Comparison of the effectiveness of WHO short-course chemotherapy and standard Russian antituberculous regimens in Tomsk, western Siberia.

BACKGROUND: There has been a resurgence of tuberculosis in Russia in the past decade. Traditional Russian services for treatment of tuberculosis are very different from those in the west. We aimed to compare the effects of WHO short-course chemotherapy with standard Russian antituberculous regimens. METHODS: New tuberculosis patients aged 18 years or older were included in a trial and systematically allocated to traditional Russian tuberculosis treatments or WHO short-course chemotherapy in the two largest tuberculosis diagnostic and treatment centres of Tomsk Oblast, western Siberia. Standard WHO tuberculosis outcomes and rates of sputum conversion were used as primary outcomes. Analyses were by intention-to-treat. FINDINGS: 646 new cases were enrolled into the trial, of which 356 patients were given Russian tuberculosis treatment (155 smear positive) and 290 were given WHO short-course chemotherapy (155 smear positive). There was no statistical difference between the proportion cured or completing treatment (63% for both groups [difference in proportion=0%, 95% CI -11 to 11%]); or dying (short-course chemotherapy, 8% vs Russian, 11% [difference in proportion=-3%, 95% CI -9 to 4%]). There was no statistical difference with respect to sputum conversion rate at 6 months (91% vs 85% [difference in proportion=6%, 95% CI -2 to 13%]). Overall, outcomes were worse among patients with multidrug resistant isolates than non-resistant isolates. INTERPRETATIONS: WHO short-course chemotherapy treatment for tuberculosis can work well in Russia.

Evaluating and developing contraceptive services: the results of an audit of the North Lambeth Primary Care Commissioning Group.

Primary care groups are expected to meet the primary health care needs of their local population. In the inner-city London borough of Lambeth there are high levels of sexual health needs. The North Lambeth Primary Care Commissioning Group identified the evaluation and further development of contraceptive services, particularly to those under the age of 25, as a priority. An evaluation of current contraceptive service provision from general practice was carried out. The evaluation covered contraceptive service factors identified from the literature as linked to effective, acceptable, accessible and equitable service delivery. Factors linked to the effectiveness of services included service use, information provision, training of staff, provision of the full range of methods and services. Factors linked to the acceptability of services included confidentiality and the choice of the gender of the provider. The strengths and limitations of the data and indicators used are outlined. Areas requiring further evaluation are highlighted. The evaluation indicated scope for service development in all the key areas evaluated, and illustrated examples of good practice. For example, whilst information in practice leaflets and surgery waiting areas about the contraceptive services available was generally limited, one practice provided excellent information. Recommendations for service development were made covering information provision, staff training, and confidential access to services. These are being taken forward by an ongoing project.