Particularităţile tuberculozei la adolescenţi

În studiu au fost incluse 296 de cazuri de tuberculoză la adolescenţi în vîrsta de la 14 pînă la 18 ani depistaţi în perioada anilor 2007 - iunie 2011. Predomină metoda pasivă de depistare a TB la adolescenţi – 161 (54,39 %). Situaţia epidemiologică actuală a tuberculozei la adolescenţi este caracterizată ca tensionată, cu frecvenţa înaltă a tuberculozei pulmonare infi ltrative (68,7%), cu distrucţie (27,7%) şi diseminaţie (16,3%), prezenţa TB MDR (9,4%). Factorii de risc a tuberculozei la adolescenţi sunt: condiţii de trai nesatisfăcătoare, neefectuarea chimioprofi laxiei, contact cu bolnavi de TB, maladii concomitente, focar de deces TB, nevaccinarea sau vaccinarea necalitativă BCG, chimioprofi laxia neregulată

Ответ на эпидемию туберкулеза в Республике Молдова

Response to the tuberculosis epidemic in the Republic of MoldovaÎn plan național tuberculoza rămâne una dintre problemele prioritare de sănătate publică, țara aflându-se printre 18 țări din regiunea Europeană a OMS cu prioritare înaltă în controlul tuberculozei și printre 30 țări ale lumii cu povară înaltă a TB MDR. În rezultatul implementării activităților de control a tuberculozei centrate pe necesitățile oamenilor: prevenire, depistare, tratament, din cadrul Programului Național de control a tuberculozei pentru anii 2016-2020, datele statistice demonstrează o ameliorare a indicatorilor epidemiologici TB pe parcursul ultimilor ani.Ответ на эпидемию туберкулеза в Республике Молдов

Public health benefits of shifting from hospital-focused to ambulatory TB care in Eastern Europe: Optimising TB investments in Belarus, the Republic of Moldova, and Romania

High rates of drug-resistant tuberculosis (DR-TB) continue to threaten public health, especially in Eastern Europe. Costs for treating DR-TB are substantially higher than treating drug-susceptible TB, and higher yet if DR-TB services are delivered in hospital. The WHO recommends that multidrug-resistant (MDR) TB be treated using mainly ambulatory care, shown to have non-inferior health outcomes, however, there has been a delay to transition away from hospital-focused MDR-TB care in certain Eastern European countries. Allocative efficiency analyses were conducted for three countries in Eastern Europe, Belarus, the Republic of Moldova, and Romania, to minimise a combination of TB incidence, prevalence, and mortality by 2035. A primary focus of these studies was to determine the health benefits and financial savings that could be realised if DR-TB service delivery shifted from hospital-focused to ambulatory care. Here we provide a comprehensive assessment of findings from these studies to demonstrate the collective benefit of transitioning from hospital-focused to ambulatory TB care, and to address common regional considerations. We highlight that transitioning from hospital-focused to ambulatory TB care could reduce treatment costs by 20% in Romania, 24% in Moldova, and by as much as 40% in Belarus or almost 35 million US dollars across these three countries by 2035 without affecting quality of care. Improved TB outcomes could be achieved, however, without additional spending by reinvesting these savings in higher-impact TB diagnosis and more efficacious DR-TB treatment regimens. We found commonalities in the large portion of TB cases treated in hospital across these three regional countries, and similar obstacles to transitioning to ambulatory care. National governments in the Eastern European region should examine barriers delaying adoption of ambulatory DR-TB care and consider lost opportunities caused by delays in switching to more efficient treatment modes

Public health benefits of shifting from inpatient to outpatient TB care in Eastern Europe: optimising TB investments in Belarus, the Republic of Moldova, and Romania

Background: High rates of drug-resistant tuberculosis (DR TB) continue to threaten public health, especially in Eastern Europe. Costs for treating DR TB are substantially higher than treating drug-susceptible TB, and higher yet if DR TB services are delivered in hospital. Therefore, countries are encouraged to transition from inpatient to ambulatory-focused TB care, which has been shown to have non-inferior health outcomes. / Methods: Allocative efficiency analyses were conducted for three countries in Eastern Europe, Belarus, the Republic of Moldova, and Romania to minimise a combination of active TB cases, prevalence of active TB, and TB-related deaths by 2035. These mathematical optimisations were carried out using Optima TB, a dynamical compartmental model of TB transmission. The focus of this study was to project the health and financial gains that could be realised if TB service delivery shifted from hospital to ambulatory-based care. / Findings: These analyses show that transitioning from inpatient to ambulatory TB care could reduce treatment costs by 5%−31% or almost 35 million US dollars across these three countries without affecting the quality of care. Improved TB outcomes could be achieved without additional spending by reinvesting these potential savings in cost-effective prevention and diagnosis interventions. / Conclusions: National governments should examine barriers delaying the adoption of outpatient DR TB care and consider the lost opportunities caused by delays in switching to more efficient and effective treatment modes

