Multi-drug resistant tuberculosis in Uzbekistan: The role of MSF in the country’s TB Programme and the challenges of conducting a large, randomised control trial in a LMIC setting (TB PRACTECAL)

Dr. Ffion Carlin is a clinical research fellow in infectious diseases, HIV and sexual health currently working in the Centre for Clinical Research in Infection and Sexual Health at UCL Institute of Global Health. 

The team’s portfolio of trials includes those on HIV prevention, treatments, and cure, co-morbidity and HIV, antibiotic resistance and prophylaxis in sexually transmitted infections.

From March 2018 until October 2019, Ffion was in Uzbekistan, working for the humanitarian organisation Médecins Sans Frontières (MSFTB) on a large multi-drug resistant tuberculosis (MDR-TB) health delivery project alongside a randomised control trial (RCT) looking at novel, all-oral, shorter regimens for MDR-TB (TB PRACTECAL).

More recent developments in TB diagnostics and the availability of new and repurposed treatments for rifampicin-resistant and MDR-TB have lead to improved treatment outcomes. Despite this, treatment still takes 9-24 months to complete. There is a clear need for shorter treatment regimens that don’t compromise on cure rates in order to achieve the current SDG for TB. Until recently, there has been little investment in tuberculosis; however, due to being one of the leading infectious causes of death in the world, it has gained much needed attention globally.

There are multiple ongoing large clinical trials as well as operational research informing new and rapidly changing WHO guidelines. Uzbekistan ranks in the top 20 countries with the highest burden of TB and MDR-TB. Additionally, due to being a former Soviet state, it is still developing its healthcare infrastructure and geographically has several hard-to-reach communities. MSF has been the only international NGO present in Uzbekistan for over 20 years with projects for TB, HIV and Hepatitis treatment.

Due to the burden of TB in this area and patient need, MSF chose Uzbekistan as one of its main sites for the RCT TB PRACTECAL. No clinical trial of its kind, or scale, has been previously done in Uzbekistan in collaboration with multiple international organisations. Differing country rules, regulations, geography, and a research-naïve population with a proud culture brought multiple logistical challenges.

Dr. Carlin’s research interests are in lung disease post-TB infection, diagnostics in recurrent TB, and the immunological spectrum of TB infection.