Evaluation of MSF-OCA's Mission to Uzbekistan, 2011-2021

Médecins sans Frontières Operational Centre Amsterdam (MSF OCA) has been working in Uzbekistan from the beginning of 1998 with a profile of running vertical, specialised medical projects, sometimes on a very advanced technical level. MSF runs its programme in close collaboration with the relevant institutes within the Uzbek Ministry of Health (MoH). MSF in Uzbekistan mainly works through the MoH in an advisory and supportive capacity.

The mainstay of MSF OCA’s presence since 1998 has been in the semiautonomous Republic of Karakalpakstan, focusing on tuberculosis (TB) diagnosis and treatment. The main drivers of this mission have changed over the years. In the beginning there was a two-pronged approach, focusing on the impact of the environmental disaster in the Aral Sea Area on human health and on directly observed treatment (DOT) strategies for tuberculosis. The mission abandoned the environmental component in the early years of the 21st century, while it extended the TB DOTS component (1998-2002). Subsequently, the TB component evolved into a comprehensive care provision emphasizing drug resistant forms of TB (2003-2010) with the (long) DR-TB regimens of that time. Continuing its DR-TB efforts, MSF addressed issues of optimising TB treatment targeting all patients with TB (2010-2014). Eventually this resulted in supporting the rollout of the latest World Health Organization (WHO) guidelines across the republic, introducing innovative practices through operational research, as well as promoting shorter course regimens and the use of new and repurposed anti-TB drugs. In addition, from 2017 until recently, the project was one of the sites of a globally significant multi-centre, multi-arm, open-label, randomised, controlled, phase II-III non-inferiority trial (TB PRACTECAL) to identify a new, shortened, safe, effective, and tolerable treatment regimen for adults with pulmonary drugresistant (DR-) TB. Additionally, since 2012, MSF has operated an HIV project in Tashkent that focuses on the diagnosis and treatment of co-infected patients, with particular emphasis on co-infection with hepatitis C virus (HCV), syphilis, and other sexually transmitted infections (STIs). A further extension of this integrated model of care includes increased provision of services to high-risk groups such as people who inject drugs, sex workers, and men who have sex with men.

The main objectives of the current programme are:

• Increasing access to and improve the quality of diagnosis and treatment of Drug Resistant Tuberculosis (in Karakalpakstan) and HIV and major co-infections (in Tashkent).
• Determining and implementing shorter, less toxic, and more effective treatment regimens and models of care for TB patients in the targeted areas, with a special focus on Multi-Drug Resistant (MDR) and Extensive Drug Resistant (XDR) treatments.
• Advocating for (1) the advancement of person centred approaches to care in the national healthcare system, (2) improved access to effective TB/HIV medicines, (3) improved care for people living with HIV across Uzbekistan, and (4) reduced stigma at the government, social, and individual levels against people living with TB/HIV. 

Given the last objective, the mission includes a strong (medical) advocacy component that targets national, regional and international levels, through organisation of conferences and roundtables, participation in relevant meetings and scientific publications.

This evaluation takes place in a general context of taking stock of MSF OCA’s activities in Central Asia and former Soviet Union (FSU) countries in general. Against this background, (re)defining MSF OCA's role and purpose in the region and Uzbekistan is needed to guide future activities.