The New Profile of Drug-Resistant Tuberculosis in Russia A Global and Local Perspective: Summary of a Joint Workshop by the Institute of Medicine and the Russian Academy of Medical Science (2011) / Chapter Skim
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7 TB and Drug-Resistant TB in Vulnerable Populations
7 TB and Drug-Resistant TB in Vulnerable Populations
Pages 75-86
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From page 75... ...
• nterventions in the lives of TB patients who suffer from alcohol or I drug dependence can greatly reduce treatment default rates and the spread of drug-resistant strains. • espite an increase in HIV infection rates, the number of active D TB patients in Russian prisons has fallen by more than half over the past decade, in part because of more effective diagnostic and treatment programs.
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From page 76... ...
TB in children is a "hidden epidemic" and a major neglected child health problem he suggested, especially in communities that are ill equipped to address the problem adequately. Data typically include only microbiologically confirmed and mainly smear-positive cases, yet children frequently have extrapulmonary TB, which can be difficult to diagnose clinically and confirm bacteriologically and carries its own set of complications.
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From page 77... ...
, with associated massive mediastinal TABLE 7-1 Varying MDR TB Rates Revealed by Surveys of Anti-TB Drug Resistance in South American Children, 2001−2009 Any Isoniazid Patients Resistance Resistance MDR Country Year(s) of Survey Tested (%)
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From page 78... ...
Of the new cases, 99 were drug-susceptible, 14 exhibited monoresistance, 8 exhibited polyresistance, and 4 were MDR TB. The accuracy of these results depends on having both accurate bacteriological tests and good-quality samples, Pérez-Vélez empha érez-Vélez empha rez-Vélez élez lez sized.
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From page 79... ...
In unpublished 2008 data, among 140 culture-confirmed pediatric cases in two Johannesburg academic hospitals, 49 percent were infected with HIV, 14.2 percent showed resistance to isoniazid, and 8.8 percent had MDR TB. Among this latter group, 85 percent had received no previous TB treatment, none had a history of contact with an adult with MDR TB, 30 percent had a history of contact with an adult with TB, 54 percent were infected with HIV, and the mortality rate was 30 percent (with a quarter of these deaths occurring prior to confirmation of MDR TB)
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From page 80... ...
MDR TB TREATMENT FOR PEOPLE WITH DRUG AND ALCOHOL DEPENDENCIES2 According to Shin, people who abuse alcohol have a higher risk of contracting TB, having drug-resistant TB, and experiencing excess morbidity and mortality. Researchers have looked at the ethnography of alcohol abuse in different settings, the role of alcohol in causes of death, and the effect of alcohol interventions on TB and alcohol dependency outcomes.
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From page 81... ...
With financial support from Partners In Health, a cohort of patients was enlisted in MDR TB treatment from 2000 to 2002. Of 244 patients, 191 were cured, 16 failed, 12 died, and 25 defaulted.
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From page 82... ...
For those dependent on drugs, counseling is available from a substance abuse professional and psychologist throughout the course of therapy. Outreach workers from Nasha Klinika, a nongovernmental organization, encourage intravenous drug users and MDR TB patients to receive treatment, and arrangements are made for patients to visit a drug abuse clinic to address their addiction or reduce their doses of drugs.
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From page 83... ...
These efforts have had a dramatic effect on the outcomes of MDR TB patients, said Golubchikov. In 2005, the year after the Global Fund grant was launched in Tomsk, defaults among civilian patients in the DOTS-Plus program dropped from 28.8 percent to 13.9 percent, and this percentage has continued to fall since then (Figure 7-2)
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From page 84... ...
. The number of drug-resistant and MDR TB patients in Russia's penal institutions also has risen.
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From page 85... ...
percent of patients exhibited drug resistance, and 21.9 percent had MDR TB. Among relapse TB patients, these percentages were much higher -- 82.9 and 49.9 percent, respectively.
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From page 86... ...
Figure 7-5.eps SOURCE: Safonova, 2010. The Russian penitentiary service has several priorities, said Safonova: • e arly diagnosis of TB through x-ray and microbiological investigation, • c ontinued development of the prison service's laboratories and bacteriological investigation of all categories of TB patients, • i nternal and external quality control of laboratories, • c ontinued development of the expertise of medical staff and provi sion of training, and • c ontinuing international cooperation.
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