Mobile Health Intervention for Outpatient Treatment of Tuberculosis and HIV Infection

Aim of the study. To describe the results of using mobile health intervention for improving the compliance of patients with tuberculosis and HIV (TB/HIV). Materials and methods. Piloted clinic-affiliated mobile intervention was carried out in 54 patients with TB/HIV and with a history of psychoactive substances abuse in Irkutsk Regional Clinical Tuberculosis Hospital. The mobile intervention included a smartphone application that connected the participants to the staff of Irkutsk Regional TB Hospital and provided daily queries on stress, mood and medication adherence; appointment reminders; virtual support group and consultation resources; weekly quizzes. We assessed longitudinal impact on retention in medical care, visit constancy, viral loads and CD4 counts, TB outcomes. Results. In 6 months, we registered the increase (in comparison with baseline) in mean CD4 counts (F = 6.61; р = 0.04) and in the number of cases of suppressed viral loads – from 20.5 % (9/44) to 55.3 % (21/38) (p < 0.01) in TB/HIV users of e-health app. We found a lower level of TB treatment interruption in patients who used the application in comparison with the patients who refused to use it (4/44 vs 5/10; χ2 = 7.09; р = 0.008). App users completed the course of TB treatment in 63.6 % of cases (28/44), and 61.4 % of patients (27/44) were cured which was higher than the level in the control group (20 % (2/10)) (χ2 = 7.54; p = 0.03). Conclusion. This study has demonstrated that a mobile health intervention can have a positive impact on improving the medical and social care and clinical outcomes for TB/HIV patients with history of psychoactive substances abuse

HYLOGEOGRAPHY OF THE BEIJING LINEAGE IN MONGOLIA

Background. Mongolia is one of the seven countries in Western Pacific regions with high burden of tuberculosis. The earlier research indicates that there is a difference in the distribution of some epidemiologically important subtypes of the Beijing lineage in Mongolia and adjacent Russian regions. Aim of the research: assessment of genotypic structure of M. tuberculosis (MBT) on the border of Russia and central regions of Mongolia. Materials and methods: The DNAs of 143 clinical isolates of MBT from Russian border (46.2 %) and central (53.8 %) regions of Mongolia have been genotyped by the 24-locus MIRU-VNTR and RD105/RD207. Strains of the Beijing lineage have been analyzed additionally according to the classification by Merker et al. (2015). Results. The study of MBT in Mongolia indicates significant predominance of strains of the Beijing lineage (79.0 %) and Beijing MIT 17 subtype (72.6 %). However, the strains of the Beijing subtype W148, widespread in Irkutsk Oblast and Buryatia, have not been noted in Mongolia. According to the classification by M. Merker et al., the majority of studied strains of the Beijing lineage (85.8 %) relate to the clonal complexe CC4, infrequently detected in Russian border regions. Statistically significant differences between distribution of clonal complexes among border with Russia and central regions of Mongolia have not been detected. Conclusions. Strains of the clonal complex CC4 of Beijing lineage dominate in central and border to Russia regions of Mongolia, this allows assuming that the different geographical regions were sources of MBT strains, prevalent in Mongolia and adjacent Russian regions

GENETIC POLYMORPHISM OF MYCOBACTERIUM TUBERCULOSIS IN PATIENTS WITH TUBERCULOSIS AND HUMAN IMMUNODEFICIENCY VIRUS INFECTION IN EASTEN SIBERIA

A total 61 randomly selected strains of M. tuberculosis were genotyped by the 12 loci of MIRU-VNTR. It was shown the predominance of the Beijing genetic group (78,4 %) in population of mycobacterium from the patients with tuberculosis and. human immunodeficiency virus infection in Irkutsk region and. Buryatia. Multidrug resistance was observed in 34,4 % of the studied strains without significant differences among representatives of Beijing and non-Beijing

Genetic structure and drug resistance of <i>Mycobacterium tuberculosis</i> strains in the Kemerovo Region — Kuzbass

