title: Does one size fit all? Drug resistance and standard treatments: results of six tuberculosis programmes in former Soviet countries.
abstract: METHODS
  After the collapse of the Soviet Union, countries in the region faced a dramatic increase in tuberculosis cases and the emergence of drug resistance.
  
  
  OBJECTIVE
  To discuss the relevance of the DOTS strategy in settings with a high prevalence of drug resistance.
  
  
  METHODS
  Retrospective analysis of one-year treatment outcomes of short-course chemotherapy (SCC) and results of drug susceptibility testing (DST) surveys of six programmes located in the former Soviet Union: Kemerovo prison, Russia; Abkhasia, Georgia; Nagorno-Karabagh, Azerbaijan; Karakalpakstan, Uzbekistan; Dashoguz Velayat, Turkmenistan; and South Kazakhstan Oblast, Kazakhstan. Results are reported for new and previously treated smear-positive patients.
  
  
  RESULTS
  Treatment outcomes of 3090 patients and DST results of 1383 patients were collected. Treatment success rates ranged between 87% and 61%, in Nagorno-Karabagh and Kemerovo, respectively, and failure rates between 7% and 23%. Any drug resistance ranged between 66% and 31% in the same programmes. MDR rates ranged between 28% in Karakalpakstan and Kemerovo prison and 4% in Nagorno-Karabagh.
  
  
  CONCLUSIONS
  These results show the limits of SCC in settings with a high prevalence of drug resistance. They demonstrate that adapting treatment according to resistance patterns, access to reliable culture, DST and good quality second-line drugs are necessary.
authors.affiliation: Médecins Sans Frontières, Paris, France. maryline.bonnet@geneva.msf.org
authors.forename: M
authors.initials: M
authors.lastname: Bonnet
authors.forename: V
authors.initials: V
authors.lastname: Sizaire
authors.forename: Y
authors.initials: Y
authors.lastname: Kebede
authors.forename: A
authors.initials: A
authors.lastname: Janin
authors.forename: D
authors.initials: D
authors.lastname: Doshetov
authors.forename: B
authors.initials: B
authors.lastname: Mirzoian
authors.forename: A
authors.initials: A
authors.lastname: Arzumanian
authors.forename: T
authors.initials: T
authors.lastname: Muminov
authors.forename: E
authors.initials: E
authors.lastname: Iona
authors.forename: L
authors.initials: L
authors.lastname: Rigouts
authors.forename: S
authors.initials: S
authors.lastname: Rüsch-Gerdes
authors.forename: F
authors.initials: F
authors.lastname: Varaine
mesh_terms: D000995:Antitubercular Agents / Q000008:administration & dosage*; D016001:Confidence Intervals; D023801:Directly Observed Therapy / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000453:epidemiology; D014586:USSR / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents