Protecting the Future: Paediatric TB Care in Tajikistan

What happens to children when there are no effective drugs to treat them? Kyle blogs from Tajikistan about new treatments that are bringing hope to young tuberculosis patients...

Since January this year, I’ve been based in Tashkent, Uzbekistan, working as MSF’s Regional Advocacy Manager covering both Uzbekistan and Tajikistan. Both programs focus on the treatment of TB, and in particular, drug resistant forms of the disease.

In Tajikistan, MSF focuses on treating children in two different projects: one project in the capital focused on tuberculosis (TB), and the other in the south of the county focused on children living with HIV. This is very important work because children are some of the most vulnerable patients in the world.

people dressed as cartoon characters entertain children at the paediatric tuberculosis hospital in Tajikistan

Play therapy at the paediatric ward. Photo: MSF (2016)

When a child has TB, for example, it can be very difficult to diagnose the disease in the first place. Even once a diagnosis is made, treatment can take a very long time (in some cases, years) and it can be an extremely painful process. As a result, children often don’t get the care they require.

A positive difference 

For this reason, MSF has partnered with local health workers from the Ministry of Health in Tajikistan to develop better ways to provide care to children. The impact of this work can be measured in many ways, but none more important than the positive difference it can make to the life of a child.

Every day, we see and hear stories from our patients that demonstrate this. Around four years ago, in 2014, a girl named Anna from Dushanbe fell ill. Only months before, her grandmother had passed away from extensively drug-resistant TB (XDR TB; a form of the disease that’s very difficult to treat) and Anna had most likely contracted the disease from her.

The early stages of Anna’s treatment were not very promising, and she would go back and forth in treatment from progress to a new setback.

In this early stage, Anna was finding it a challenge to take her medication because of the difficult side-effects, and because her tuberculosis had become more resistant to medicines used in conventional treatment.

A beacon of hope

With few options left, the MSF medical team suggested that she begin a treatment regimen that included bedaquiline – one of only two new TB drugs developed in 50 years. It seemed like her only beacon of hope but Anna and her family were reluctant for her to take the new drugs as they were in the early stages of use.

Two women at the MSF TB hospital in Tajikistan

Staff and patients at the paediatric hospital in Dushanbe. Photo: Wendy Marijnissen (2013)

Finally, after seeing the good progress made by her cousin on the same drug, Anna decided to forge ahead with the plan. This was a turning point for her; but time was running out.

The drugs that seemed to finally be making a difference for challenges cases like Anna were bedaquiline and imipenem.

Overcoming challenges

Bedaquiline is a new drug showing promising results, while imipenem, due to difficulty of administering it, is only used in cases where there are no other options. It can only be given by injections twice a day for six months.

Anna experienced a range of harsh side effects, from inflammation of nerves, to joint pain, nausea, discoloration of her skin and chronic dizziness.

On top of the side-effects, because of her personal situation, she could not stay in hospital and therefore needed to travel there twice a day to receive the injections. These included the insertion of a plastic catheter in her chest, to make it easier to administer the injections.

Just as these infusions were set to end, her doctors became concerned that her test results were switching between ‘TB negative’ and ‘TB positive’. Under a new plan, they proposed that delamanid be added to her medications, combining it with bedaquiline, another new TB drug.

However, this had never been done in the country before and the Ministry of Health doctors were understandably very hesitant to embark down this uncharted path. It was only after persistent discussions with her medical team, and based on the successful outcomes these treatment combinations had in Georgia and Armenia, that they eventually agreed on the new course of treatment.

Reaching more patients

In the final, most promising chapter of this story, Anna was cured of extensively drug-resistant TB in November of 2017.

This story is one of many that demonstrates how, in many ways, 2017 was an exciting year for MSF in Tajikistan. MSF’s updated paediatric protocol was adopted as the 3rd edition of Ministry of Health Paediatric TB National Guidelines, two paediatric patients finished on a shorter treatment regimen for the first time, and new drugs were introduced for more patients – just to name a few achievements. While the significance of these milestones is important for MSF’s TB programmes, their true value is the impact such an approach to treatment can have for patients like Anna.