Background. Kemerovo Region has a high burden of tuberculosis (TB) with incidence rates twice the national average. The circulating variants of Mycobacterium tuberculosis significantly influence the TB epidemic process. Screening of epidemically significant variants of the pathogen in areas with a high burden of TB underlies epidemiological diagnosis and is necessary for the development of effective prevention measures. However, the population structure of M. tuberculosis in the Kemerovo Region — Kuzbass is poorly understood. Aims: to study genetic heterogeneity and phenotypic resistance to anti-tuberculosis drugs of M. tuberculosis strains in the Kemerovo Region. Materials and methods. The MIRU-VNTR genotyping of 163 M. tuberculosis strains isolated from TB patients in the Kemerovo Region in March–October 2022 was carried out. Cultivation of M. tuberculosis, drug susceptibility testing, and isolation of genomic DNA were carried out by standard methods. Genotypic identification was performed using MIRU-VNTR (24 loci) typing. In parallel, express genotyping was carried out: identification of isolates of the Beijing genotype (by RD105/207) and non-Beijing; subtyping Beijing using real-time PCR tests for detection of Central Asian Russian and B0/W148; identification of the non-Beijing group by real-tine PCR RT tests for LAM, S, Ural. Results. The isolates of the Beijing genotype (67.5%) were found to dominate both among newly diagnosed (64.4%) and previously treated patients (88.5%). MIRU-VNTR typing revealed 75 profiles, of which 94-32 (35.3%) and 100-32 (15.7%) were the most abundant and belonged to the Beijing genotype. Overall, 39.9% and 20.9% of isolates, respectively, were assigned to the Beijing Central Asian Russian and B0/W148 epidemic clusters, which differed significantly in MDR levels (50.8% and 85.3%, respectively; p = 0.005). The second most common were strains of the genetic family of the Euro-American lineage (L4) (31.9%): LAM (6.7%) Ural (7.4%) Haarlem (4.9%) and L4-unclassified (12.9%), MDR among of these minor genotypes was significantly lower than among Beijing genotype strains, and amounted to 11.5% (p 0.001). Strains from HIV-TB patients (56.4% of the total sample) carried an MDR profile more often (54.8%) compared to TB cases without HIV infection (35.2%) (p = 0.005), which may be due to higher proportion of Beijing genotype strains in the HIV-TB group (75.0% vs. 57.7%; p = 0.026). Complete comparability of the SNP analysis (in-house tests) to identify the main genotypes and epidemically significant Beijing subtypes was shown, which made it possible to characterize 75.5% of the sample by the express method. Conclusions. The molecular genetic screening carried out in the Kemerovo Region revealed the heterogeneity of the M. tuberculosis population, which was dominated by strains of the Beijing genotype, with the frequency of subtypes comparable with other territories of the Siberian Federal District

Molecular epidemiology of multidrug resistant tuberculosis in Mongolia and Eastern Siberia: two independent dissemination processes for dominant strains

