ORGANIZATION OF TUBERCULOSIS TREATMENT IN RUSSIAN PRISONS IN 2012: CURRENT SITUATION AND RESOURCES TO IMPROVE EFFECTIVENESS
Background. Analysis of unfavorable outcomes of TB treatment in prisons helps to develop measures to improve treatment effectiveness which is crucial for improving tuberculosis epidemic situation in general. The aim of the study was to review problems related to treatment of patients with tuberculosis in prisons and develop possible solutions. Methods. A prospective cohort study of treatment outcomes of 16,922 patients with pulmonary tuberculosis, including 11,300 new cases, 3,979 relapse cases and 1,649 other cases of re-treatment. Causes for low effectiveness of TB treatment have been analyzed based on the sample of 541 new smear positive pulmonary cases in prisons in 18 regions of Russia that met the quality criteria of cultural diagnostics and with the share of transferred out less than 20%. Results. In 75.6% of cases (97.1% among new cases) chemotherapy regimens with first-line drugs were used. In 2011, 56.5% of new cases cured and completed, while 10.8% failed. 5.3% of patients continued treatment for multidrug resistant tuberculosis, 2.5% died, 3.5% defaulted and 21.4% transferred out. Sample review of treatment results in 18 regions showed that the main cause of unfavorable outcomes (42.4%) is multi-drug resistant tuberculosis (MDR-TB). The outcome of "transferred out" accounted for 20.4% of unfavorable outcomes. Other causes were less common. Treatment effectiveness of relapse cases was 45.0% and 25.3% for other courses of re-treatment; decreased treatment effectiveness is due to early termination of treatment. Conclusion. Treatment effectiveness among new cases decreases primarily due to multiple drug resistance, while treatment effectiveness among re-treatment cases decreases due to lack of compliance to treatment. To improve patient compliance actions aimed at developing motivation for treatment adherence should be intensified. Scope of application. Prisons in Russia.