Phthisiology

doi: 10.25005/2074-0581-2018-20-2-3-235-239
EFFECTIVENESS OF TREATMENT OF PATIENTS WITH DRUG-RESISTANT FORMS OF PULMONARY TUBERCULOSIS IN THE REPUBLIC OF TAJIKISTAN

P.U. Makhmudova1, R.U. Makhmudova2, K.A. Zakirova2, P.U. Makhmudova1, R.U. Makhmudova2, K.A. Zakirova2

1Republican Center for the Protection of the Population from Tuberculosis, Dushanbe, Republic of Tajikistan
2Department of Phthisiopulmonology, Institute of Postgraduate Education in Healthcare of the Republic of Tajikistan, Dushanbe, Republic of Tajikistan

Objective: To conduct a comparative analysis of the effectiveness of treatment of drug-resistant (DR) forms of tuberculosis (TB) in the Republic of Tajikistan, including combination infection of DR TB/HIV for 2014-2017 years by region of the country.

Methods: The analysis of official statistic data on DR forms of TB with combined HIV infection from 2014 to 2017 was carried out in the framework of the implementation of the "National Strategic Plan for Population Protection from Tuberculosis in the Republic of Tajikistan for 2015-2020 years".

Results: Number of new cases of DR forms of TB with the started treatment in 2014 was 46.3%. In 2017, this number increased to 56%, which confirms the growth of TB with DR among new cases in the country. The number of cases with DR TB among the re-infected during this period decreased from 58% to 37%. The results of the treatment effectiveness of the DR TB cohort of 2015 at the level of the republic among cured and completed treatment were 58%. The failure of treatment – 7.8%, separation from treatment – 14.4%, lethality – 17.7%, continue treatment – 2.1%. The highest rate of treatment effectiveness of DR TB is observed in Dushanbe (72.8%). This is due to the fact that in all institutions organized DOTS cabinets, are available all diagnostics methods, have almost complete security personnel; more quality control of treatment is conducted. The failure to treat patients with DR forms of tuberculosis is 9.1%, separation from treatment is 4.5%, and mortality is 13.6%.

Conclusions: The comparatively high rate of treatment effectiveness of patients with DR TB in Dushanbe city (72.8%) proves the positive impact of such factors as the availability of modern diagnostic equipment and system are provided by qualified personnel treatment.

Keywords: Tuberculosis, drug resistance, co-infection of TB/HIV, treatment effectiveness, outcomes.

