ANALYSIS OF MORTALITY FROM TUBERCULOSIS CONCURRENT WITH HIV INFECTION

The presidential order lays down that tuberculosis mortality is a main criterion for evaluating the efficiency of antibuberculosis care to the population.Objective: to determine whether this criterion may be used to assess the activity of a phthisiatric service in its work with HIV-infected patients.Materials and methods. Why there was a discord in statistical data on death in patients with tuberculosis concurrent with HIV infection in the subjects of the Russian Federation was analyzed applying recording form No. 263-y/TB (a total of 49,559 cases during 7 years) and discussed with a number of investigators.Results. Analysis of death rates in patients with tuberculosis concurrent with HIV infection has shown that it may be of informative value only when the determinations of accounted cases are clearly understood. The use of statistical data without clearly understanding the pathogenesis of both diseases leads to incorrect conclusions and may considerably discredit the activity of a phthisiatric service.The latter should have individual criteria based on the clear understanding of the pathogenesis of tuberculosis at different stages of HIV infection to assess antituberculosis care to HIV-infected patients. Of them, the basic criteria must be those reflecting the extent to which the antiepidemic measures are observed when rendering health care to HIV-infected patients

THE STATUS OF A CONTINGENT OF PATIENTS WITH TUBERCULOSIS CONCURENT WITH HIV INFECTION IN THE RUSSIAN FEDERATION, INTERSECTORAL AND INTERDEPARTMENTAL INTERACTION IN ORGANIZING ANTITUBERCULOSIS CARE TO HIV-INFECTED PATIENTS

Multivariate analysis was made to analyze a contingent of patients with tuberculosis concurrent with HIV infection in the Russian Federation over 7 years, by applying recording form No. 263-y/TB “Tuberculosis/HIV Patient Card”. The tuberculosis/HIV patients were shown to be the most difficult contingent among both the patients with tuberculosis and those with HIV infection.Based on the characteristics of the contingent of co-infected patients, the authors propose additional recommendations to activate and improve approaches to preventing tuberculosis in HIV-infected patients. Among other activities, work is done in penitentiary and narcological facilities where there are commonly HIV-infected patients who are at high risk for tuberculosis and those who are unregistered in the AID center

АНАЛИЗ СМЕРТНОСТИ ОТ ТУБЕРКУЛЕЗА, СОЧЕТАННОГО С ВИЧ-ИНФЕКЦИЕЙ

The presidential order lays down that tuberculosis mortality is a main criterion for evaluating the efficiency of antibuberculosis care to the population.Objective: to determine whether this criterion may be used to assess the activity of a phthisiatric service in its work with HIV-infected patients.Materials and methods. Why there was a discord in statistical data on death in patients with tuberculosis concurrent with HIV infection in the subjects of the Russian Federation was analyzed applying recording form No. 263-y/TB (a total of 49,559 cases during 7 years) and discussed with a number of investigators.Results. Analysis of death rates in patients with tuberculosis concurrent with HIV infection has shown that it may be of informative value only when the determinations of accounted cases are clearly understood. The use of statistical data without clearly understanding the pathogenesis of both diseases leads to incorrect conclusions and may considerably discredit the activity of a phthisiatric service.The latter should have individual criteria based on the clear understanding of the pathogenesis of tuberculosis at different stages of HIV infection to assess antituberculosis care to HIV-infected patients. Of them, the basic criteria must be those reflecting the extent to which the antiepidemic measures are observed when rendering health care to HIV-infected patients. Основным критерием оценки эффективности противотуберкулезной помощи населению указом Президента определен показатель смертности от туберкулеза. Цель - определить возможность использования этого критерия для оценки деятельности фтизиатрической службы при работе с больными ВИЧ-инфекцией. Материалы и методы. Анализ причин диссонанса статистических данных о случаях смерти больных туберкулезом, сочетанным с ВИЧ-инфекцией, по субъектам РФ выполнен на основании учетных форм № 263/у-ТВ (за 7 лет, всего 49 559), и проведено их обсуждение с рядом исполнителей. Результаты. Анализ смертности больных туберкулезом, сочетанным с ВИЧ-инфекцией, показал, что он может быть информативным только при четком понимании определений учитываемых случаев. Использование статистических данных без ясного понимания патогенеза обеих болезней ведет к некорректным выводам и может серьезно дискредитировать деятельность фтизиатрической службы. Для оценки противотуберкулезной помощи больным ВИЧ-инфекцией во фтизиатрической службе необходимы отдельные критерии, построенные на четком понимании патогенеза туберкулеза на различных стадиях ВИЧ-инфекции. Основными из них должны стать те, которые отражают качество соблюдения противоэпидемических мероприятий при оказании медицинской помощи больным ВИЧ-инфекцией

СОСТОЯНИЕ КОНТИНГЕНТА БОЛЬНЫХ ТУБЕРКУЛЕЗОМ, СОЧЕТАННЫМ С ВИЧ-ИНФЕКЦИЕЙ, В РОССИЙСКОЙ ФЕДЕРАЦИИ, МЕЖСЕКТОРАЛЬНОЕ И МЕЖВЕДОМСТВЕННОЕ ВЗАИМОДЕЙСТВИЕ ПРИ ОРГАНИЗАЦИИ ПРОТИВОТУБЕРКУЛЕЗНОЙ ПОМОЩИ БОЛЬНЫМ ВИЧ-ИНФЕКЦИЕЙ

Multivariate analysis was made to analyze a contingent of patients with tuberculosis concurrent with HIV infection in the Russian Federation over 7 years, by applying recording form No. 263-y/TB “Tuberculosis/HIV Patient Card”. The tuberculosis/HIV patients were shown to be the most difficult contingent among both the patients with tuberculosis and those with HIV infection.Based on the characteristics of the contingent of co-infected patients, the authors propose additional recommendations to activate and improve approaches to preventing tuberculosis in HIV-infected patients. Among other activities, work is done in penitentiary and narcological facilities where there are commonly HIV-infected patients who are at high risk for tuberculosis and those who are unregistered in the AID center. Проведен многофакторный анализ контингента больных туберкулезом, сочетанным с ВИЧ-инфекцией, в Российской Федерации за 7 лет по учетной форме № 263-у/ТВ «Карта персонального учета больного туберкулезом, сочетанным с ВИЧ-инфекцией». Показано, что больные, имеющие одновременно туберкулез и ВИЧ-инфекцию, относятся к наиболее сложному контингенту как среди больных ВИЧ-инфекцией, так и среди больных туберкулезом. С учетом особенностей контингента больных сочетанной инфекцией предложены дополнительные рекомендации по активизации и усовершенствованию подходов к профилактике туберкулеза у больных ВИЧ-инфекцией. В частности, работа в пенитенциарных и наркологических учреждениях, где часто пребывают больные ВИЧ-инфекцией, относящиеся к группе высокого риска заболевания туберкулезом, в том числе не вставшие на учет в ЦСПИД