ABSTRACT
SETTING: Joint World Health Organization (WHO) projects in Vladimir and Orel regions, Russia. OBJECTIVE: To study the prevalence of extensively drug-resistant (XDR) tuberculosis (TB). METHODS: Drug susceptibility testing of second-line drugs (ofloxacin, kanamycin, capreomycin, ethionamide, cycloserine and para-aminosalicylic acid) was performed on isolates from multidrug-resistant TB cases from 1 January to 31 December 2006. RESULTS: In Orel, 16 (21.3%) of 75 tested isolates were XDR-TB; in Vladimir, 9 (4.9%) of 182 isolates were XDR-TB. Bilateral lung involvement was significantly associated with XDR-TB (prevalence ratio = 2.61, 95%CI 1.01-6.72). CONCLUSION: XDR-TB has emerged in Russia. It is crucial to prevent, diagnose and treat TB and MDR-TB more effectively.
Subject(s)
Antitubercular Agents/therapeutic use , Extensively Drug-Resistant Tuberculosis/epidemiology , Mycobacterium tuberculosis/drug effects , Adult , Aged , Cross-Sectional Studies , Extensively Drug-Resistant Tuberculosis/drug therapy , Female , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Prevalence , Retrospective Studies , Russia/epidemiology , World Health Organization , Young AdultABSTRACT
The aim of this study was to assess the impact of social and psychological factors on treatment adherence of patients with tuberculosis (TB). To this end a cross-sectional questionnaire-based study was conducted among TB patients in four Russian regions (Orel, Vladimir, Belgorod oblasts, and Republic of Mari-El) from 01/04/2004 to 31/03/2005. A total of 87 non-adherent and 1302 adherent patients were interviewed. Compared to adherents, non-adherents were significantly more likely to be male, unemployed, have a technical college education, have a history of imprisonment, have a negative emotional status, consider themselves "not sick", not know the treatment period, have negative feelings and distrust for medical staff, not believe they will fully recover, and not want to continue treatment. Patients at highest risk for non-adherence should be identified at the start of treatment, and offered the services of a psychologist. A case management and patient-centered approach should be applied.
Subject(s)
Antitubercular Agents/therapeutic use , Medication Adherence , Tuberculosis, Pulmonary/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Counseling/methods , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Russia , Surveys and Questionnaires , Tuberculosis, Pulmonary/psychologyABSTRACT
SETTING: Tuberculosis (TB) services including social support and incentive programmes in four Russian regions (Orel, Vladimir, Belgorod Oblasts and Republic of Mari-El). OBJECTIVES: To determine reasons for TB treatment default among non-adherent patients and to describe patient views of social support programmes and the organisation of treatment. METHODS: Standard anonymous questionnaires were administered to new pulmonary TB patients registered for treatment. RESULTS: A total of 87 non-adherent patients and 1302 adherent patients were interviewed. The leading reasons for treatment default given by non-adherent patients were the need to earn money (30%), alcohol use (30%) and not perceiving themselves as being sick (25%). Monetary incentives were preferred by the majority of patients (67%), followed by food/hot meals (41%) and transportation reimbursement (32%). Overall, among the proposed social support programmes, those that offered small daily incentives (23%) or a big final bonus (21%) were the most popular. The majority of patients (67%) preferred out-patient treatment. CONCLUSION: Collaboration between TB services and social organisations and substance abuse services as well as availability of psychological testing/counselling for patients are social support modalities for improving adherence suggested by study findings. Social support should be combined with a patient-centred approach to TB treatment.
Subject(s)
Antitubercular Agents/therapeutic use , Patient Compliance , Social Support , Tuberculosis/drug therapy , Adult , Antitubercular Agents/administration & dosage , Cross-Sectional Studies , Female , Humans , Male , Russia , Surveys and QuestionnairesSubject(s)
Antitubercular Agents/administration & dosage , Patient Compliance , Social Support , Tuberculosis, Pulmonary/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Case-Control Studies , Female , Humans , Male , Middle Aged , Prevalence , Retrospective Studies , Risk Factors , Russia/epidemiology , Surveys and Questionnaires , Treatment Refusal , Tuberculosis, Pulmonary/epidemiologyABSTRACT
SETTING: Tuberculosis (TB) services in six Russian regions in which social support programmes for TB patients were implemented. OBJECTIVE: To identify risk factors for default and to evaluate possible impact of social support. METHODS: Retrospective study of new pulmonary smear-positive and smear-negative TB patients registered during the second and third quarters of the 2003. Data were analysed in a case-control study including default patients as cases and successfully treated patients as controls, using multivariate logistic regression modelling. RESULTS: A total of 1805 cases of pulmonary TB were enrolled. Default rates in the regions were 2.3-6.3%. On multivariate analysis, risk factors independently associated with default outcome included: unemployment (OR 4.44; 95%CI 2.23-8.86), alcohol abuse (OR 1.99; 95%CI 1.04-3.81), and homelessness (OR 3.49; 95%CI 1.25-9.77). Social support reduced the default outcome (OR 0.13; 95%CI 0.06-0.28), controlling for age, sex, region, residence and acid-fast bacilli (AFB) smear of sputum. CONCLUSION: Unemployment, alcohol abuse and homelessness were associated with increased default outcome among new TB patients, while social support for TB patients reduced default. Further prospective randomised studies are necessary to evaluate the impact and to determine the most cost-effective social support for improving treatment outcomes of TB in patients in Russia, especially among populations at risk of default.
