[Monitoring detection and treatment of new patients with pulmonary tuberculosis].

We estimated results of detection and treatment of TB patients registered in 2006 in 15 regions of RF under supervision of the Central Research Institute of Tuberculosis. The fraction of sputum positive patients increased in comparison with 2005. It ranged from 77.1% in Orel region to 35.2% in Astrakhan region. The primary MDR rate varied significantly from 2.5% in the Republic of Mordovia to 14.7% in Mary El (estimated level 5%). The frequency of efficient chemotherapy (evaluated from sputum microscopy data) increased in 8 regions and decreased in 7 ones. The efficiency varied from 69.0 to 81.1% in 9 regions (recommended level for 2007 68.5%). It amounted to 68.5% or higher (based on sputum culturing data) in Republics of Kalmykia and Tatarstan, Nizhny Novgorod, Saratov and Ul'yanovsk regions. TB mortality rate in 2006 exceeded the acceptable level of 2.5% in 13 regions and the frequency of refusals to continue chemotherapy was higher than 5% recommended for 2010 by the Global Fund Target Project in 10 regions. The efficiency of treatment in sputum-positive patients was frequently evaluated by X-ray in 3 regions with poorly organized microbiological services. TB treatment efficiency estimated from cavity closure was higher than 60% in 10 regions; it the remaining ones it varied from 36,3% (Nizhny Novgorod) to 52.2% (Vladimir). The system of evaluation being tested permits to accurately register new TB patients, objectively estimate effectiveness of their treatment, and reveal causes of its failure. Also, it makes possible corrections of therapeutic strategy on a trimestrial basis instead of postponing them till the end of the year. Introduction of cohort analysis combined with supervision of responsibility regions by specialists of relevant research institutions would increase efficiency of TB control in each subject of Russian Federation. Supervisory management appears to be an efficacious tool for monitoring implementation of the TB control Program.

[Role of health care facilities in verifying the diagnosis of respiratory tuberculosis by laboratory methods].

Reasons for laboratory misdiagnosis that is observed in general health care network (GHCN) and penitentiaries were studied. The clinical efficiency of the diagnosis of tuberculosis in the GHCN by the Ziehl-Neelsen method is largely determined by three major factors, each of which is fundamentally important in assessing the result. The first factor is the adequacy of making up a cohort of patients having the symptoms of productive cough in the course of 2-3 weeks or more who are to be examined for tuberculosis by laboratory studies. The second is the quality of a diagnostic material. The third is the quality of laboratory specialists' work. The paper shows it necessary to implement programs for the internal control and external assessment of the quality of laboratory studies and to optimize (centralize) the activities of laboratories under the conditions of a regional network.

[Monitoring of the detection of new pulmonary tuberculosis cases and the efficiency of their treatment in the area supervised by the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences].

The results of the detection and treatment of new pulmonary tuberculosis cases in 2006 were assessed in 15 subjects of the Russian Federation, supervised by the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences. As compared with 2005, in 2006 the proportion of bacteria-discharging individuals increased among the new cases of pulmonary tuberculosis and ranged from 77.1% in the Oryol Region to 35.2% in the Astrakhan Region. The frequency of multidrug-resistant MBT among the new cases of pulmonary tuberculosis (the expected frequency was 5%) showed a wide scatter and varied from 0.7% in the Republic of Ingushetia to 14.7% in that of Mariy El. The higher and lower percentages of patients receiving an effective course of chemotherapy, as shown by microscopy, were noted in 8 and 7 regions, respectively. Their scatter was 42.4% in the Nizhni Novgorod Region to 81.1% in the Republic of Mordovia. The efficiency of treatment, as evidenced by sputum culture, varied from 46.3% in the Nizhni Novgorod Region to 79.0% in the Republic of Mordovia. More than 3% of those who died from tuberculosis were recorded in 10 regions and more than 5% of those who discontinued a course of chemotherapy before the appointed time were notified in 8 regions. The cavity decay closure rate ranged from 36.3% in the Nizhni Novgorod Region to 52.2% in the Vladimir Region. Quarterly monitoring of the detection and treatment allows a precise registration of identified tuberculosis patients, objective assessment of the results of treatment, elucidation of reasons for ineffective chemotherapy, and corrections of a treatment process.

