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Measures to
Decrease
TB Prevalence in
the Barents Region
Andrey O. Maryandyshev
Elena I. Nikishova
Dmitry V. Perkhin
Tuberculosis incidence in the civil sector
(per 100,000 and in absolute figures)
2007
2008
2009
Arkhangelsk Region
45,7
(578)
46,0
(584)
45,2
(570)
Murmansk Region
45,9
(423)
68,7
(698)
43,0
(364)
67,4
(674)
46,6
(391)
60,1
(611)
62,5
(433)
49,1
(341)
51,9
(358)
Komi Republic
Republic of Karelia
Mortality from tuberculosis in the civil sector (per
100,000 and in absolute figures)
2007
2008
2009
Arkhangelsk Region
12,0
(154)
9,7
(123)
7,8
(99)
Murmansk Region
11,8
(101)
9,0
(76)
7,4
(62)
Komi Republic
14,1
(137)
16,2
(151)
15,7
(157)
Republic of Karelia
13,8
(150)
18,6
(129)
16,8
(116)
Total number of MDR TB patients in the civil sector
(in absolute figures)
2007
2008
2009
Arkhangelsk Region
434
436
439
Murmansk Region
260
263
244
Komi Republic
263
287
309
Republic of Karelia
185
206
213
The number of TB/HIV co-infection cases, detected
in the civil sector (in absolute figures)
2007
2008
2009
3
5
11
Murmansk Region
12
18
14
Komi Republic
11
20
6
Republic of Karelia
3
5
8
Arkhangelsk Region
Targets of the TB Control Program in the
Barents Region
• To cure at least 85% of new sputum smear-positive TB cases,
including drug resistant cases
• To detect at least 70% of the sputum smear-positive TB cases,
and rapidly detect drug resistant cases
• To prevent transborder transmission of the infection
Major activities
Provide treatment for TB patients
• Treatment strategies for susceptible and drug resistant TB complies
with international guidelines and recommendations
• TB drugs to treat drug susceptible tuberculosis cases are procured
from the Regional budgets
• Arkhangelsk Oblast, Republic of Karelia and Komi Republic have
been approved by the GLC – reserve line drugs (for the majority of
MDR TB patients) were procured by GFATM
Detection of smear-positive
and drug resistant TB cases
• At the primary health care level from 55 to 70% cases are
detected with sputum smear microscopy.
• Automated BACTEC system (liquid media) for rapid detection
of drug resistant TB strains is used.
Main challenges and possible solutions (1)
1. In 2010 the Global Fund ceases to support the Russian
Federation, therefore there is a risk of a drug supply
insufficient to cover all TB patients.
Suggestions (solutions):
• Purchase the drugs from the Federal and Regional budgets
(through target-oriented programs)
• Apply to the GFATM for continued support for reserve line
drug procurement
2. A high default rate among MDR TB patients is reported in
all territories
Suggestion:
• Patient social support should be an integral part of
treatment
Main challenges and possible solutions (2)
3. Amplification of drug resistance, including XDR TB
development, during treatment
Suggestion:
• in order to prevent nosocomial infection, in-patient TB
departments should have separated wards for:
- Susceptible TB cases;
- MDR TB cases;
-XDR TB and failure cases
4. MDR among new cases varies from 20 to 30 %; time needed to
detect drug resistance – 1 month (automated systems with liquid
media)
Suggestion:
• introduce molecular-genetic diagnostic methods and detect drug
resistance in 7 days (TB-BIOCHIP test system, Russia;
GenoType® MTBDRplus and GenoType® MTBDRsl, Hain
Lifescience GmbH, Germany)
Main challenges and possible solutions (3)
5. High risk of infection with M. Tuberculosis strains,
incl. MDR TB strains, for TB/HIV patients,
hospitalized in the inpatient departments
Suggestions:
• Open specialized isolated boxes for such patients in
the infectious diseases hospitals (infectious
departments)
• Develop together with the Center for Infectious
Diseases and HIV/AIDS Prevention joint patient
management programs
Suggestions
• To coordinate joint efforts it is recommended to regularly summon the
working group, which includes the head doctors of the TB facilities and heads of
Phthisiopulmonology chairs in the Barents Region
• To exchange experience in treatment and management of MDR TB and XDR
TB patients
• To exchange experience in the methods, allowing rapid detection of drug
resistant forms of tuberculosis
• To strengthen coordination between the civil and penal sectors in order to
reduce TB prevalence, including TB/HIV co-infection
• To establish an information system for MDR TB monitoring, allowing for
the analysis of the dynamic changes within this patient group
Immediate Plans
• Training on Infection Control (Murmansk)
• LFA Seminar on the challenges of TB and HIV (Saint
Petersburg)
• Conference for the head doctors of TB facilities, MDR and
XDR TB clinicians, heads of bacteriological laboratories and
TB registers of the Barents Region (Arkhangelsk, second half
of 2010)
Thank you for attention!