Does one size fit all? Drug resistance and standard treatments: results of six tuberculosis programmes in former Soviet countries
OBJECTIVE: To discuss the relevance of the DOTS strategy in settings with a high prevalence of drug resistance.
DESIGN: Retrospective analysis of one-year treatment outcomes of short-course chemotherapy (SCC) and results of drug susceptibility testing (DST) surveys of six programmes located in the former Soviet Union: Kemerovo prison, Russia; Abkhasia, Georgia; Nagorno-Karabagh, Azerbaijan; Karakalpakstan, Uzbekistan; Dashoguz Velayat, Turkmenistan; and South Kazakhstan Oblast, Kazakhstan. Results are reported for new and previously treated smear-positive patients.
RESULTS: Treatment outcomes of 3090 patients and DST results of 1383 patients were collected. Treatment success rates ranged between 87% and 61%, in Nagorno-Karabagh and Kemerovo, respectively, and failure rates between 7% and 23%. Any drug resistance ranged between 66% and 31% in the same programmes. MDR rates ranged between 28% in Karakalpakstan and Kemerovo prison and 4% in Nagorno-Karabagh.
CONCLUSION: These results show the limits of SCC in settings with a high prevalence of drug resistance. They demonstrate that adapting treatment according to resistance patterns, access to reliable culture, DST and good quality second-line drugs are necessary.
Document Type: Regular Paper
Affiliations: 1: Médecins Sans Frontières (MSF), Paris, France 2: MSF Belgium, Brussels, Belgium 3: MSF Holland, Amsterdam, The Netherlands 4: MSF Switzerland, Geneva, Switzerland 5: TB Dispensary, Karakalpakstan, Uzbekistan 6: TB Dispensary, Nagorno-Karabagh, Azerbaijan 7: TB Hospital, Abkhasia, Georgia 8: Almaty University, Almaty, Kazakhstan 9: Istituto Superiore Di Sanita, Roma, Italy 10: Institute of Tropical Medicine, Antwerp, Belgium 11: National Mycobacterial Reference Laboratory, Borstel, Germany
Publication date: 2005-10-01
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