PULMONARY TUBERCULOSIS PATIENTS DETECTED DURING MASS SCREENING AND BY REFERRAL TO MEDICAL UNITS

In Russia tuberculosis patients are detected during preventive mass screening and by self referral to medical units with clinical signs of the disease.Goal of the study: to compare pulmonary tuberculosis patients detected during mass screening and by self referral to medical units with clinical signs of the disease.Materials and methods: Data about 446 pulmonary tuberculosis patients treated in Republican TB Dispensary of Saransk in 2012-2014 were retrieved from Rosttsat Forms no. 8 and 33 and Russian Ministry of Health Reporting Forms (Edict 50). Statistica software was used for data processing.Results. Among 446 pulmonary tuberculosis patients detected in 2012-2014, the part of those detected during mass screening made ¾ out of total number, and those detected by self-referral made ¼, however the latter group of patients was significantly more dangerous from epidemiological point of view, since among them the part of those with long period of the disease before treatment start was higher, the positive sputum tests were more often observed as well as pulmonary cavities and primary MDR compared to the patients detected during mass screening.The obtained results point out at the need to focus on mass screening in the targeted groups of population concentrated around sources of infection

Подходы к организации выявления туберкулеза органов дыхания в условиях снижения его распространенности

The objective of the study: to develop a number of organizational measures aimed to improve the effectiveness of early detection and prevention of respiratory tuberculosis among the population including people living with HIV (PLHIV) exposed to tuberculosis infection.Subjects and methods. The authors used data of 34 patients suffering from chronic respiratory tuberculosis residing in Saransk; they all had bacterial excretion and were monitored in the TB dispensary in 2015; also, data of 198 respiratory tuberculosis patients residing in Saransk in 2014-2015 were used, these data were obtained from Rosstat Form No. 33 and reporting forms of Edict no. 50 of the Ministry of Health of Russia. For all patients, gender, age, year of birth, address of actual residence (street, house number) are indicated. For the analysis, statistical and cartographic analysis based on geographic information systems (GIS) was used as well as data on the number and density of the population in Saransk, and the type of development in each district of the city. The cartographic web service of OpenStreetMap (OSM) was used as a cartographic basis.Results. The use of a cartographic method based on GIS allowed expanding the concept of a tuberculous nidus setting up buffer zones, within which tuberculosis infection also spread as a result of accidental exposure of population to the source of infection. Use of the cartographic method demonstrated that within the buffer zones for 1 patient with chronic respiratory tuberculosis with MTB+ there were 4 new tuberculosis patients. To reduce this ratio, multi-level comprehensive organizational measures were developed aimed at the early detection and diagnosis of tuberculosis among population, including PLHIV residing near infection nidi. Цель исследования: разработка комплекса организационных мероприятий, направленных на повышение эффективности раннего выявления и профилактики туберкулеза органов дыхания среди населения, в том числе лиц, живущих с ВИЧ (ЛЖВ), проживающего вблизи эпидемических очагов туберкулезной инфекции.Материалы и методы. Использованы данные о 34 пациентах из г. Саранска с хроническим течением туберкулеза органов дыхания, с бактериовыделением, находившихся под наблюдением в противотуберкулезном диспансере в 2015 г., и сведения о 198 заболевших туберкулезом органов дыхания в г. Саранске в 2014-2015 гг., полученные из отчетной формы Росстата № 33 и отчетных форм приказа 50 Минздрава России. Для всех пациентов указаны пол, возраст, год рождения, адрес фактического проживания (улица, номер дома).Для анализа применяли методы статистического и картографического анализа на основе геоинформационных систем (ГИС), использованы сведения по г. Саранску о численности и плотности населения, о типе застройки в каждом районе города. В качестве картографической основы использован картографический web-сервис OpenStreetMap (OSM).Результаты исследования. Использование картографического метода на основе ГИС позволило расширить понятие туберкулезного очага за счет буферных зон, в пределах которых происходит также распространение туберкулезной инфекции в результате случайных контактов источника инфекции с населением. Использование картографического метода показало, что в пределах буферных зон на 1 больного с хроническим туберкулезом органов дыхания с МБТ+ приходилось 4 пациента, впервые заболевших туберкулезом. Для снижения величины данного соотношения был разработан многоуровневый комплекс организационных мероприятий, направленных на раннее выявление и диагностику туберкулеза среди населения, в том числе ЛЖВ, проживающего вблизи эпидемических очагов

