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Implementing DOTS in settings with high prevalence of drug-resistant tuberculosis

Abstract number: p1118

Balabanova  Y., Fedorin  I., Zakharova  S., Nikolayevskyy  V., Atun   R., Coker  R., Drobniewski  F.

Only a few DOTS programmes have been implemented in the Russian Federation, one of 22 high burden countries.

Objective: 

Describe DOTS cohorts recruited in Samara Oblast (pilot Oblast) and assess the outcomes.

Methods: 

DOTS cohorts were recruited from April 2002 till September 2004 across civil and prison sector. Standard technical documentation and diagnostic/treatment protocols have been employed. All received cultures underwent subsequent epidemiological molecular typing using IS6110 insertions detection in the dnaA-dnaN intergenic region.

Results: 

2093 patients were recruited. Only 29.3% of new cases were smear-positive in total and 42.9% of all new cases had bacteriologically confirmed TB. Drug resistant rates including multi-drug resistance were substantial with significantly higher rates in prison patients versus civil patients (Table 1).

Approximately half of all isolated strains (51.7%; 371/717) belonged to the Beijing family with a significantly higher proportion isolated from prisoners compare to civilians (60.9%; 117/192 vs 48.4%; 254/525; RR1.3 (95%CI 1.1–1.5).

In total 75.3% (592/786) of patients successfully completed the course of TB therapy while 7.3% (57/786) failed or defaulted, the rate being significantly higher among smear-positive patients compared to smear-negative (RR 3.3; 95%CI 2.0–5.4). The death rate was 3.6 % (28/786); a significantly higher proportion (11.3%) of smear-positive cases dying versus smear-negative (RR 11.2; 95% CI 4.6–27.2).

Conclusions: 

Lower case detection rate can be addressed by changing the national policy of radiological screening; prioritarisation of bacteriology in diagnostic, monitoring and measurement of cure of TB as well as and further improvement of laboratory services. The rate of successful treatment was below the 85% WHO threshold but slightly higher than reported from other DOTS pilot regions in the former Soviet Union. High prevalence of primary drug resistance (associated with Beijing strain) proves active transmission. It is vital to improve patients' adherence to therapy to reduce acquired resistance and improve institutional infection control measures to prevent transmission. Introduction of rapid techniques of drug resistance identification to allow early resistance detection needs to be considered.

Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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