The 30-second, animated TV spot begins with an Uzbek farmer working in the fields with his hoe. He is coughing and so tired he has to stop his work to return home and lie down. The voiceover - in Uzbek, Russian or Karakalpak - describes the farmer’s symptoms: coughing, pain, loss of energy, a high temperature. These can be the symptoms of tuberculosis (TB), and if you have them, you should see a doctor to be tested. TB can be cured, and the treatment is free of charge, the narrator assures the viewers.

In recent months, this public service announcement (PSA) has been shown about 6,000 times on 22 regional TV stations that cover nearly all of Uzbekistan. Two more PSAs will air soon: the first telling that those infected with TB can be cured if they follow the treatment plan; and the second addressing possible stigmatization by explaining that TB is an airborne disease that anyone can get.

The TV spots are one of several components of the USAID funded Project HOPE’s efforts to combat TB in Uzbekistan. The nation has a network of TB hospitals and clinics, about 1,400 doctors trained in the treatment of TB and availability of medicines to fight the disease, said Artur Niyazov, the TB Program Manager of Project HOPE in Uzbekistan. With an effective infrastructure in place, what is needed now is for people to report TB so they can be properly diagnosed and then to stick with their treatment until they are cured, he said.

"This is a curable disease, and all the resources and political support are now here," he said. "The only need is to mobilize doctors and increase community awareness. With all these together, the TB situation can be changed quite soon."

On 24 March, the World Health Organization (WHO) commemorates World TB Day. The annual event marks the day in 1882 when Dr. Robert Koch announced the discovery of the bacteria that causes TB. World TB Day highlights the gains made in treating the disease, publicizes programs to combat the disease, and acknowledges the challenges ahead.

More than 1.7 million people die from TB every year, making it the world’s second-deadliest infectious disease, behind only HIV/AIDS. Although an effective cure for TB exists, the disease is often diagnosed late and is poorly treated, if treated at all.

The US Government, with USAID as its lead agency, is at the forefront of combating TB worldwide. In 2008, Congress authorized spending up to US$48 billion to combat HIV/AIDS, TB and malaria, according to the US State Department. The US has contributed US$3.3 billion to the Global Fund to Fight AIDS, TB and Malaria, about 27% of the total funding. USAID supports active TB programs in more than 40 countries, including Uzbekistan.

The Global Fund has authorized more than US$50 million to purchase TB medicines and provide other services to fight TB in Uzbekistan in the next five years, according to Niyazov. USAID spent about US$1.5 million on TB projects in Uzbekistan in 2008, according to Benjamin Mills, the Health Advisor for USAID in the country. The WHO estimates a rate of 121 cases of TB per 100,000 people for Uzbekistan in 2006, or a total of about 33,000 cases. The mortality rate was reported at 17 per 100,000 people, or about 4,600 deaths from TB. The relatively high mortality rate and prevalence of multi-drug resistant TB indicate that a high percentage of TB cases in Uzbekistan are not being fully treated, Mills said. Ending treatment before a patient is fully cured can lead to a relapse with multi-drug resistant TB, which is much harder to cure.

"It is particularly important to fight TB here in Uzbekistan because of the rise in multi-drug resistant TB. It is becoming more and more common to see these new strains," Mills said. "If this continues, we won’t be able to say any longer that TB is a curable disease."

USAID, working through Project HOPE, has been assisting the Government of Uzbekistan to combat TB since 2000. Its programs include the public awareness campaign, education of TB patients about the disease and its cure, training of doctors and nurses in following WHO-recommended treatment programs, and implementation of a computerized system to track medicines needed for every TB patient in the nation. As part of these programs, Project HOPE:

* Studied the reasons why nearly 20% of TB patients in Uzbekistan stop their treatment before they are fully cured. Based on this study, the group developed educational materials that are now part of each patient’s treatment program, with the goal of raising the number of patients who stick with treatment until they are cured;

* Trains laboratory specialists to properly handle and monitor materials used to diagnose TB;

* Supports the implementation of the Logistics Management Information System (LMIS). The database tracks TB cases to allow the efficient purchasing and distribution of the necessary medicines;

* Organizes public outreach programs ranging from youth activities to theater productions to educate the population about TB and its treatment.

Each of USAID and Project HOPE’s programs follows the WHO’s world-wide strategy to cut the number of TB cases in half by 2015, relative to 1990 levels, and to eliminate TB as a public-health concern by 2050. "We try to cover as much as possible with what we have," said Niyazov from Project HOPE. "We can’t just educate doctors or the patient population. If the community doesn’t come in for observation and treatment, then the TB rate will just increase. That’s where we’re trying to make an impact."