Doctors Without Borders/Médecins Sans Frontières (MSF) has been confronted with tuberculosis since its first day of operation more than 30 years ago. In the past few years, MSF has expanded TB treatment to include patients in a growing number of projects, and the focus has shifted from disease control to patient care.

In 2004, MSF treated patients for TB in nearly 50 projects in 24 countries: Angola, Afghanistan(*), Abkhazia/Georgia, Burma, Burundi, Cambodia, Caucasus/Chechnya, Chad, China, Congo, DRC, Ethiopia, Guinea, Ivory Coast, Kenya, Liberia, Malawi, Nepal, Nigeria, Sudan, Somalia, Thailand, Uganda and Uzbekistan. Approximately 16,500 new TB patients were admitted in programs supported by MSF in 2004, and many more were diagnosed by MSF medical teams and referred to local TB services, some of them supported by MSF.

The settings in which MSF provides TB care vary widely:

• Chronic conflicts: MSF projects treat TB patients in chronic conflicts, including work in Abkhazia and in South Sudan, and refugee camps in Chad and in Thailand.
  
• Primary health care: An increasing number of patients receive TB care from MSF in health centers, for example in South Sudan, Congo, DRC, and Angola.
  
• Prisons: Two MSF projects offer treatment in prison settings: in Abkhazia and Abidjan/Ivory Cost.
  
• Multi-drug resistant TB: MSF is treating multi-drug resistant tuberculosis in Ivory Coast, Abkhazia, Thailand, and Uzbekistan.

Steps towards improving TB care recently taken in MSF projects include:

• HIV/AIDS co-infection: As TB is a major threat to people with HIV/AIDS, MSF provides TB treatment in its AIDS programs in several countries, including China, Cambodia, Kenya, Malawi, South Africa, and Zambia, and is working on integrating treatment of the two diseases in some countries in order to improve the follow up and care of co-infected patients.
  
• Alternative models: MSF has sought to find ways to treat patients who are difficult to follow, such as migrants or nomadic people, by reducing their need to come to a clinic. These efforts include home-based care in Cambodia and factory-based treatment in Thailand.
  
• Improving adherence to treatment: MSF is introducing strategies offering more flexibility to patients and at the same time guaranteeing good adherence. Self-administered treatment models have been begun with selected patients in Somalia, among co-infected patients in South Africa, and among pediatric patients in Angola. Community- or family-based direct observation has recently been introduced in Cambodia and Mozambique.
  
• Increasing the use of easy-to-use, pre-qualified fixed-dose combinations of TB drugs.
  
• Increasing the use of the WHO-recommended six-month treatment regimen(instead of eight months) within MSF projects.
  
• MSF is also upgrading diagnostic facilities in some countries, including introducing culture in Sudan and enhanced (fluorescence) microscopy in Cambodia and Angola, and improving follow-up of diagnosis with the use of culture, drug sensitivity testing and x-rays in Thailand, Ivory Coast, and Abkhazia.
  

(*) MSF withdrew from Afghanistan in August 2004 following the killing of five of its aid workers there in June 2004.