«The path to recovery is difficult, but I will succeed!»
Tajikistan is listed among the 27 countries with the highest burden of multi-drug resistant tuberculosis (MDR-TB). 16.8% of all new TB cases and 61% of retreatment cases are resistant to the first line treatment regimen and thus require longer and much more expensive treatment. TB in penitentiary facilities is assessed at 50 times higher than among the civil population.
“I suffered from suffocating coughs and pleurisy, my legs were swollen, I was losing weight and I felt an overall fatigue”, recounts Vladislav Vaymer. It was 2010 – while serving his sentence – when he got the shattering diagnosis of multi-drug resistant TB.
After 13 years in prison, Vladislav was released during the "gold" amnesty devoted to the 20th anniversary of Tajikistan’s independence, among other 4,500 discharged prisoners and as one of 110 inmates, who caught tuberculosis in prisons.
- MDR-TB program expanded to over 16 districts of the country as well as to the penitentiary sector
- Providing treatment for over 1,000 patients
- Development of treatment follow up mechanisms and guidelines for the referral of released prisoners to civilian TB services
Until 2009 there was no treatment for MDR-TB available in the country. With concerted efforts of UNDP, international and national partners, the pilot program which started with only 50 patients now provides treatment to more than 1,000 people. The MDR-TB program expanded to over 16 districts of the country as well as to the penitentiary sector. One of the main challenges of the National TB program was to overcome the systemic gap between civil and penitentiary health care services and to establish joint follow up mechanisms between the two structures. When released from prison, former inmates with TB were often overlooked by public health services. Development partners in Tajikistan, including UNDP, Caritas Luxemburg, AFEW and other organizations supported the development of treatment follow up mechanisms and guidelines for the referral of released prisoners with their documents and TB drugs from prison to civilian TB services.
“Day after day I feel better, and I hope I will recover very soon”, says Vladislav today. Fortunately Vaymer was one of the first patients enrolled to pilot the MDR-TB treatment program in prisons, implemented by the National TB program and UNDP. The treatment was long and difficult, but Vladislav had strong treatment adherence, in spite of side effects to the liver and leg, and stomach aches. He understood that defaulting treatment would bring his death!
Upon discharge, Vladislav continued his treatment in a TB centre in his native district. The doctor of the TB Center was informed about his treatment regimen and ensured that the patient continued his treatment without a single day of delay. Now Vladislav’s health has considerably improved. He is one of the 70% of patients with MDR-TB who have been successfully treated within the pilot MDR-TB program in Tajikistan.
Vladislav’s life has taken a turn for the better: he found work at a construction company and is getting ready to marry the love of his life, which waited for his return all those 13 long years.
Despite considerable increase in coverage since 2009, the MDR-TB program in Tajikistan is still at the pilot stage. With all the available funds of the Global Fund and other donors, the country is able to provide treatment to only 30% of people with MDR-TB. The need for scaling up is a vital requirement for the country and is a major leitmotif of the resource mobilization efforts of the National TB program.