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Free Content Countrywide management of pulmonary tuberculosis reverses increasing incidence

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OBJECTIVE: To evaluate the impact of countrywide management of tuberculosis (TB) and the availability of second-line drugs (SLDs) on the notification rates of pulmonary TB (PTB) overall and of multidrug-resistant TB (MDR-TB), taking into account human immunodeficiency virus (HIV) co-infection and the national economy in Estonia.

DESIGN: Retrospective analysis of notification rates and treatment outcomes of PTB and MDR-TB during 1998–2006.

RESULTS: The annual notification rates of both PTB and MDR-TB decreased significantly, by on average 3.3 (P = 0.007) and 1.7 (P = 0.008) cases per 100 000 population, respectively. The accelerating impact of SLD availability on the annual decline was significant for both PTB overall and MDR-TB (P = 0.003 and P = 0.025, respectively). During 1998–2006, an increase in TB-HIV co-infection (P = 0.009) significantly affected the notification rates of both PTB overall and MDR-TB (P < 0.001 and P < 0.001, respectively). The negative impact of TB-HIV co-infection was counterbalanced by the availability of SLDs, the decrease in the MDR-TB rate and the increase in gross domestic product (GDP) per capita, as confirmed by multivariate analysis.

CONCLUSION: Countrywide access to SLDs and the coordinated effect of programmatic conditions can, in parallel with increasing GDP, reverse the increasing notification rates of PTB and MDR-TB in the context of an HIV epidemic.
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Keywords: Estonia; MDR-TB; National TB Programme; PTB

Document Type: Regular Paper

Affiliations: 1: Lung Clinic, Tartu University Clinics, Tartu, Estonia; Department of Communicable Diseases Prevention and Control, Reykjavik Health Care Services, Reykjavik, Iceland 2: National Institute for Health Development, Estonian Tuberculosis Registry, Tallinn, Estonia 3: Department of Communicable Diseases Prevention and Control, Reykjavik Health Care Services, Reykjavik, Iceland; Landspitali University Hospital, Department of Pulmonology, Reykjavik, Iceland 4: Department of Pulmonary Medicine, University of Tartu, Tartu, Estonia

Publication date: 2011-07-01

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  • 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.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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