Mongolia and Russia are among the countries with the high tuberculosis (TB) burden. The prevalence of tuberculosis, including multidrug-resistant tuberculosis (MDR), in Eastern Siberia bordering Mongolia is significantly higher than in the European part of Russia. In addition, unlike Mongolia, Eastern Siberia is characterized by a high prevalence of HIV infection. The cross-border spread of socially significant infections in these countries seems to occur due to their wide-range cooperation and cultural exchange. Whereas the HIV infection has no epidemiological significance for Mongolia at the moment, tuberculosis, however, has a similar prevalence on both sides of the border. The aim was to evaluate the cross-border MDR M. tuberculosis distribution in Mongolia and Eastern Siberia by using molecular genetic data. Materials and methods. A total of 1045 M. tuberculosis strains isolated in Mongolia (291) and the three regions of Eastern Siberia (754) were studied by using the MIRU-VNTR-24 loci genotyping. The CC2/W148 and CC1 subtypes were identified by the specific deletion in the kdpD gene and SNP in the pks17 gene at position 1887060, respectively. Phylogenetic analysis of MIRU-VNTR patterns was carried out by generating UPGMA tree and maximum likelihood tree. Results. The Beijing genotype was found in 75.3% (219/291) and 69.0% (520/754) from Mongolian and East Siberian collection, respectively. Common minor genotypes were LAM (11.0% and 15.1%), T (10.3% and 4.5%), and Haarlem (1.4% and 2.4%) found in Mongolia and Eastern Siberia, respectively. The genotypes S (1.3%) and Ural (5.0%) were found solely in the Russia-derived samples. The main epidemic Beijing subtypes in each country belonged to different clonal complexes (CC): the majority of Mongolian Beijing strains displayed profiles 342-32, 3819-32, 1773-32 MLVA types and belonged to the CC4 subtype; Russian Beijing strains mainly belonged to the CC1 (43.7% — 227/520) and CC2/W148 (34.8% — 181/520) subtypes. The MDR level and distribution patterns differed significantly between Mongolia and Eastern Siberia. Modeling of Beijing strain expansion evidences about extremely subtle contribution of the M. tuberculosis cross-border transmission between Mongolia and Russia. The phylogenetic reconstruction of Beijing CC4 subtype evolution in Mongolia suggests that its distribution is primarily associated with China and other countries of the Western Pacific Region. Three main phylogenetic branches of CC4 subtype were traced, which probably spread throughout Mongolia in the 11—12th centuries. It may be assumed that spreading of the epidemic Beijing CC4 subtype might occur in two stages: early period — emergence of ancestral CC4 variants in Mongolia or their introduction from China (they are homologous to the strains preserved in the Chinese population), later period — dissemination due to the active exchange of M. tuberculosis with countries of Southeast Asia, but not Russia. Conclusion. Using MIRU-VNTR-24 genotyping as well as classification according to specific single nucleotide polymorphisms specific to certain Beijing subtypes, it allowed to describe separate patterns of the epidemic variants spread in Mongolia and Russia. It has been demonstrated that emergence and spread of MDR-TB in Mongolia are entirely iatrogenic in nature, while the epidemic subtypes of the Beijing genotype (subtypes CC1 and CC2/W148) contribute markedly into the MDR-TB spreading in Eastern Siberia

THE DETECTION OF EPIDEMIC SUBTYPES OF BEIJING GENOTYPE OF MYCOBACTERIUM TUBERCULOSIS CIRCULATED IN THE PRIMORSKY KRAI

Background. The Far East is the territory with high rate of incidence and prevalence of tuberculosis. Cases of tuberculosis caused by epidemic strains have high frequency of MDR and XDR. It is important to study the prevalence of TB in areas with a high burden of infection, to which the Far East belongs. The aim of the research is to carry out genotyping of strains and assess the prevalence of CC1 and CC2 subtypes in the territory of Primorsky Krai. Materials and methods. The DNAs of 99 clinical isolates of MBT from Primorsky Krai have been genotyped by the 24-locus MIRU-VNTR and RD105/RD207. Results. The dominant number of strains pertained to Beijing genotype (59.6 %). The express method revealed 22 isolates of the CC2/W148 subtype, which had 6 different MIRU-VNTR-24 profile. According to MLVA classification MtbC 15-9, the most common among the isolates of CC2/W148 profile is 100-32 (59.1 %). Among these profiles the highest frequency of MDR/XDR was recorded – 69,2 %. According to the results of the express analysis, 39 isolates with 26 different MIRU-VNTR-24 profiles belonged to the CC1 subtype, of which the dominant number belonged to 99-32 and 94-32. Conclusions. The methods of express genotyping of epidemic subtypes of the Beijing genotype are very important for epidemiological surveillance and clinical practice. The developed methods allow to define a wider range of strains than previously used methods

INVESTIGATION PHYLOGENETIC RELATIONSHIPS MAJOR GENOTYPES MYCOBACTERIUM TUBERCULOSIS BY MIRU-VNTR-24 GENOTYPING

Thirty-one isolates of M. tuberculosis was identified in Buryatia by MIRU-VNTR-24 typing and deletion analysis by RD105 and RD207. Beijing family strains accountedfor 67,4 % and had a variety of profiles with a prevalence (22,6 %) of two modern epidemic subtype Beijing MIT17 and MIT16. Strains Beijing MIT 642 differed in the number of repeats of the variable loci, it may reflect a longer circulation of these subtypes without shaping their properties of epidemic circulating strains in modern populations, or they had epidemic importance in the past. It is also apparent heterogeneity in the number of loci among strains according to group LAM, T, and X, which requires additional research. The aim of this work was to determine the current epidemiologically important genotypes of Mycobacterium tuberculosis, as well as the genotypes had an epidemic importance in the past as an example of the region with a high prevalence of tuberculosis - the Republic of Buryatia

