Tuberculosis control in the Caucasus: successes and constraints in DOTS implementation.

SETTING: The pilot projects for tuberculosis (TB) control, supported by the World Health Organization (WHO) and based on the WHO recommended control strategy, directly-observed treatment, short-course (DOTS) in the Caucasian countries (Armenia, Azerbaijan, Georgia). OBJECTIVE: To evaluate the results 2 years after the implementation of the pilot projects. METHODS: Analysis of data on case detection, sputum conversion and treatment outcome reported quarterly to the WHO from the Ministries of Health in each country. RESULTS: Since the establishment of the project, 1330, 764 and 4866 new cases and relapses, respectively, of TB have been detected in the pilot areas of Armenia, Azerbaijan and Georgia. In Armenia and Azerbaijan, respectively 46% and 57% of all cases were smear positive, whilst in Georgia, the corresponding figure was only 12%. After 3 months' treatment, 93% of new smear-positive patients had become smear-negative. The sputum conversion rate for relapses and other retreatment cases (failure, treatment interrupted) was 85%. In Armenia, 78.1% of new smear-positive patients were treated successfully (cured or completed treatment). The corresponding percentages for Azerbaijan and Georgia were 87.9% and 59.6%. Treatment success rates among retreatment cases was generally low, at respectively 46%, 64%, and 35%, in Armenia, Azerbaijan, and Georgia. CONCLUSION: The results of the implementation of the WHO TB control pilot projects in Armenia, Azerbaijan and Georgia suggest that the DOTS strategy is feasible in emergency situations in general, and in the Caucasus in particular.

Standardized tuberculosis treatment outcome monitoring in Europe. Recommendations of a Working Group of the World Health Organization (WHO) and the European Region of the International Union Against Tuberculosis and Lung Disease (IUATLD) for uniform reporting by cohort analysis of treatment outcome in tuberculosis patients.

Consensus-based recommendations have been developed by a Working Group of the World Health Organisation (WHO) and the International Union Against Tuberculosis and Lung Disease (IUATLD) on uniform reporting of tuberculosis (TB) treatment outcome data in countries in Europe. The main purpose of treatment monitoring is to find out how many of the potential infectious TB patients notified were declared cured at the end of treatment. Following the uniform case definitions as defined in 1996, emphasis is placed on cohort analysis of definite cases of pulmonary TB. The Working Group recommends using a minimal set of six mutually exclusive categories of treatment outcome: cure, treatment completed, failure, death, treatment interrupted, and transfer out. More detailed subsets may be chosen. Treatment outcome is expressed as a percentage of the total number of cases notified. Analysis should be separate for new and retreatment cases. Treatment outcome data have to be collected at the local level and passed on to regional and national authorities on an ongoing basis. Evaluation of treatment results becomes, preferably, an inbuilt component of national monitoring of programme performance. Because of the long duration of treatment, it is recommended that analysis is carried out in the first quarter of the calendar year that follows a full year after the last patient was enrolled. Feedback is essential. Treatment outcome results should become an inseparable part of the annual report on tuberculosis.

The epidemiology of tuberculosis in Latvia.

An increase in the number of outbreaks of tuberculosis (TB) has been reported during recent years in many parts of the world, including the countries of Eastern Europe and the former USSR. This study was performed with the aim of assessing the current epidemiological situation with respect to TB in Latvia, one of the three Baltic States, in comparison to the previous decades (since 1950), and to evaluate trends in the incidence of TB during recent years. Data on the incidence of TB were obtained from the Tuberculosis Registers and the Information Department of the State TB and Lung Diseases Centre of Latvia. The results of this study show that, in Latvia, a deterioration in the epidemiological situation with respect to TB occurred from 1990 onwards. The incidence of TB and TB mortality rates virtually doubled from 1991 to 1995: from 28.7 to 50.4 and from 6.4 to 14.1 per 100,000 population, respectively. The majority of new TB cases occurred in persons from the economically productive age group, i.e. 25-54 yrs. In 1995, 61% of pulmonary TB patients were found to be sputum and/or culture positive, the rate of primary drug resistance was 19%, and of total drug resistance was 38%. In order to prevent a further deterioration in the epidemiology of TB in Latvia, it is vital to revise the National TB Control Programme according to the recommendations of the World Health Organization (WHO) and International Union Against Tuberculosis and Lung Disease (IUATLD).