Ethics and human rights considerations regarding involuntary isolation of people with TB.

Involuntary isolation of people with tuberculosis is rarely medically required, ethically permitted or justified on the ground of human rights law. The rare circumstances that do call for involuntary isolation must only occur once a number of conditions are met. These include just procedural protections and ensuring that all other options have been exhausted before resorting to involuntary isolation. This article is intended to outline for healthcare workers, policy makers and advocates the ethical reasoning behind isolation and involuntary isolation, as well as describing the requisite human rights laws that impinge on the topic. Finally, we present a list of conditions that must be met to justify involuntary isolation on the grounds of both ethics and human rights.

Performance of Cepheid ® Xpert MTB/RIF ® and TB-Biochip ® MDR in two regions of Russia with a high prevalence of drug-resistant tuberculosis.

The purpose of this study was to assess the performance of Cepheid® Xpert MTB/RIF® ("Xpert") and TB-Biochip® MDR ("TB-Biochip"). Sputum specimens from adults with presumptive tuberculosis (TB) were homogenized and split for: (1) direct Xpert and microscopy, and (2) concentration for Xpert, microscopy, culture [Lowenstein-Jensen (LJ) solid media and Mycobacteria Growth Indicator Tube® (MGIT)], indirect drug susceptibility testing (DST) using the absolute concentration method and MGIT, and TB-Biochip. In total, 109 of 238 (45.8 %) specimens were culture-positive for Mycobacterium tuberculosis complex (MTBC), and, of these, 67 isolates were rifampicin resistant (RIF-R) by phenotypic DST and 64/67 (95.5 %) were isoniazid resistant (INH-R). Compared to culture of the same specimen, a single direct Xpert was more sensitive for detecting MTBC [95.3 %, 95 % confidence interval (CI), 90.0-98.3 %] than direct (59.6 %, 95 % CI, 50.2-68.5 %) or concentrated smear (85.3 %, 95 % CI, 77.7-91.1 %) or LJ culture (80.8 %, 95 % CI, 72.4-87.5 %); the specificity was 86.0 % (95 % CI, 78.9-91.3 %). Compared with MGIT DST, Xpert correctly identified 98.2 % (95 % CI, 91.5-99.9 %) of RIF-R and 95.5 % (95 % CI, 85.8-99.2 %) of RIF-susceptible (RIF-S) specimens. In a subset of 104 specimens, the sensitivity of TB-Biochip for MTBC detection compared to culture was 97.3 % (95 % CI, 91.0-99.5 %); the specificity was 78.1 % (95 % CI, 61.5-89.9 %). TB-Biochip correctly identified 100 % (95 % CI, 94.2-100 %) of RIF-R, 94.7 % (95 % CI, 76.7-99.7 %) of RIF-S, 98.2 % (95 % CI, 91.4-99.9 %) of INH-R, and 78.6 % (95 % CI, 52.1-94.2 %) of INH-S specimens compared to MGIT DST. Xpert and Biochip were similar in accuracy for detecting MTBC and RIF resistance compared to conventional culture methods.

Barriers and motivators affecting tuberculosis infection control practices of Russian health care workers.

SETTING: Five in-patient and out-patient tuberculosis (TB) care facilities in two regions of Russia. OBJECTIVE: To identify barriers and motivators to the use of infection control measures among Russian TB health care workers. DESIGN: In this qualitative study, a convenience sample of 96 health care workers (HCWs) was used to generate 15 homogeneous focus groups, consisting of physicians, nurses, and laboratory or support staff. RESULTS: Barriers and motivators related to knowledge, attitudes and beliefs, and practices were identified. The three main barriers were 1) knowledge deficits, including the belief that TB was transmitted by dust, linens and eating utensils; 2) negative attitudes related to the discomfort of respirators; and 3) practices with respect to quality and care of respirators. Education and training, fear of infecting loved ones, and fear of punishment were the main motivators. CONCLUSIONS: Our results point to the need for evaluation of current educational programs. Positive health promotion messages that appeal to fear might also be successful in promoting TB infection control. Individualized rewards based on personal motivators or group rewards that build on collectivist theory could be explored.

Russian health care workers' knowledge of tuberculosis and infection control.

BACKGROUND: Lack of knowledge may contribute to a higher risk of nosocomial tuberculosis (TB) among Russian TB health care workers (HCWs). DESIGN: Community-based participatory study. Russian TB HCWs at five TB facilities (n = 96) were surveyed to assess knowledge specific to TB and infection control. RESULTS: Overall scores were low. Analysis of variance showed a significant difference in knowledge by job category. Physicians scored significantly higher than nurses, laboratory staff and support staff. Nurses and laboratory technicians scored significantly higher than support staff. The biggest area of knowledge deficit was in infection control. CONCLUSION: Knowledge level of TB among HCWs could influence the prevalence of nosocomial TB infection.

Prevalence of extensively drug-resistant tuberculosis in Vladimir and Orel regions, Russia.

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.