title: Management of multi- and extensively drug-resistant tuberculosis in Ukraine: how well are we doing?
abstract: METHODS
  A tertiary care facility in Ukraine, a high multi- and extensively drug-resistant tuberculosis (MDR/XDR-TB) burden country.
  
  
  OBJECTIVE
  To assess the management and treatment outcomes of MDR, pre-XDR-TB and XDR-TB.
  
  
  METHODS
  Cohort study using programme data, 2006-2011.
  
  
  RESULTS
  Of 484 individuals with drug-resistant TB, 217 (45%) had MDR-, 153 (32%) pre-XDR- and 114 (24%) XDR-TB. Of all resistant types completing the intensive phase of treatment, 322 (67%) were alive and had culture converted. This included 157 (72%) with MDR- and 61 (54%) with XDR-TB. At the end of the continuation phase of treatment, 106 (22%) had treatment success and 378 (78%) had unfavourable outcomes, including 110 (23%) failures, 21 (4%) deaths, 71 (15%) losses to follow-up and 176 (36%) with an unknown outcome. This was associated with more than one lung cavity being affected, a history of treatment with second-line anti-tuberculosis drugs, poor adherence and XDR-TB. A total of 226 (47%) patients reported at least one adverse drug reaction, the most common being gastrointestinal and vestibular toxicity.
  
  
  CONCLUSIONS
  Outcomes of MDR- and XDR-TB were satisfactory in the intensive phase; however, this was not sustained during the ambulatory period. If we are to do better, urgent measures are needed to improve ambulatory management, including making safer, shorter and more effective drug regimens available.
authors.affiliation: F G Yanovsky National Academy of Medical Sciences of Ukraine, Kiev, Ukraine.
authors.forename: N
authors.initials: N
authors.lastname: Lytvynenko
authors.affiliation: F G Yanovsky National Academy of Medical Sciences of Ukraine, Kiev, Ukraine.
authors.forename: S
authors.initials: S
authors.lastname: Cherenko
authors.affiliation: F G Yanovsky National Academy of Medical Sciences of Ukraine, Kiev, Ukraine.
authors.forename: Y
authors.initials: Y
authors.lastname: Feschenko
authors.affiliation: F G Yanovsky National Academy of Medical Sciences of Ukraine, Kiev, Ukraine.
authors.forename: M
authors.initials: M
authors.lastname: Pogrebna
authors.affiliation: F G Yanovsky National Academy of Medical Sciences of Ukraine, Kiev, Ukraine.
authors.forename: Y
authors.initials: Y
authors.lastname: Senko
authors.affiliation: F G Yanovsky National Academy of Medical Sciences of Ukraine, Kiev, Ukraine.
authors.forename: A
authors.initials: A
authors.lastname: Barbova
authors.affiliation: Brussels Operational Center, Médecins Sans Frontières (MSF), MSF Luxembourg, Luxembourg.
authors.forename: M
authors.initials: M
authors.lastname: Manzi
authors.affiliation: Global AIDS Alliance, Kiev, Ukraine.
authors.forename: O
authors.initials: O
authors.lastname: Denisiuk
authors.affiliation: Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland ; University of St Andrews Medical School, North Haugh, Scotland, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Ramsay
authors.affiliation: Brussels Operational Center, Médecins Sans Frontières (MSF), MSF Luxembourg, Luxembourg.
authors.forename: R
authors.initials: R
authors.lastname: Zachariah
keywords: MDR-TB drug regimens; SORT IT; decentralisation; operational research