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Multidrug-resistant Tuberculosis in Central Asia

Helen CoxMédecins Sans Frontières Aral Sea Area Programme, Uzbekistan and Turkmenistan, Tashkent, UzbekistanJuan Daniel OrozcoMédecins Sans Frontières Aral Sea Area Programme, Uzbekistan and Turkmenistan, Tashkent, UzbekistanRoy MaleMédecins Sans Frontières Aral Sea Area Programme, Uzbekistan and Turkmenistan, Tashkent, UzbekistanSabine Ruesch-GerdesDennis FalzonMédecins Sans Frontières Aral Sea Area Programme, Uzbekistan and Turkmenistan, Tashkent, UzbekistanIan SmallMédecins Sans Frontières Aral Sea Area Programme, Uzbekistan and Turkmenistan, Tashkent, UzbekistanDarebay DoshetovYared KebedeMédecins Sans Frontières, Amsterdam, the NetherlandsMohammed A. AzizWorld Health Organization, Geneva, Switzerland
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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 selected districts of Karakalpakstan (Uzbekistan) and Dashoguz (Turkmenistan). High levels of MDR-TB were found in both regions. In Karakalpakstan, 14 (13%) of 106 new patients were infected with MDR-TB; 43 (40%) of 107 previously treated patients were similarly infected. The proportions for Dashoguz were 4% (4/105 patients) and 18% (18/98 patients), respectively. Overall, 27% of patients with positive smear results whose infections were treated through the DOTS program in Karakalpakstan and 11% of similar patients in Dashoguz were infected with multidrug-resistant strains of TB on admission. These results show the need for concerted action by the international community to contain transmission and reduce the effects of MDR-TB.

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