were recruit...

Uzbekistan inherited a hospital-based health system from the Soviet Union. We explore the health system-related challenges faced during the scale-up of ambulatory (outpatient) treatment for drug-susceptible and drug-resistant tuberculosis (TB) in Karakalpakstan in Uzbekistan. Semi-structured interviews were conducted with key informants of the TB services, the ministries of health and finance, ...