КОГОРТНЫЙ АНАЛИЗ РЕЗУЛЬТАТИВНОСТИ ЛЕЧЕНИЯ БОЛЬНЫХ ТУБЕРКУЛЕЗОМ, В ТОМ ЧИСЛЕ С УСТОЙЧИВОСТЬЮ К РИФАМПИЦИНУ, С МНОЖЕСТВЕННОЙ И ШИРОКОЙ ЛЕКАРСТВЕННОЙ УСТОЙЧИВОСТЬЮ ВОЗБУДИТЕЛЯ К ПРОТИВОТУБЕРКУЛЕЗНЫМ ПРЕПАРАТАМ В РОССИЙСКОЙ ФЕДЕРАЦИИ ЗА 2016–2020 гг.

Abstract

Objective: to analyze treatment outcomes in patients with TB, including multiple and extensive drug resistant TB (MDR/XDR-TB), in the Russian Federation in 2016–2020. Materials and methods. We used data from the state statistical observation and specialized inquiries. Results. During the five years the treatment success rate decreased from 64.9% in 2016 to 61.4% in 2020 while the proportion of unfavourable outcomes (treatment failure, death, lost for observation) grew from 27.1% in 2016 to 28.0% in 2020. The treatment success rate for chemotherapy regimens 1, 2, and 3 decreased from 69.0% in 2017 to 66.0% in 2020, which produced a negative impact on the indicative rate of treatment success for all TB cases (r = 0.99; p < 0.05). There was persistent growth in the number of cases (15,896 in 2011, 28,336 in 2018) and the treatment success rate for chemotherapy regimens 4 and 5 (MDR-TB cases) (37.1% in 2011, 56.1% in 2017). In 2020 the proportion of favourable outcomes for MDR-TB cases decreased from 56.1% in 2019 to 54.9% due to a growing number of treatment interrupters. During the recent five years we observed a dramatic growth in the number of XDR-TB cases (from 1,318 in 2012 to 4,968 in 2018) and the growing treatment success rate for XDR-TB cases (from 26.1% in 2012 to 42.9% in 2017 and 39.7% in 2018) while the lethality from XDR-TB decreased from 25.3% of cases notified in 2012 to 19.8% of cases notified in 2018. In 2017 and 2018 we observed the growing proportion of treatment failure cases (from 21.0% to 23.9%) and treatment interrupters (from 7.4% to 10.3%). Conclusion. The current dynamics of treatment success rate cannot lead to achieving the goals of the «Stop TB» strategy in the Russian Federation by 2025. The goals might be achieved by increasing effectiveness of treatment of TB patients, which receive chemotherapy regimens 1, 2, and 3. The treatment success rate for chemotherapy regimens 4 and 5 has grown from 54.7% to 56.1% due to decreased lethality from TB or other causes; this was preconditioned by the wide use of modern drugs (bedaquiline), new treatment protocols, and increased implementation of molecular genetic examinations for TB. The proportion of transferred out cases decreased due to the implementation of the Federal register of TB cases and improved access to ultimate treatment outcomes. In 2018 the number of MDR/XDR-TB cases continued to grow predominantly due to newly diagnosed cases. However, the treatment success rate fell due to a growing proportion of treatment interrupters (the typical effect of the COVID-19 pandemic) and increasing lethality from causes other than TB (including deaths from COVID-19). Effectiveness of XDR-TB treatment is slowly growing because of undeveloped infrastructure for testing novel drugs. The proportion of cases lost for the observation increased in the cohort of 2018 due to the COVID-19 pandemic; the general death rate decreased.Keywords: TB, multiple drug resistance, extensive drug resistance, the WHO «Stop TB» strategy, TB treatment, chemotherapy regimens, cohort analysis, deaths from TB.