Encouraging outcomes in the first year of a TB control demonstration program: Orel Oblast, Russia.
METHODS
Orel, Russia.


OBJECTIVE
To evaluate outcomes of tuberculosis (TB) patients treated in the first year of a TB control demonstration project using a revised strategy of directly observed treatment, short-course (DOTS). Standard methods recommended by World Health Organization (WHO) were adapted to include mycobacterial cultures.


METHODS
Retrospective cohort analysis of TB patients diagnosed between October 1999 and September 2000.


RESULTS
Among 749 TB patients, 65% had bacteriologic confirmation of pulmonary TB, 31% were diagnosed clinically, and 4% had extra-pulmonary TB. Most (92%) had no previous TB treatment, but 8% were identified as retreatment cases. Of all patients, 41% had new sputum smear-positive TB. No patients were HIV-infected. Multidrug-resistant (MDR) TB levels were 3% among new and 17% among retreatment patients. Among new smear-positive patients, treatment success was 79% (72% cure, 7% completion); remaining outcomes were 8% failure, 3% default, 8% death, and 1% transfer. Success rates for new culture-positive and clinically diagnosed patients were 81% and 91%, respectively.


CONCLUSIONS
Despite historical differences, successful implementation of the revised TB strategy in Russia is possible. Treatment success rates were high, suggesting WHO targets of 85% cure for smear-positive patients is attainable. Obstacles include drug resistance and elevated death rates among smear-positive patients.
Orel Oblast TB Dispensary, Orel Oblast TB Control Program, Orel, Russian Federation.
T
T
Kherosheva
L E
LE
Thorpe
E
E
Kiryanova
L
L
Rybka
V
V
Gerasichev
M
M
Shulgina
E
E
Nemtsova
T
T
Aptekar
H
H
Kluge
W
W
Jakubowiak
M
M
Grzemska
G
G
Aquino
C
C
Wells
B
B
Kazionny
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D023801:Directly Observed Therapy; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012426:Russia; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000517:prevention & control; D014397:Tuberculosis, Pulmonary / Q000517:prevention & control*