Building a tuberculosis-free world: The Lancet Commission on tuberculosis

___Key messages___ The Commission recommends five priority investments to achieve a tuberculosis-free world within a generation. These investments are designed to fulfil the mandate of the UN High Level Meeting on tuberculosis. In addition, they answer

Factorii de risc ai abandonului şi ai eşecului tratamentului strict supravegheat al tuberculozei

Summary. Risk Factors Associated with Default and Failure of Directly Observed Treatment for Tuberculosis. BACKGROUND: In the Republic of Moldova the success rates of TB treatment remain low (62% in 2007). GOAL: To identify and measure factors associated with DOT failure and default. METHODS: a retrospective case-control study of 99 cases (registered cases of treatment failure or default) and 198 controls (new TB cases that were still under TB treatment). RESULTS: Outpatient DOT program was correctly implemented in only 21.3% of cases and 33.2% of controls. Most significant predictors of adherence to treatment were: attending a physician for outpatient DOT within 5 days after hospital discharge (55.6% of cases and 74.2% of controls) and correct knowledge of length of treatment (62.8% cases and 80.2% controls). CONCLUSIONS: TB treatment success rate depends mostly on the health care providers, such as patient management, quality of medical care, continuity of health care, and information given to the patient about TB disease and treatment.Резюме. Факторы риска, ассоциированные с прерыванием курса противотуберкулезной контролируемой терапии. АКТУАЛЬНОСТЬ. В Республике Молдова уровень успешного лечения туберкулеза остается низким (62% в 2007 г.). ЦЕЛЬ. Oпределить и измерить факторы, связанные с прерыванием лечения ТБ. МЕТОДЫ. Pетроспективное исследование типа „случай-контроль”, основанноe на опросе 99 случаев (зарегистрированных случаев прерывания лечения туберкулеза) и 198 случяев в контрольной группе (новых случаев заболевания туберкулезом, которые находятся в фазе продолжения лечения туберкулеза). РЕЗУЛЬТАТЫ. Амбулаторный DOT был соблюден только в 21,3% случаев и 33,2% случяев в контрольной группе. Наиболее значимыми факторами приверженности к лечению ТБ были обращаемость к врачу для амбулаторного DOT в течение 5 дней после выписки из стационара (55,6% случаев и 74,2% – в контрольной группе) и правильные знания о продолжительности лечения (62,8% случаев и 80,2% – в контрольной группе). ВЫВОДЫ. Успех лечения туберкулеза в основном зависит от поставщиков медицинских услуг, своевременного перенаправления пациента, качества медицинской помощи, преемственности, и таже от качества информации, предоставляемой пациенту о болезни и лечении туберкулеза

Narrating the social relations of initiating injecting drug use: transitions in self and society.

Few studies have explored drug injectors' accounts of their initiation of others into injecting. There also lacks research on the social relations of initiating injecting drug use in transitional society. We draw upon analyses of 42 audio-recorded semi-structured interviews with current and recent injecting drug users, conducted in 2009 in the Republic of Moldova, a transitional society of south-eastern Europe. A thematic analysis informed by narrative theory was undertaken, focusing on accounts of self-initiation and the initiation of others. We also reflect upon the potential of peer efforts to dissuade would-be injectors from initiating. Findings emphasise initiation into injecting as a symbolic identity transition, enabled through everyday social relations. In turn, our analysis locates the drug transitions of the self inside an account of societal transition. We find that personal narratives of self transition are made sense of, and presented, in relation to broader narratives of social transition and change. Furthermore, we explore how narratives of self-initiation, and especially the initiation of others, serve to negotiate initiation as a moral boundary crossing. Self-initiation is located inside an account of transitioning social values. In looking back, initiation is depicted as a feature of a historically situated aberration in normative values experienced by the 'transition generation'. Accounts of the initiation of others (which a third of our sample describe) seek to qualify the act as acceptable given the circumstances. These accounts also connect the contingency of agency with broader narratives of social condition. Lastly, the power of peers to dissuade others from initiating injection was doubted, in part because most self-initiations were accomplished as a product of agency enabled by environment as well as in the face of peer attempts to dissuade