S.A. Sterlikov1, S.N. Vorobey2, V.E. Odintsov2, A.V. Gazheva1
1Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow
2Department of Medical and Sanitary Care, Federal Penitentiary Service of Russia, Moscow
Summary. Background. Analysis of unfavorable
outcomes of TB treatment in prisons helps to develop measures to improve
treatment effectiveness which is crucial for improving tuberculosis
epidemic situation in general.
The aim of the study was to review problems related to treatment of patients with tuberculosis in prisons and develop possible solutions.
Methods. A prospective cohort study of treatment outcomes
of 16,922 patients with pulmonary tuberculosis, including 11,300 new
cases, 3,979 relapse cases and 1,649 other cases of re-treatment. Causes
for low effectiveness of TB treatment have been analyzed based on the
sample of 541 new smear positive pulmonary cases in prisons in 18
regions of Russia that met the quality criteria of cultural diagnostics
and with the share of transferred out less than 20%.
Results. In 75.6% of cases (97.1% among new cases)
chemotherapy regimens with first-line drugs were used. In 2011, 56.5% of
new cases cured and completed, while 10.8% failed. 5.3% of patients
continued treatment for multidrug resistant tuberculosis, 2.5% died,
3.5% defaulted and 21.4% transferred out.
Sample review of treatment results in 18 regions showed that the main
cause of unfavorable outcomes (42.4%) is multi-drug resistant
tuberculosis (MDR-TB). The outcome of "transferred out" accounted for
20.4% of unfavorable outcomes. Other causes were less common. Treatment
effectiveness of relapse cases was 45.0% and 25.3% for other courses of
re-treatment; decreased treatment effectiveness is due to early
termination of treatment.
Conclusion. Treatment effectiveness among new cases
decreases primarily due to multiple drug resistance, while treatment
effectiveness among re-treatment cases decreases due to lack of
compliance to treatment. To improve patient compliance actions aimed at
developing motivation for treatment adherence should be intensified.
Scope of application. Prisons in Russia.
Keywords: tuberculosis in prisons; organization of
treatment of patients with tuberculosis; outcomes of TB treatment in
prisons; TB treatment effectiveness; multiple drug resistance.
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