title: Poor treatment outcomes among multidrug-resistant tuberculosis patients in Gomel Region, Republic of Belarus.
abstract: METHODS
  Tuberculosis (TB) health facilities in the Gomel Region, Republic of Belarus-settings with a high burden of multidrug-resistant TB (MDR-TB) and human immunodeficiency virus (HIV) infection.
  
  
  OBJECTIVE
  To determine treatment outcomes among MDR-TB patients diagnosed in 2009-2010 and factors associated with unsuccessful outcomes (death, failure and loss to follow-up).
  
  
  METHODS
  Retrospective cohort study involving a review of an electronic patient database maintained under the National Tuberculosis Control Programme.
  
  
  RESULTS
  Of 517 patients diagnosed, 78 (15%) did not start treatment. Among 439 patients who started treatment (84% males, median age 45 years, 15% HIV-infected), 291 (66%) had unsuccessful outcomes (35% deaths, 18% treatment failure and 13% lost to follow-up). Multivariate regression analysis showed that patients aged ⩾45 years (aRR 1.2, 95%CI 1.1-1.3), HIV-infected patients and those not receiving antiretroviral therapy (ART) (aRR 1.5, 95%CI 1.4-1.6) and those with a previous history of anti-tuberculosis treatment (aRR 1.2, 95%CI 1.1-1.4) had significantly higher risk of unsuccessful outcomes.
  
  
  CONCLUSIONS
  Treatment outcomes among MDR-TB patients were poor, with high rates of death, failure and loss to follow-up (including pre-treatment loss to follow-up). Urgent measures to increase ART uptake among HIV-infected MDR-TB patients, improved access to second-line anti-tuberculosis drug susceptibility testing and comprehensive patient support measures are required to address this grim situation.
authors.affiliation: Gomel Regional Tuberculosis Hospital, Gomel, Belarus.
authors.forename: A
authors.initials: A
authors.lastname: Khaliaukin
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 of Pulmonology and Tuberculosis, Minsk, Belarus.
authors.forename: A
authors.initials: A
authors.lastname: Skrahina
authors.affiliation: Republican Scientific and Practical Centre of Pulmonology and Tuberculosis, Minsk, Belarus.
authors.forename: H
authors.initials: H
authors.lastname: Hurevich
authors.affiliation: World Health Organization (WHO) Country Office in Belarus, Minsk, Belarus.
authors.forename: V
authors.initials: V
authors.lastname: Rusovich
authors.affiliation: WHO Country Office in Uzbekistan, Tashkent, Uzbekistan.
authors.forename: J
authors.initials: J
authors.lastname: Gadoev
authors.affiliation: WHO, Global TB Programme, Geneva, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Falzon
authors.affiliation: Operational Research Unit/Operations, Medical Department Médecins Sans Frontières (MSF), Operational Centre Brussels, MSF-Luxembourg, Luxembourg.
authors.forename: M
authors.initials: M
authors.lastname: Khogali
authors.affiliation: WHO Regional Office for Europe, Copenhagen, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: de Colombani
keywords: Eastern Europe; SORT IT; operational research