To evaluate outcomes of tuberculosis (TB) patients treated in the first year of a TB control demonstration project using a revised strategy of directly observed treatment, short-course (DOTS). Standard methods recommended by World Health Organization (WHO) were adapted to include mycobacterial cultures.
Retrospective cohort analysis of TB patients diagnosed between October 1999 and September 2000.
Among 749 TB patients, 65% had bacteriologic confirmation of pulmonary TB, 31% were diagnosed clinically, and 4% had extra-pulmonary TB. Most (92%) had no previous TB treatment, but 8% were identified as retreatment cases. Of all patients, 41% had new sputum smear-positive TB. No patients were HIV-infected. Multidrug-resistant (MDR) TB levels were 3% among new and 17% among retreatment patients. Among new smear-positive patients, treatment success was 79% (72% cure, 7% completion); remaining outcomes were 8% failure, 3% default, 8% death, and 1% transfer. Success rates for new culture-positive and clinically diagnosed patients were 81% and 91%, respectively.
Despite historical differences, successful implementation of the revised TB strategy in Russia is possible. Treatment success rates were high, suggesting WHO targets of 85% cure for smear-positive patients is attainable. Obstacles include drug resistance and elevated death rates among smear-positive patients.
Orel oblast, Russia, is the site of a WHO demonstration project for tuberculosis control. We used data acquired by the Center for Prevention of AIDS and Infectious Diseases to show that, in this region, the seroprevalence of HIV-1 infection has increased 33-fold in 4 years. The rapid spread of HIV-1 in Russia has serious implications for control of tuberculosis epidemics. Although the HIV-1 epidemic is at an early stage, aggressive prevention measures must be taken quickly to avoid the adverse effects of widespread HIV on tuberculosis control that have been seen in sub-Saharan Africa.