Médecins Sans Frontières TB field research in Tajikistan, Uzbekistan and Kyrgyzstan
Childhood TB in Dushanbe, Tajikistan
Abstract
Children exposed to active TB, particularly within the
household, have an increased risk of developing TB disease. In
Tajikistan, a high-priority country for TB, the national policy
is that all children <7 years who have been in contact with
an active TB case should be screened and given isoniazid
preventive therapy (IPT), if not contraindicated. Currently,
little information is available on whether this policy is being
followed. We aimed to identify the trends in paediatric TB,
characteristics and treatment outcomes of paediatric TB, and
coverage of contact tracing and IPT delivery in the country.
We undertook a retrospective cohort study of
notified paediatric TB cases and household contacts in Dushanbe,
Tajikistan from 2009 to 2013 to investigate trends in, and
characteristics and outcomes of childhood TB cases, contact
tracing and the proportion of eligible paediatric contacts who
received IPT. During the study period, 380 paediatric TB cases
were notified, of which 218 (57%) treatment records were
available for analysis.
The majority of cases (N=138;
63%) were in the age group of 7–14 years. One hundred
thirty-seven cases (63%) had extrapulmonary TB, of which 78
cases had hilar lymph node TB, 20 had peripheral lymph node TB,
19 had tuberculous pleurisy, 10 had bone TB, 8 had intestinal TB
and 2 had TB meningitis. Successful treatment outcomes were
registered in 94% of cases. Household contacts of 157 (72%)
analysed paediatric TB cases were investigated; 61 households
were identified with smear-positive pulmonary TB; 44 (76%) out
of58 eligible children (<7 years) received IPT.
We
found successful treatment outcomes, contact tracing and IPT
coverage. However, strategies could be developed to further
scale up active case finding and national protocols, including
data linkages, to routinely monitor and evaluate the quality of
contact tracing.
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Characteristics and treatment outcomes of new pulmonary TB patients with comorbidities in the Samarkand Region, Uzbekistan
Abstract
Despite good progress made in the fight against tuberculosis
(TB), the disease remains a major public health threat
worldwide. Comorbid diseases that increase the risk of
developing active TB and have a negative impact on final
treatment outcomes include HIV and diabetes mellitus. The effect
of other conditions such as peptic ulcer and asthma/chronic
obstructive pulmonary disease (together defined as COPD for this
study) on TB is not clear. There is also little information in
Uzbekistan about the interaction between these comorbidities and
TB. This study was therefore carried out to assess the
characteristics and treatment outcomes of TB patients with these
specific comorbid conditions. This was a descriptive study of a
cohort of patients with newly diagnosed pulmonary TB with
specific comorbidities in the Samarkand region, Uzbekistan, from
2012 to 2013. There were 1260 patients with newly diagnosed TB,
of whom 193 (15%) had comorbidities: diabetes
(n = 116, 9%), HIV (n = 27, 2%), COPD
(n = 29, 2%) or peptic ulcer (n = 22, 2%).
Diabetes, COPD and peptic ulcer disease were mainly found in
patients aged 55 years and above, while HIV coinfection was
mainly found in patients aged 25–54 years. Clinical
characteristics were fairly similar between those with and
without comorbidities. Compared with those who had no
comorbidities, patients with comorbidities had significantly
reduced treatment success (78% versus 92%), a higher rate of
death (9% versus 2%) and higher treatment failure (2% versus
<1%). In conclusion, more attention needs to be paid to a
systematic and timely approach to the screening and treatment of
comorbidities in TB patients, to improve treatment outcomes and
reduce mortality.
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paper, click
here.
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Linkage between diagnosis and treatment of smear-positive pulmonary TB in urban and rural areas in Kyrgyzstan
Abstract
The performance of the tuberculosis (TB) programme should be
judged on the basis of detected TB cases recorded in the
laboratory register and not just those placed on treatment and
recorded in the TB treatment register. We examined the
performance of the TB programme in this regard in Kyrgyzstan in
2012.
This retrospective cohort study included all
sputum smear-positive pulmonary TB cases registered in the TB
laboratory register (584 persons). Data variables on
geographical region, TB diagnosis, TB treatment and outcomes
were sourced from various registers. We analysed (1) initial
lost to follow-up (LTFU) between urban and rural areas; (2) time
of starting treatment after diagnosis; (3) treatment outcomes of
laboratory-registered and treatment-registered patients.
Of
584 patients diagnosed with new smear-positive pulmonary TB in
two cities and eight rural districts, 59 (10%) were not traced
in the patient TB treatment register and considered as initial
LTFU. Rural areas had significantly higher initial LTFU (13%)
compared with urban areas (8%). The mean time to initiating
treatment among those who were entered in the TB register was 14
days (range 8–28 days). When all TB cases included in the
laboratory register were used as the denominator, the overall
treatment success rate reduced from 75% to 67% (a drop of
8%).
Reporting on TB programme outcomes without
including initial LTFU tends to exaggerate TB programme
performance. Concerted efforts are needed to limit initial LTFU
and accelerate progress towards ending TB as a public health
problem.
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here.
