title: Multidrug-resistant tuberculosis in Belarus: the size of the problem and associated risk factors.
abstract: OBJECTIVE
  To assess the problem of multidrug-resistant tuberculosis (MDR-TB) throughout Belarus and investigate the associated risk factors.
  
  
  METHODS
  In a nationwide survey in 2010-2011, 1420 tuberculosis (TB) patients were screened and 934 new and 410 previously treated cases of TB were found to meet the inclusion criteria. Isolates of Mycobacterium tuberculosis from each eligible patient were tested for susceptibility to anti-TB drugs. Sociobehavioural information was gathered in interviews based on a structured questionnaire.
  
  
  RESULTS
  MDR-TB was found in 32.3% and 75.6% of the new and previously treated patients, respectively, and, 11.9% of the 612 patients found to have MDR-TB had extensively drug-resistant TB (XDR-TB). A history of previous treatment for TB was the strongest independent risk factor for MDR-TB (odds ratio, OR: 6.1; 95% confidence interval, CI: 4.8-7.7). The other independent risk factors were human immunodeficiency virus (HIV) infection (OR: 2.2; 95% CI: 1.4-3.5), age < 35 years (OR: 1.4; 95% CI: 1.0-1.8), history of imprisonment (OR: 1.5; 95% CI: 1.1-2.0), disability sufficient to prevent work (OR: 1.9; 95% CI: 1.2-3.0), alcohol abuse (OR: 1.3; 95% CI: 1.0-1.8) and smoking (OR: 1.5; 95% CI: 1.1-2.0).
  
  
  CONCLUSIONS
  MDR-TB is very common among TB patients throughout Belarus. The numerous risk factors identified for MDR-TB and the convergence of the epidemics of MDR-TB and HIV infection call not only for stronger collaboration between TB and HIV control programmes, but also for the implementation of innovative measures to accelerate the detection of TB resistance and improve treatment adherence.
authors: Republican Scientific and Practical Centre for Pulmonology and Tuberculosis, Avenue Dolginovskitrakt 157, 220053 Minsk, Belarus. alena_skrahina@tut.by
authors: Alena
authors: A
authors: Skrahina
authors: Henadz
authors: H
authors: Hurevich
authors: Aksana
authors: A
authors: Zalutskaya
authors: Evgeni
authors: E
authors: Sahalchyk
authors: Andrei
authors: A
authors: Astrauko
authors: Sven
authors: S
authors: Hoffner
authors: Valiantsin
authors: V
authors: Rusovich
authors: Andrei
authors: A
authors: Dadu
authors: Pierpaolo
authors: P
authors: de Colombani
authors: Masoud
authors: M
authors: Dara
authors: Wayne
authors: W
authors: van Gemert
authors: Matteo
authors: M
authors: Zignol
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D016001:Confidence Intervals; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D016017:Odds Ratio; D002094:Republic of Belarus / Q000453:epidemiology; D012307:Risk Factors; D017678:Sex Distribution; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology*; D055815:Young Adult
references: Int J Tuberc Lung Dis. 2003 Sep;7(9):866-72
references: 12971671
references: BMC Public Health. 2009 Dec 05;9:450
references: 19961618
references: Thorax. 2005 Feb;60(2):130-5
references: 15681501
references: Int J Tuberc Lung Dis. 2008 Jul;12(7):756-62
references: 18544200
references: BMC Public Health. 2008 Aug 14;8:289
references: 18702821
references: Int J Tuberc Lung Dis. 2010 Apr;14(4):454-63
references: 20202304
references: Lancet. 2010 May 22;375(9728):1814-29
references: 20488524
references: Alcohol Clin Exp Res. 2011 Sep;35(9):1557-60
references: 21599711
references: PLoS One. 2010 Jan 07;5(1):e8479
references: 20062531
references: Eur Respir J. 2012 Jun;39(6):1425-31
references: 22005924
references: Bull World Health Organ. 2009 Sep;87(9):683-91
references: 19784448
references: Arch Intern Med. 2007 Feb 26;167(4):335-42
references: 17325294
references: Alcohol Clin Exp Res. 2010 Feb;34(2):317-30
references: 19930235
references: J R Soc Interface. 2010 Nov 6;7(52):1559-69
references: 20427332
references: Bull World Health Organ. 2006 Jan;84(1):43-51
references: 16501714
references: J Clin Microbiol. 2006 Mar;44(3):811-8
references: 16517859
references: J Clin Microbiol. 2006 Mar;44(3):688-92
references: 16517840
references: N Engl J Med. 2010 Sep 9;363(11):1005-15
references: 20825313
references: Thorax. 2006 Feb;61(2):158-63
references: 16254056
references: Bull World Health Organ. 2012 Feb 1;90(2):111-119D
references: 22423162
references: Emerg Infect Dis. 2005 Sep;11(9):1461-3
references: 16229783
references: Eur J Public Health. 2009 Jan;19(1):16-8
references: 19112073
references: Emerg Infect Dis. 2009 Nov;15(11):1812-4
references: 19891872
references: Eur Respir J. 2011 May;37(5):1269-82
references: 20947679
references: Bull World Health Organ. 2008 Feb;86(2):147-54
references: 18297170
references: Soc Sci Med. 2009 Jun;68(12):2240-6
references: 19394122