Does one size fit all? Drug resistance and standard treatments: results of six tuberculosis programmes in former Soviet countries
Abstract:SETTING: After the collapse of the Soviet Union, countries in the region faced a dramatic increase in tuberculosis cases and the emergence of drug resistance.
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: October 1, 2005
The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.
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