title: High time to use rapid tests to detect multidrug resistance in sputum smear-negative tuberculosis in Belarus.
abstract: METHODS
  Belarus (Eastern Europe) is facing an epidemic of multidrug-resistant tuberculosis (MDR-TB). In 2012, rapid molecular diagnostics were prioritised for sputum smear-positive pulmonary tuberculosis (PTB) patients to diagnose MDR-TB, while pulmonary sputum smear-negative pulmonary TB (SN-PTB) patients were investigated using conventional methods, often delaying the diagnosis of MDR-TB by 2-4 months.
  
  
  OBJECTIVE
  To determine the proportion of MDR-TB among SN-PTB patients registered in 2012 and associated clinical and demographic factors.
  
  
  METHODS
  Retrospective cohort study using countrywide data from the national electronic TB register.
  
  
  RESULTS
  Of the 5377 TB cases registered, 2960 (55%) were SN-PTB. Of the latter, 1639 (55%) were culture-positive, of whom 768 (47%) had MDR-TB: 33% (363/1084) were new and 73% (405/555) previously treated patients. Previous history of treatment, age, region, urban residence, human immunodeficiency virus (HIV) status and being a pensioner were independently associated with MDR-TB.
  
  
  CONCLUSIONS
  About half of culture-positive SN-PTB patients have MDR-TB and this rises to over 7/10 for retreatment cases. A national policy decision to extend rapid molecular diagnostics universally to all PTB patients, including SN-PTB, seems justified. Steps need to be taken to ensure implementation of this urgent priority, given the patient and public health implications of delayed diagnosis.
authors.affiliation: World Health Organization (WHO) Country Office, Minsk, Belarus.
authors.forename: V
authors.initials: V
authors.lastname: Rusovich
authors.affiliation: International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India.
authors.forename: A M V
authors.initials: AM
authors.lastname: Kumar
authors.affiliation: Republican Scientific and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus.
authors.forename: A
authors.initials: A
authors.lastname: Skrahina
authors.affiliation: Republican Scientific and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus.
authors.forename: H
authors.initials: H
authors.lastname: Hurevich
authors.affiliation: Republican Scientific and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus.
authors.forename: A
authors.initials: A
authors.lastname: Astrauko
authors.affiliation: WHO Regional Office for Europe, Copenhagen, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: de Colombani
authors.affiliation: Médecins Sans Frontières (MSF), Operational Centre Brussels, MSF-Luxembourg, Luxembourg.
authors.forename: K
authors.initials: K
authors.lastname: Tayler-Smith
authors.affiliation: WHO Regional Office for Europe, Copenhagen, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Dara
authors.affiliation: Médecins Sans Frontières (MSF), Operational Centre Brussels, MSF-Luxembourg, Luxembourg.
authors.forename: R
authors.initials: R
authors.lastname: Zachariah
keywords: Eastern Europe; SORT IT; operational research