V Rusovich1, A M V Kumar2, A Skrahina3, H Hurevich3, A Astrauko3, P de Colombani4, K Tayler-Smith5, M Dara4, R Zachariah5. 1. World Health Organization (WHO) Country Office, Minsk, Belarus. 2. International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India. 3. Republican Scientific and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus. 4. WHO Regional Office for Europe, Copenhagen, Denmark. 5. Médecins Sans Frontières (MSF), Operational Centre Brussels, MSF-Luxembourg, Luxembourg.
Abstract
SETTING: Belarus (Eastern Europe) is facing an epidemic of multidrug-resistant tuberculosis (MDR-TB). In 2012, rapid molecular diagnostics were prioritised for sputum smear-positive pulmonary tuberculosis (PTB) patients to diagnose MDR-TB, while pulmonary sputum smear-negative pulmonary TB (SN-PTB) patients were investigated using conventional methods, often delaying the diagnosis of MDR-TB by 2-4 months. OBJECTIVE: To determine the proportion of MDR-TB among SN-PTB patients registered in 2012 and associated clinical and demographic factors. DESIGN: Retrospective cohort study using countrywide data from the national electronic TB register. RESULTS: Of the 5377 TB cases registered, 2960 (55%) were SN-PTB. Of the latter, 1639 (55%) were culture-positive, of whom 768 (47%) had MDR-TB: 33% (363/1084) were new and 73% (405/555) previously treated patients. Previous history of treatment, age, region, urban residence, human immunodeficiency virus (HIV) status and being a pensioner were independently associated with MDR-TB. CONCLUSION: About half of culture-positive SN-PTB patients have MDR-TB and this rises to over 7/10 for retreatment cases. A national policy decision to extend rapid molecular diagnostics universally to all PTB patients, including SN-PTB, seems justified. Steps need to be taken to ensure implementation of this urgent priority, given the patient and public health implications of delayed diagnosis.
SETTING: Belarus (Eastern Europe) is facing an epidemic of multidrug-resistant tuberculosis (MDR-TB). In 2012, rapid molecular diagnostics were prioritised for sputum smear-positive pulmonary tuberculosis (PTB) patients to diagnose MDR-TB, while pulmonary sputum smear-negative pulmonary TB (SN-PTB) patients were investigated using conventional methods, often delaying the diagnosis of MDR-TB by 2-4 months. OBJECTIVE: To determine the proportion of MDR-TB among SN-PTB patients registered in 2012 and associated clinical and demographic factors. DESIGN: Retrospective cohort study using countrywide data from the national electronic TB register. RESULTS: Of the 5377 TB cases registered, 2960 (55%) were SN-PTB. Of the latter, 1639 (55%) were culture-positive, of whom 768 (47%) had MDR-TB: 33% (363/1084) were new and 73% (405/555) previously treated patients. Previous history of treatment, age, region, urban residence, human immunodeficiency virus (HIV) status and being a pensioner were independently associated with MDR-TB. CONCLUSION: About half of culture-positive SN-PTB patients have MDR-TB and this rises to over 7/10 for retreatment cases. A national policy decision to extend rapid molecular diagnostics universally to all PTB patients, including SN-PTB, seems justified. Steps need to be taken to ensure implementation of this urgent priority, given the patient and public health implications of delayed diagnosis.
Entities:
Keywords:
Eastern Europe; SORT IT; operational research
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