Tuberculosis Treatment Interruptions—Ivanovo Oblast, Russian Federation, 1999

Irina G Danilova ,Erokhin ,N Afanasiev ,Oswald G ,Shapkin ,Mitunina L ,Punga ,Urastova M ,Stoyunin M ,Irina O Vassilieva

doi:10.1001/jama.285.15.1953

Abstract

In 1995 WHO implemented a pilot TB control project in the Ivanovo oblast of the Russian Federation. The project was based on five elements of WHO’s directly observed treatment short-course strategy for controlling TB and in most settings the strategy has resulted in cure rate of 85% or higher. However little improvement was noted in Ivanovo after the implementation of the strategy. Although 17% of these poor outcomes were attributed to primary multidrug-resistant TB other factors like treatment delay and interruption were not quantified. Thus CDC reviewed the TB treatment records for all newly diagnosed never-treated pulmonary TB patients registered in Ivanovo from April through June 1999. The aim was to determine the extent of treatment interruption as a potential cause of poor outcomes among TB patients. This report summarizes the results of the analysis and indicates that approximately one-fourth of highly infectious TB patients interrupted treatment for 2-8 weeks and nearly one-fourth of them interrupted treatment for more than 8 weeks. Based on these results TB project staff have increased efforts to reduce treatment interruption through use of incentives.

Highlights

IN THE RUSSIAN FEDERATION, THE NUMber of tuberculosis (TB) cases increased from 45,000 (34 per 100,000 population) in 1991 to 124,000
In most settings, implementing this strategy has resulted in cure rates of $85%2,3; little improvement occurred in cure rates in Ivanovo after implementation of this strategy in 1995.4,5 17% of these poor outcomes were attributed to primary multidrugresistant TB (MDR TB) (i.e., TB resistant to at least isoniazid and rifampin),[4] other factors that may have contributed to poor outcomes, such as treatment delay and interruption, were not quantified
The analysis was limited to new patients whose sputum smears were positive for acid-fast bacilli (AFB)

Summary

AND PREVENTION

IN THE RUSSIAN FEDERATION, THE NUMber of tuberculosis (TB) cases increased from 45,000 (34 per 100,000 population) in 1991 to 124,000 The frequency and duration of treatment interruptions and treatment outcomes were recorded. Patients were considered to have had a poor outcome if treatment failed (i.e., patient remained or again became AFB smear-positive following $5 months of treatment), they defaulted (i.e., interrupted treatment for .8 consecutive weeks), or they died for any reason during the course of TB treatment. Of the 31 AFB smear-positive patients who completed treatment, the median duration of treatment was 10 months (range: 6-18 months). Half of the patients interrupted treatment more than once, and the median duration of interruption was long, resulting in considerable delays in treatment completion and increasing the workload of staff responsible for tracking patients who interrupted or defaulted. Health-care providers are receiving performance-based rewards if their patients complete treatment

Strategy for Treating

DURING LATE MARCH AND EARLY APRIL

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