ТУБЕРКУЛЕЗ ЛЕГКИХ У ПАЦИЕНТОВ, ВЫЯВЛЕННЫЙ ВО ВРЕМЯ ПЕРИОДИЧЕСКИХ ОСМОТРОВ И ПРИ ОБРАЩЕНИИ В МЕДИЦИНСКИЕ ОРГАНИЗАЦИИ

In Russia tuberculosis patients are detected during preventive mass screening and by self referral to medical units with clinical signs of the disease.Goal of the study: to compare pulmonary tuberculosis patients detected during mass screening and by self referral to medical units with clinical signs of the disease.Materials and methods: Data about 446 pulmonary tuberculosis patients treated in Republican TB Dispensary of Saransk in 2012-2014 were retrieved from Rosttsat Forms no. 8 and 33 and Russian Ministry of Health Reporting Forms (Edict 50). Statistica software was used for data processing.Results. Among 446 pulmonary tuberculosis patients detected in 2012-2014, the part of those detected during mass screening made ¾ out of total number, and those detected by self-referral made ¼, however the latter group of patients was significantly more dangerous from epidemiological point of view, since among them the part of those with long period of the disease before treatment start was higher, the positive sputum tests were more often observed as well as pulmonary cavities and primary MDR compared to the patients detected during mass screening.The obtained results point out at the need to focus on mass screening in the targeted groups of population concentrated around sources of infection. В России выявление больных туберкулезом происходит во время массовых периодических осмотров и при самостоятельном обращении лиц в медицинские организации с клиническими проявлениями болезни.Цель исследования: сравнительная характеристика больных туберкулезом легких, выявленных во время периодических осмотров и при обращении в медицинские организации с клиническими проявлениями болезни.Материалы и методы: сведения о 446 больных туберкулезом легких, лечившихся в ГКУЗ «Республиканский противотуберкулезный диспансер» г. Саранска в 2012-2014 гг., получены из отчетных форм Росттата № 8 и 33 и отчетных форм Минздрава России (приказ № 50). Для обработки данных применены стандартные пакеты статистических программ Statistica.Результаты. Среди 446 больных туберкулезом легких, выявленных в 2012-2014 гг., доля выявленных при периодических осмотрах составляла ¾ от их общего числа, а при обращении в медицинские организации с клиническими проявлениями болезни - ¼, однако именно эти пациенты были значительно опаснее в эпидемическом плане, поскольку среди них была достоверно выше доля лиц с длительными периодами заболевания до начала лечения и достоверно чаще обнаруживались бактериовыделение, полости распада в легких и первичная МЛУ МБТ по сравнению с пациентами, выявленными при периодических осмотрах. Полученные результаты свидетельствуют о необходимости фокусирования массовых периодических осмотров на целевых группах населения, сконцентрированных вокруг очагов инфекции

Tuberculosis preventive chemotherapy in the HIV infected in the regions of the Russian Federation with high prevalence of HIV infection

In 2014 in 18 regions of the Russian Federation with the high prevalence of HIV infection the part of HIV patients covered by tuberculosis preventive chemotherapy was extremely small making 5.8% out of the total number. And the part of children and adolescents in the age from 0 to 17 years old made only 1.8%. Only in 6 out of 18 Russian regions the preventive tuberculosis chemotherapy was conducted among new HIV patients. In 15 Russian regions among HIV infected children and adolescents in the age from 0 to 17 years old no preventive tuberculosis chemotherapy was done

Efficiency evaluation of regular mass screening aimed at tuberculosis detection

For the last 15 years the incidence of tuberculosis decreased 1.5 fold in Russia and in 2014 it made 59.5 per 100,000 population. And for the last 5 years the part of the population covered by regular mass screening increased by 1.1 fold and achieved 67.7% in 2014. On the contrary the number of tuberculosis patients detected during the same period decreased 1.3 fold and in 2014 it made 0.044% out of the total number of those screened. This situation provides evidence that given tuberculosis incidence decreasing every year, screening is ineffective from economic point of view since the costs of one TB case detection multiply increase

ANALYSIS OF TUBERCULOSIS AND HIV INFECTION MORTALITY IN THE REGIONS OF THE RUSSIAN FEDERATION WITH THE MATRIX USE

The use of the matrix to analyze mortality from tuberculosis and HIV-infection allows uniting the RF regions into homogeneous groups depending on the mortality level due to both infections. The matrix analysis has proved that only in 23 regions of Russia with low mortality level from both infections the risk of increase in HIV mortality due to the increase of lethal outcomes among tuberculosis patients with concurrent HIV infection is minimal while in the remaining 57 Russian regions it remains high

TUBERCULOSIS WITH CONCURRENT HIV INFECTION IN RUSSIA: STATISTICS AND CORRELATIONS

The objective of the study is to analyze TB/HIV co-infection situation in the regions of RF and to identify correlated epidemiological rates.Subjects and methods. The data from Rosstat Forms no. 61, 8 and 33 were used as well as Rosstat data on the number of population for 2017.The data reflecting the structure of the patients with TB/HIV co-infection were obtained from Rosstat Form no. 61 for 2017.In order to define correlations between the rates characterizing the population of tuberculosis patients and patients with TB/HIV co-infection, the correlation analysis was performed (the standard tools of Statistica software).Results of the study. In Russia, TB/HIV co-infection was not equally prevalent and it was the highest in 35 regions of Russia. According to the results of correlation analysis, in 37 RF regions with a low level of TB/HIV co-infection (< 7% of the total number of tuberculosis patients), tuberculosis mortality during the 1st year of follow-up depended on the prevalence of multiple drug resistant tuberculosis (MDR TB) among all tuberculosis patients. In 48 Russian regions with a high level of TB/HIV co-infection (≥ 7% of the total number of tuberculosis patients), the prevalence of MDR TB and mortality in the patients within the 1st year of follow up directly depended on the prevalence of this co-infection. In 16 Russian regions, where the portion of new cases with concurrent MDR TB made from 23 to 60%, the risk of lethal outcome was the highest. The co-morbidity with hepatitis was observed in 42% of new cases of co-infection and in 43% of all those being followed-up