[The significance of parameters of the reservoir of bacillary patients with pulmonary tuberculosis in the assessment of tuberculosis epidemic situation].

The author analyzes the tuberculosis epidemic situation in Russia, by using the traditional scheme accepted in Russia and the procedure based on the follow-up of bacillary patients with pulmonary tuberculosis. The proposed procedure enabled the author to ascertain the reasons for the decreased rates of normalization of the tuberculosis situation and to make an objective proposal to implement tuberculosis-controlling measures. The performed study has led the author to recommend a new form of calculating the abacillation index and of establishing the standard for the proportion (75-85%) of bacterial isolation in patients with new-onset pulmonary tuberculosis.

[Impact of introduction of the WHO tuberculosis-controlling recommendations adapted to the Russian conditions on the Russian statistical tuberculosis data]. / Vliianie vnedreniia adaptirovannykh k Rossiiskim usloviiam rekomendatsii voz po bor'be s tuberkulezom na otechestvennye statisticheskie pokazateli po tuberkulezu.

The authors share their experience in introducing the WHO tuberculosis-controlling recommendations adapted to the Russian conditions into the Republic of Mariy El, in the Ivanovo, Oryol, and Tomsk Regions. All the areas are marked by high rates of diagnosis of MBT in the clinical diagnostic laboratories of the general medical network, by the increased rates of detection of patients of tuberculosis who isolate Mycobacterium tuberculosis, by the enhanced efficiency of treatment of patients with tuberculosis, as shown by the Russian statistical data, by the lower rates of growth of the contingents of patients with tuberculosis or by their reduction.

[Tuberculosis in Russia]. / Tuberkulez v Rossii.

An unfavorable epidemiological trend in tuberculosis morbidity and mortality has been registered in the last decade. The number of newly detected cases and mortality in 1997 vs 1991 rose more than 2-fold reaching 73.9 and 16.7 per 100,000, respectively. The effectiveness of tuberculosis treatment is worsening: bacterial discharge stopped in 72.6%, destruction cavities in the lungs closed in 62.6%, clinical recovery was obtained in 17.2% of patients (relevant statistics for 1986 were 89.9, 81.6 and 21.9%, respectively). To correct the situation, government of the Russian Federation has adopted the program of tuberculosis control for 1998-2004. The Health Administration of the Ivanovo and Tomsk Regions has successfully introduced the DOTS program. Now, this positive experience is applied in other regions and institutions.

[Increasing the general practitioner's role in detecting patients with tuberculosis]. / O povyshenii roli vrachei obshchei praktiki v vyiavlenii bol'nykh tuberkulezom.

Due to the fact that the concept of detection of tuberculosis mainly using fluorographic studies have been long existing in Russia (for about 40 years), the general practitioners have lost their skills in differentiating tuberculosis from other lund diseases, eventually leading to its late diagnosis and a higher proportion of advanced tuberculosis cases. Recommendations are given how to involve general practitioners in detecting patients with tuberculosis actively.

[Concept basic principles of antituberculous measures management under the new socioeconomic conditions in Russia]. / Osnovnye printsipy kontseptsii upravleniia protivotuberkuleznymi meropriiatiiami v novykh sotsial'no-ékonomicheskikh usloviiakh Rossii.

The changed socioeconomic conditions require that a new concept of management of antituberculous measures be established. This includes measures, such as to set up interdepartmental tuberculosis control commissions, to adopt a law on protection of the population from tuberculosis, to transit from extensive to intensive methods of detection and treatment of tuberculosis, and requires a monitoring system for antituberculosis measures, regular supply with antituberculous drugs, and a medical educational system. The government must be the leader to control tuberculosis. Publicity should be at all stages of antituberculous activities.

[Prevalence of tuberculosis in the personnel of antituberculosis institutions in Russian Federation]. / O zabolevaemosti tuberkulezom personala protivotuberkuleznykh uchrezhdenykh uchrezhdenii Rossiiskoi Federatsii.

Questionnaires were distributed among all the heads of regional antituberculous services in Russia as to cases of tuberculosis among medical personnel in contact with tuberculous patients. The results of this study as well as programs to control tuberculosis in medical personnel are presented. Special measures of social support for those at occupational risk of tuberculosis are detailed.