E.B. Tsybikova, I.M. Son, T.P. Sabgaida
Federal Research Institute for Health Organization and Informatics of Ministry of Health and Social Development of the Russian Federation, Moscow

Summary. The aim of this study was to establish frequency of early discontinuation of the course of therapy and assess its impact on the efficacy of treatment administered for primary identified patients with destructive pulmonary tuberculosis in various regions of the Russian Federation.

The data from a Russian cohort trial for 2008-2009 was used in this study. Questionnaire survey was staged in 66 regions of the Russian Federation for various aspects of the problem, particularly with the purpose of identifying the number of patients with pulmonary bacteria excretion detected in sputa, including patients with multiple drug resistance of Mycobacterium tuberculosis. These 66 regions were ranged along the figures thus obtained. Then, three groups of patients were created and correlation analysis was performed in these three groups. A comparative analysis for pulmonary bacteria excretion was performed. These comparisons were estimated with the use of four-field tables along the criterion of χ² .

Correlation analysis showed that percentage of patients with discontinued therapy equivalent or lower than 5% did not influence total results of TB treatment in the population. More than 10% increase in their number also did not produce any tangible influence on the estimated efficacy of treatment of the whole pool of pulmonary TB patients obviously because the number of unsuccessful outcome of the treatment progressively increased irrespective of the relatively small share of discontinued cases. In one third of the surveyed regions of Russia the share of discontinued cases was from 5% to 10%, and in them a correlation between number of discontinued cases and unsuccessful outcomes was revealed. Comparative analysis in the pool of primary identified patients who then developed unsuccessful outcomes of treatment for destructive pulmonary tuberculosis showed that the share of patients with pulmonary bacteria excretion, including patients with multiple drug resistance of Mycobacterium tuberculosis, was much larger than of those with inopportune discontinued therapy. An index of efficacy of pulmonary TB treatment was elaborated and implemented in this study. It showed that 38% of regions of Russia had low efficacy, while 8% had an extremely low one where unsuccessful outcomes pre-dominated.

It turned out that any impact of discontinued cases was determined by the magnitude of the index of expectancy. The correlation analysis showed that the impact of the frequency of discontinued treatment upon the efficacy of treatment in the total pool of pulmonary TB patients diminished with the progressive increase of the share of unsuccessful outcome and that the very impact of a decision to discontinue therapy on an individual pulmonary TB affected patient was pre-determined by the index of expectancy which was rather low in the afore-depicted epidemiology situation. 79% of regions had low or very low indices of expectancy in the total pool of pulmonary TB patients. In the pool of pulmonary TB patients with unsuccessful outcome, the share of patients with pulmonary bacteria excretion, including patients with multiple drug resistance of Mycobacterium tuberculosis, was much larger than of those with merely early discontinued therapy.

Keywords. Cohort analysis; pulmonary tuberculosis; destruction of pulmonary tissue; treatment outcomes; correlation analysis; comparative analysis.

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