TB care in Georgia

In its two projects in Sukhumi (Abkhazia) and Zugdidi (Central Georgia), MSF treats multi-drug resistant tuberculosis. The estimated MDR-TB prevalence here is as high as over 10 percent for new TB cases, and 57 percent for re-treatment cases. As the period of treatment (six to eight months) is too long, and many families barely make both ends meet, very often patients cannot afford staying for too long in the hospital, when their dependants remain without support. Thus, adherence to treatment is generally poor. MSF tries to bring in innovations into the treatment practices, which will minimize the hospitalization period and help improve the patient's adherence to the treatment course. Within this pilot project, MSF has introduced a new discharge policy, which is based on the results of the sputum smear test (usually in MDR-TB treatment programs its based on the "culture" test results, which can take up to ten weeks to obtain). As soon as two consecutive sputum smear tests show negative, the risk of the patient being contagious is considered to be reduced to a sensible minimum. At that point, he may be released into the follow-up ambulatory stage. MSF also facilitates rehabilitating patients' houses, which often do not allow for enough comfort for a patient. But more significantly, MSF provides patients and their families with additional resources in order to help fill the gap that the patient's incapacity often leaves in the family's income basket. This is done with donations, or by directly covering the costs of the food, fuel and/or school fees. Some donations are also made to help patients' families generate income from new sources. This practice helps to shorten the period of the patient's isolation from the usual six to eight months to approximately two months in the hospital ward. Since 2006, when MSF started its programme in Zugdidi, no patient has failed the treatment. Currently, there are 81 MDR-TB patients. MSF renovated the TB facility and provides uninterrupted supply of drugs and medical materials. In Abkhazia, MSF has supported the local National programme to treat TB patients since 1996. MSF rehabilitated Gulripsh hospital near Sukhumi, the Abkhaz capital, and supplies it with drugs, materials and laboratory equipment. Since 2001 the programme focuses on the treatment for drug resistant TB. There are currently 51 patients on treatment.