title: Treatment outcomes in an integrated civilian and prison MDR-TB treatment program in Russia.
abstract: METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, MA 02120, USA. sshin@partners.org
authors.forename: S S
authors.initials: SS
authors.lastname: Shin
authors.forename: A D
authors.initials: AD
authors.lastname: Pasechnikov
authors.forename: I Y
authors.initials: IY
authors.lastname: Gelmanova
authors.forename: G G
authors.initials: GG
authors.lastname: Peremitin
authors.forename: A K
authors.initials: AK
authors.lastname: Strelis
authors.forename: S
authors.initials: S
authors.lastname: Mishustin
authors.forename: A
authors.initials: A
authors.lastname: Barnashov
authors.forename: Y
authors.initials: Y
authors.lastname: Karpeichik
authors.forename: Y G
authors.initials: YG
authors.lastname: Andreev
authors.forename: V T
authors.initials: VT
authors.lastname: Golubchikova
authors.forename: T P
authors.initials: TP
authors.lastname: Tonkel
authors.forename: G V
authors.initials: GV
authors.lastname: Yanova
authors.forename: M
authors.initials: M
authors.lastname: Nikiforov
authors.forename: A
authors.initials: A
authors.lastname: Yedilbayev
authors.forename: J S
authors.initials: JS
authors.lastname: Mukherjee
authors.forename: J J
authors.initials: JJ
authors.lastname: Furin
authors.forename: D J
authors.initials: DJ
authors.lastname: Barry
authors.forename: P E
authors.initials: PE
authors.lastname: Farmer
authors.forename: M L
authors.initials: ML
authors.lastname: Rich
authors.forename: S
authors.initials: S
authors.lastname: Keshavjee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011329:Prisoners; D015397:Program Evaluation; D012189:Retrospective Studies; D012426:Russia / Q000453:epidemiology; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents