When Dr. Kamila Khudoynazarova graduated from Tashkent State Medical Institute back in 1984, her family and friends tried to dissuade her from specializing in treatment of tuberculosis (TB). The disease carried a huge stigma in Uzbekistan—among the 30 highest-burden countries for multidrug-resistant TB—and there was always the risk of getting infected herself. Kamila was undeterred.
“I have spent my life working as a TB doctor and if there is a future life, I would still choose the same profession,” Kamila said with a smile.
But when she launched her career as a phthisiologist—or TB specialist—in Syrdarya’s Bayavut district, she could not have imagined how she would be practicing today. Thanks to training by the Abt-led, U.S. Agency for International Development (USAID)-funded, Eliminating TB in Central Asia (ETICA) activity, she can treat her patients remotely via video, a boon to both her and the patients.
Digital health approaches are new to Uzbekistan, but they’ve already proven effective in other countries, and the World Health Organization (WHO) recommends them—for good reason. Any lapse in TB treatment can be risky. TB patients traditionally have had to take their daily medications under the watchful eye of a nurse over a period of many months, but daily visits to a health center or clinic are expensive and time-consuming and pull people away from work. These days extra travel and clinic time also may put them at risk of contracting COVID-19. Additionally, many patients fear that clinic trips will mean other people will shame them if they discover the patient has TB.
With digital health treatment, Kamila and her patients use smartphones and internet connections so that the patients take their medication at home with her remote supervision. This method is convenient for both her and her patients and provides more equitable access to treatment. Patients can continue to work, engage in their daily activities, and devote time to family while receiving life-saving treatment. Since the Abt training, Kamila has managed the treatment of 23 patients through video-supported treatment, and 12 have completed their treatment.
The ETICA training includes another WHO recommendation: a treatment regimen for latent TB infections. Many people carry TB bacteria without knowing it. They risk developing active TB, which can entail long and costly treatment and is contagious. Systematic testing and treatment of at-risk groups, including migrants, people with HIV, and those in close contact with TB patients, is crucial for controlling TB’s spread.
Kamila’s participation in the training led to the rapid introduction of diagnosis and treatments for latent TB infections in at-risk populations in her district. During the seven months after the Abt training, Kamila organized and led the screening of 1,215 at-risk persons, identifying 96 cases of patients with latent TB, who began receiving preventive treatment.
“I feel the pain of each patient and do my best to make that pain go away,” said Kamila. “I’m eager to learn new treatment regimens to improve the treatment process, so people can enjoy their life again.”
The training is just one piece of USAID’s multifaceted approach to supporting the governments of Kazakhstan, Tajikistan, and Uzbekistan in strengthening TB detection and treatment. Through ETICA, Abt is enhancing the capacity of Central Asian institutions in leadership, management, financing, and information systems to successfully combat TB.