In Zhytomyr, Ukraine, our teams works with the Regional TB Dispensary to treat patients who have drug-resistant forms of tuberculosis (DR-TB). They are treated with a short course of DR-TB medication and the possibility of being treated at home most of the time; meaning patients can get back to their lives, families and careers sooner. Yet, completing the new treatments can still be tough.
“When I got TB, I lost the will to live. My grandparents had told me that TB was a slow death,” says Natalia Tsopa, a DR-TB survivor. “During the treatment, I felt ill and tired. I lost a lot of weight, too.
“I was irritable, I was depressed but my psychologists, Vova and Lesya, counselled me,” says Natalia. “I used to speak with them about my family, my aspirations and how to recover.”
Most patients in this programme can be treated with an all-oral course of medication, including the new medicines delamanid and bedaquiline, instead of the painful injections that were previously used and caused serious side-effects. But many patients still struggle to keep taking their medication for the full nine to 12 months.
“The goal of eliminating tuberculosis remains unreached, driven by multiple factors, including a lack of patient adherence to treatment,” says Iryna Yakymuk, MSF psychiatrist.
“Mental health is one of the main reasons for this. Psychiatric and drug addiction diseases, as well as psychological problems such as stigmatisation and self-stigmatisation, isolation and social deprivation, all negatively affect patients' adherence to treatment,” says Yakymuk.
Counselling and social support can help patients to continue their treatment even when it is difficult. “If you have the desire then you can be cured,” says Bohdan Cherniv*, a TB patient. “People can lose hope but I don’t want to. I regularly speak with the psychologist in this facility.”
Patients also face practical challenges. In our programme, patient support teams (nurses and social workers) work with DR-TB patients to understand and resolve potential barriers to completing treatment, from unpaid pensions to a lack of gas or heating in their homes.
“Once I came home, I also received food parcels, hygiene kits, soap and detergents as part of my treatment,” says Natalia. “My condition improved, I gained weight and felt even hungrier than before falling ill. I want to tell all patients not to be afraid and to continue treatment.”
“People are scared of hospitals due to fear of how they will be treated by health workers, family or their community, and/or the high costs of treatment,” says Natalia. “I am now cured but there are still people who look at me differently. I ignore them. I am looking forward to living with my children and family again.”
DR-TB can be cured, but only if patients are able to complete their treatment. Coordinated patient support – including doctors, nurses, TB specialists, psychologists and social workers – should be a central part of their treatment.
*Name changed at request of patient