Analysis of undiagnosed tuberculosis-related deaths identified at post-mortem among HIV-infected patients in Russia: a descriptive study.
BACKGROUND
Tuberculosis remains a serious public health threat and economic burden in Russia with escalating rates of drug resistance against a background of growing HIV-epidemic. Samara Oblast is one of the regions of the Russian Federation where more than 1% of the population is affected by the HIV-epidemic; almost half of the cases are concentrated in the largely-industrial city of Togliatti with a population of 800 000.


METHODS
We conducted a retrospective analysis of errors leading to death of HIV-positive patients in general health care hospitals in Togliatti, Russia, in 2008. All (n = 29) cases when tuberculosis was established at autopsy as a cause of death were included.


RESULTS
Median length of hospital stay was 20 days; in 11 cases the death occurred within the first 24 hours of admission. All cases were known to be HIV-positive prior to admission, however HAART was not initiated for any case, and no relevant tests to assess severity of immunosupression were performed despite their availability. No appropriate diagnostic algorithms were applied to confirm tuberculosis. Major gaps were identified in the work of hospital and consulting physicians including insufficient records keeping. In almost all patients earlier regular HIV-relevant tests were not performed due to poor compliance of patients, many of whom abused alcohol and drugs.


CONCLUSIONS
We conclude that introduction of prompt and accurate diagnostics tests, adequate treatment protocols and intensive training of physicians in management of AIDS and TB is vital. This should include reviewing standards of care for HIV-positive individuals with accompanying social problems.
National Mycobacterium Reference Laboratory, Center for Infectious Diseases, Institute of Cell and Molecular Sciences, Queen Mary College, Barts and the London School of Medicine, University of London, 2 Newark Street, E1 2AT, London, UK. y.balabanova@qmul.ac.uk
Yanina
Y
Balabanova
Vladimir
V
Tchernyshev
Igor
I
Tsigankov
Svetlana
S
Maximova
Natalya
N
Mikheeva
Ljudmila
L
Fedyukovitch
Sergey
S
Kuznetsov
Ivan
I
Fedorin
Francis
F
Drobniewski
D000328:Adult; D001344:Autopsy; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012426:Russia / Q000453:epidemiology; D016019:Survival Analysis