Does one size fit all? Drug resistance and standard treatments: results of six tuberculosis programmes in former Soviet countries.
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.
Bonnet
M
M
Médecins Sans Frontières, Paris, France. maryline.bonnet@geneva.msf.org
Sizaire
V
V
Kebede
Y
Y
Janin
A
A
Doshetov
D
D
Mirzoian
B
B
Arzumanian
A
A
Muminov
T
T
Iona
E
E
Rigouts
L
L
Rüsch-Gerdes
S
S
Varaine
F
F
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
D000995:Antitubercular Agents