 First I just wanted to thank the organisers for allowing us to present our data from a project that we're running in Uzbekistan. Some of the background to MDRTB treatment I think is very pertinent for those in the room that don't treat patients with that disease. The conventional treatment for MDRTB is up to two years long. It's very complex medically for doctors and nurses to manage patients on MDRTB treatment. The side effects are very significant with up to 10% developing hearing loss during the treatment and for programmes it's very expensive. Each patient we think costs around 3,000 euro for their treatment alone. Around 2010 a group in Bangladesh the Damien Foundation discovered a new regimen using conventional drugs so no new drugs but in a different combination which allowed treatment to be reduced from two years down to nine months, had lower toxicity levels and was significantly cheaper. At that stage there's very limited data about the role of this regimen and so in Uzbekistan we conducted a study to develop more data to hopefully lead to policy change. Uzbekistan for those that don't know is in Central Asia. It's a former Soviet Union country and it's on the list of the WHO list of high MDRTB countries. Amongst new cases of TB diagnosed 23% are diagnosed with MDRTB and amongst patients who've had treatment for TB before it's almost two thirds. I think importantly for the former Soviet Union which is sometimes different to other parts of the world there's very high levels of second line drug resistance so these are drugs that we kind of rely on for patients who have MDRTB with almost 8% having resistance probably the most effective drug at that time which is the fluoroquine loan group of drugs. So the analysis I'm going to present today is actually two analyses. It's comparing the shorter regimen that was discovered in Bangladesh with the conventional treatment that we were using at the time this two-year regimen and so what I'm presenting is data around the early effects of the two regiments so comparing people who had two months of the conventional treatment versus people who had two months the shorter treatment and also the end of treatment outcome to see was the shorter regimen as effective or more effective than the standard regimen in this context. So the original study was a single arm prospective study that we started in 2013. We restricted it to three districts for obviously for logistical and operational reasons in a in a program that MSF has run in collaboration with the Ministry of Health for many years. I think the program started in 1999. We started recruitment in September 2013 and this new regimen is shorter than the original so four months of this combination at the beginning with an injectable drug every day and five months following on from that with tablets. The inclusion criteria I think is essentially any patient with pulmonary MDRTB and we have an advanced laboratory there where we can use multiple tests to diagnose that and the exclusion criteria is to exclude patients we think have that second line drug resistance because when the study started we knew that they had a potentially worse outcome. So our comparison group it's important to know that this is an observational single arm study so the comparison is with is after the study finished. So for the short course regimen we have those recruited and involved in the in the short regimen so that prospective study and then the conventional care group is other patients within the same MSF Ministry of Health collaborative project but in different districts. We restricted them to the same time period to try and remove biases involved in changing of the program and that group received a protocolised WHO approved 20 or 24 month regimen based on the clinician's decision making. We looked at fairly standard outcomes for both for both analyses the first one being the effectiveness of the a measure of the effectiveness of the regimen at two months treatment and then the final one being the final outcomes at the end of treatment. Baseline characteristics across both groups were fairly similar. I think the key part from this slide is to notice that this is a region with with very very low HIV prevalence and in fact we included no patients who are HIV positive in this cohort. Unequally disease characteristics looking at the the burden of disease how how severe they're paid these patients where we looked at fairly standard TB aspects so things like cavities on the chest x-ray how much TB we discovered in patient sputum as well as some baseline resistance characteristics are all similar across the groups and so I think the the key part is coming to the results is the box in red so comparing the two two two groups of patients in their early treatment response we found that those receiving the short regimen had basically twice the effective response after adjusting for the reasonable confounders and in fact at the end of treatment outcomes we discovered that there was basically no difference between the groups. Obviously that's comparing a treatment of two years versus nine months and so actually we believe this to be quite a positive finding. Obviously the fact that our methodology was was observational the analysis that I'm presenting today was in fact retrospective raises a number of biases that I think we can't get away from. Obviously it's non-randomised but equally we felt that it was valid given that the program is the same the laboratories are the same the outcomes are the same and so we do feel that the biases although they are limited in some fashion. So in conclusion we think the short regimen shows that it has good early effects in this patient group we know that we found that the final outcomes at the end of treatment were quite similar although that's with a much shorter regimen and we think these are quite encouraging results from quite an established program and in fact last year the WHO agreed with us and other groups performing similar analyses around the world and change international guidelines to include the short regimen for some for certain groups of patients. So I think it's important to talk about the generalisability of our results. This is a context with high levels of second line drug resistance and very low HIV prevalence. We do believe across that region of former Soviet countries that that's quite similar to other countries and so maybe we can generalise to those countries. There's a question about whether this effect early on in treatment has an impact a positive impact on transmissibility. We believe that having a shorter treatment requires less work and less costs for programs and we're actually all looking forward to the randomised clinical trial that is occurring at the moment to give us valid scientific results. So just finally to thank all the patients and doctors and nurses who participated and obviously support patients with TB in this region as well as our collaboration in Uzbekistan and Kazakhstan, the region where we have this collaborative program. I'll leave it there.