ABSTRACT
OBJECTIVE: To evaluate practices in initial drug susceptibility testing (DST) in Moldova, anti-tuberculosis drug resistance and the implications for tuberculosis control. METHODS: Retrospective record review in the national reference laboratory. RESULTS: Of 3463 cases, 57.1% were recorded as 'new' and 24.6% as 'retreatment' cases; previous treatment status was not recorded for 18.3%. Of the 'new' cases, 1655 were correctly classified according to international recommendations and 322 were misclassified. The number of cases increased from 443 in 1995 to 939 in 1999; the proportion of 'retreatment' increased from 17.4% to 35.5%, 'any drug resistance' from 20.3% to 41.6%, and 'multidrug resistance' from 2.7% to 11.2%. In 1998-1999, 'any drug resistance' and 'multidrug resistance' in 800 previously untreated cases were respectively 29.1% and 5.3%, and respectively 61.0% and 21.9% in 521 'retreatment' cases. Of a total of 216 'multidrug-resistant' cases in 1998-1999, 21.8% were reported resistant to ethambutol and 81.5% to streptomycin. CONCLUSIONS: Initial specimens for culture are frequently taken late, after the start of treatment, compromising their usefulness for case management or surveillance. Inadequate treatment has led to an increase in the number of cases, the proportion of previously treated cases and the prevalence of drug resistance. In 1998-1999, a high proportion of cases with 'multidrug resistance' were susceptible to ethambutol.
Subject(s)
Antitubercular Agents/pharmacology , Drug Resistance, Multiple , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Multidrug-Resistant/epidemiology , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/epidemiology , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Child , Child, Preschool , Confidence Intervals , Drug Resistance, Bacterial , Female , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Moldova/epidemiology , Prevalence , Probability , Prognosis , Registries , Retrospective Studies , Risk Factors , Sex Distribution , Treatment Outcome , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Pulmonary/diagnosisABSTRACT
SETTING: Vientiane municipality, Laos. OBJECTIVE: To describe and evaluate the implementation of standardized registration and reporting procedures within the municipality in a period of decentralization. The purpose of the standardization was to obtain complete and reliable information on case-finding and treatment results. DESIGN: Evaluation by review of quarterly reports on case-finding and treatment results, and comparison of information from the records of individual patients on site with the records of the supervisors. RESULTS: Case-finding increased in 1994-1998. Treatment success improved from 26.8% (95% CI 21.5-44.0) to 74.6% (95% CI 69.9-79.3). Given an option for autoadministered long-course treatment versus directly observed short-course treatment, 97% of the patients registered in 1998 received the latter. Following decentralization, evaluation of results of treatment was incomplete due to a high ratio of 'transfer out' patients (16.4%, 95% CI 11.5-21.3). After intervention this proportion was reduced to 2.3% (95 %CI 0.7-3.9). In 1998, approximately 40% of smear-positive patients diagnosed at the National Tuberculosis Center and residing in the districts evaluated were 'transferred' or 'referred' to the districts. All but three of the 68 patients presented at the district hospitals, mostly without delay. Registration and reporting was reasonably accurate. At the end of the period evaluated, decentralization was only partial and problems in case-holding were still evident. CONCLUSIONS: When decentralizing services it is important to establish procedures for management of information flow in order to allow the activities to be evaluated and problems amenable for correction to