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References
  1. Tiberi S, Plessis N, Walzl G, Vjecha MJ, Rao M, Ntoumi F, et al. Tuberculosis: progress and advances in development of new drugs, treatment regimens, and host-directed therapies. The Lancet Infectious Diseases. 2018;18(7):183-98.
  2. Lange C, van Leth F, Mitnick CD, Dheda K, Günther G. Time to revise WHO-recommended definitions of MDR-TB treatment outcomes. The Lancet Infectious Diseases. 2018;6(4):246-8.
  3. Xu C, Pang Yu, Li R, Ruan Yu, Wang L, Chen M, Zhang H. Clinical outcome of multidrug-resistant tuberculosis patients receiving standardized second-line treatment regimen in China. Journal of Infection. 2018.76(4):348-53.
  4. Dedicoat MJ, Günther G, Crudu V, Duarte R, Gualano G, Magis-Escurra C, et al. Tuberculosis treatment outcomes in Europe: based on treatment completion, not cure. American Journal of Respiratory and Critical Care Medicine. 2018;196(9):1222-4.
  5. Dheda K, Chang KC, Guglielmetti L, Furin J, Schaaf HS, Chesov D, et al. Clinical management of adults and children with multidrug-resistant and extensively drug-resistant tuberculosis. J Clinical Microbiology and Infection. 2017;23(3):131-40.
  6. Hanrahan CF, van Rie A. A proposed novel framework for monitoring and evaluation of the cascade of HIV-associated TB care at the health facility level. Journal of the International AIDS Society. 2017;20(1):21-7.
  7. More on Treatment Outcomes in Multidrug-Resistant Tuberculosis. The New England Journal of Medicine. 2016;375(26):2609-11.
  8. Günther G, Lange C, Alexandru S. Treatment outcomes in multidrug-resistant tuberculosis. The New England Journal of Medicine. 2016;375(26):1103-5.
  9. Alikeeva EA, Ismailov ZhK, Berikova EA. Rezistentnye formy tuberkulyoza u VICH infitsirovannykh v Kazakhstane [Resistant forms of tuberculosis in HIV infected in Kazakhstan]. Nauka novye tekhnologii i innovatsii Kyrgyzstana. 2017;8:10-21.
  10. Yonchevska M, Munana P, Bobkova T, Khoffman KH, Kalmambetova G. Rasprostranyonnost' antituberkulyoznykh preparatov v Kyrgyzstane [Prevalence of antituberculous drugs in Kyrgyzstan]. Mezhdunarodnyy zhurnal zabolevaniy lyogkikh. 2013;12:118-26.
  11. Maksumova Z, Bikmetova F, Omar S, Yonchevska M, Abduloeva M. Pervye rezul'taty obsledovaniya MLU-TB v Tadzhikistane [The first results of a survey of MDR-TB in Tajikistan]. Mezhdunarodnyy zhurnal zabolevaniy lyogkikh. 2014;14:64-9.
  12. Yonchevska M, Khoffmann KH, Abildaev T, Bobokhodzhaev O. Nablyudenie za lekarstvennoy ustoychivost'yu v Tsentral'noy Azii [Monitoring of drug resistance in Central Asia]. Mezhdunarodnyy zhurnal zabolevaniy lyogkikh. 2013;18:104-11.
  13. Abdulloev RYu, Komissarova OG, Gerasimov LN. Vyrazhennost’ sistemnogo vospalitel’nogo otveta u bol’nykh tuberkulyozom, assotsiirovannym s VICH infektsiey [Severity of systemic inflammatory response in patients with tuberculosis associated with HIV infection]. Tuberkulyoz i bolezni lyogkikh. 2017;1:36-9.
  14. Fanosie A, Gelaw B, Tessema B, Tesfay W, Admasu A, Yitayew G. Mycobacterium tuberculosis complex and HIV co-infection among extrapulmonary tuberculosis suspected cases at the University of Gondar Hospital, Nothwestern Ethiopia. Eur J Immunol. 2016;3:32-8.
  15. Moydunova NK, Kalmambetova GI. Test Xpert MTB/RIF v diagnostike tuberkulyoznykh poliserozitov [Test Xpert MTB/RIF in the diagnosis of tuberculosis polyserosites]. Nauka novye tekhnologii i innovatsii Kyrgyzstana. 2017;8:44-6.
  16. Sterlikov SA, Rusakova LI. Model' epidemicheskoy situatsii po tuberkulyozu s shirokoy lekarstvennoy ustoychivost'yu v regionakh Rossii [Model of the epidemic situation of tuberculosis with broad drug resistance in the regions of Russia]. Vestnik TSNIIT. 2018;2:66-73.
  17. Falzon D, Gandzhi N, Miglior GB, Koks ES, Kholts T. Ustoychivost' k ftorkhinolonam i in’ektsionnym preparatam vtorogo ryada: vliyanie na rezul'taty lecheniya tuberkulyoza s mnozhestvennoy lekarstvennoy ustoychivost'yu [Resistance to fluoroquinolones and second-line injections: the impact on the results of treatment of multidrug-resistant tuberculosis]. Evropeyskiy zhurnal po respiratornym zabolevaniyam. 2013;42:156-68
  18. Okhkado A, Murase Y, Mori M, Khasegava N, Otsuka G, Nagamine M, i dr. Peredacha spetsificheskogo genotipa s shtammom mikobakteriy tuberkulyoza ustoychivykh k streptomitsinu v Tokio [Transmission of a specific genotype with a strain of Mycobacterium tuberculosis resistant to streptomycin in Tokyo]. Zhurnal infektsionnykh zabolevaniy. 2009;9:138-42.

Authors informations:

Makhmudova Parvina Ulmasovna, Phthisiatrician, Republican Center for the Protection of the Population from Tuberculosis

Makhmudova Rukhsora Ulmasovna, Assistant of the Department of Phthisiopulmonology, Institute of Postgraduate Education in Healthcare of the Republic of Tajikistan

Zakirova Kurbonkhon Akramovna, Doctor of Medical Sciences, Head of the Department of Phthisiopulmonology, Institute of Postgraduate Education in Healthcare of the Republic of Tajikistan

Address for correspondence:

Makhmudova Parvina Ulmasovna

Phthisiatrician, Republican Center for Protection of the Population from Tuberculosis

734025, Republic of Tajikistan, Dushanbe, Bukhoro str., 53

Tel.: (+992) 918 280003

E-mail: parvinahon.82@mail.ru

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