Adverse reactions among patients being treated for MDR-TB in Tomsk, Russia.

BACKGROUND AND SIGNIFICANCE: Treatment of multidrug-resistant tuberculosis (MDR-TB) is challenging because of the toxicity of second-line medications. Little is known about whether adverse events impact treatment outcome. METHODS: We conducted a retrospective case series of 244 MDR-TB patients enrolled in Tomsk between 10 September 2000 and 10 September 2002. Adverse reactions were determined by laboratory data and/or clinical criteria. A multiple logistic regression model was performed to determine whether the occurrence of adverse reactions was associated with poor treatment outcome. RESULTS: In this cohort, 76.0% were cured, 6.6% failed, 4.9% died and 11.5% defaulted. Adverse events were observed in 73.3% of patients, occurring in 74.8% of patients who were adherent (taking at least 80% of prescribed doses) and 59.1% of non-adherent individuals (P = 0.11). The impact of adverse events on outcome was modified by non-adherence; among adherent patients, the occurrence of any adverse reaction was associated with treatment cure (adjusted odds ratio 3.24, 95% confidence interval 1.56-6.70). CONCLUSION: Adverse reactions occurred frequently in MDR-TB patients in Tomsk, Russia, but did not negatively impact treatment outcome. The occurrence of adverse reactions among adherent patients was associated with treatment cure.

Causes of death during tuberculosis treatment in Tomsk Oblast, Russia.

SETTING: Tuberculosis (TB) incidence and mortality in Russia have risen dramatically over the past 15 years. OBJECTIVE: To identify risk factors and causes of death among TB patients in Russia. DESIGN: A retrospective study conducted to determine the risk factors and causes of death in patients receiving TB therapy in Tomsk, Siberia. RESULTS: Of 1916 patients who initiated treatment between 1 January 2002 and 31 December 2003, 183 (9.6%) died during treatment, 38 (21%) in the first week of therapy. Twenty-five per cent of deaths were not directly attributable to TB. Risk factors for death included older age, previous treatment for TB, multidrug resistance and alcoholism. CONCLUSIONS: The high death rate during TB treatment observed in this cohort likely reflects an increased risk of dying not only from TB, but also from comorbid conditions, such as alcoholism and cardiovascular disease. Overall, alcoholism and late presentation both contributed substantially to the mortality in this cohort.

Treatment outcomes in an integrated civilian and prison MDR-TB treatment program in Russia.

SETTING: Multidrug-resistant tuberculosis (MDR-TB) is a major problem in countries of the former Soviet Union in both the civilian and prison sectors. OBJECTIVE: To evaluate outcomes of the MDR-TB treatment program (DOTS-Plus) in Tomsk, Russia. DESIGN: Retrospective case series of all patients enrolled in this program between 10 September 2000 and 10 September 2002. The program involves both the civilian and penitentiary TB services in Tomsk. Poor treatment outcome was defined as death, default and treatment failure. RESULTS: Among the 244 patients who received treatment, 77% were cured, 5% died, 7% failed, and 12% defaulted. In a multivariable analysis, alcohol consumption during treatment and the presence of both cavitary and bilateral disease were found to be the strongest predictors of poor treatment outcome. CONCLUSIONS: The integration of civilian and penitentiary TB services in the Tomsk MDR-TB treatment program has resulted in high cure rates and low rates of default. However, alcohol use among patients with MDR-TB is associated with poor treatment outcomes. Better understanding and programmatic alcohol interventions are needed if large-scale treatment of MDR-TB is to be successful in areas with high rates of alcohol use disorders.

[Laboratory service optimization in the implementation of a complex programme for detection and treatment patients with tuberculosis].

The paper presents a model of laboratory service in implementing a complex program aimed at detecting and treating patients with tuberculosis in the Tomsk Region. Organizational, methodological, and managerial measures to set up bacteriological stations and a main (reference) laboratory for microbiological sputum study in Tomsk, intensification of this work at all clinical-and-diagnostic laboratories of general health care facilities have improved the quality of the whole system detecting bacterial isolators and ensured a close organizational and methodological interaction between the therapeutic-and-diagnostic institutions of the general medical system and tuberculosis-controlling service.

[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.