COMPREHENSIVE EPIDEMIOLOGICAL ANALYSIS OF THE TUBERCULOSIS SITUATION AMONG THE DIFFERENT ETHNIC GROUPS OF THE BURYATIA

Comprehensive epidemiological analysis of tuberculosis in the Republic of Buryatia (RB), including among different ethnicgroups (Russian, Buryat, Evenk) presents in the article. Assessment of the epidemiological situationfor 1994-2012 was examined on various parameters (incidence, prevalence and mortality). It was found that the epidemiological situation in RB in the last twenty years were characterized by high incidence of tuberculosis when compared with similar data for Russia as a whole (mean annual incidence 148,1 ± 6,90/0000 и 77.6 ± 2,10/0000 respectively). Among the various ethnic groups living in the RB, the most unfavorable epidemiological indicators identified for the Buryat population. "Safely" group of the population was Evenki. For each of the studied ethnic groups have been identified areas of tuberculosis risk, which had its own characteristics

Tuberculosis features in federal districts of the Russian Federation

Background. The retrospective assessment of key indicator levels and their trends at the start point of new strategy realization for tuberculosis control in Russia is an important predictor of the global program implementation to reduce the burden of this infection. Materials and methods. We analyzed incidence, prevalence and mortality among general and children population in Russian federal districts, in European and Asian regions, and in countries having a common border with Russia. Results. Presented material confirms the wide spread of tuberculosis in Russia, where the average annual incidence rate for 2005-2015 was 71.9 ± 2.5 0/0000, which attributes Russia to average-burden country. The most important characteristic of the studied period was a stable decreasing tendency of the key TB indicatorsformed by 2015. However, enormously uneven distribution of TB incidence, prevalence and mortality in some federal districts reveals different starting points of the regions. Relatively favorable territories include Central and Crimean Federal Districts, and the most unfavorable are Siberian and Far Eastern Federal Districts. The TB incidence significantly increases from West to East. Revealed unfavorable increasing tendency of children TB in combination with the trend described above indicates active transmission of TB infection in the Asian part of Russia. We also revealed the likelihood of mutual influence of migratory exchanges of Russian border regions and neighboring countries, which most strongly manifests on territories with low and medium TB incidence rates

Viral Load in COVID-19: Underestimated Clinical and Epidemiological Marker

Background. The viral load of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of the new coronavirus infection, is becoming increasingly important in clinical and epidemiological contexts. Despite this, there are significant complexities in the implementation of viral load quantitative measurement into clinical practice due to the limited approaches to its assessment.The aim of this work was to develop an approach for SARS-CoV-2 viral load analysis by the value of sample threshold cycles (Ct) relative to the Ct of the internal control sample obtained in routine PCR diagnostics of the COVID-19, and to use this approach for quantitative monitoring of viral load in patients with first positive SARS-CoV-2 test from the Irkutsk region.Materials and methods. Using regression models based on the least squares method, an approach to determine the number of copies of SARS-CoV-2 RNA in 1 ml of nasopharyngeal secretion was developed. The viral load of SARS-CoV-2 was assessed in nasopharyngeal and pharyngeal samples obtained from 1370 patients from Irkutsk and Angarsk with primary diagnosed positive PCR result in the period from July 1 to November 10, 2020.Results. A tenfold increase in the average monthly viral load among patients in September-October 2020 was revealed. We assume that the change in the epidemiological pattern of the spread of the new coronavirus infection during this period is associated with an increase in the number of contacts in the population due to the school year beginning. Higher viral loads are observed in populations at risk for COVID-19 – among healthcare workers and adults/elderly patients. Conclusion. The development of a standardized quantification of SARS-CoV-2 viral load in the nasopharyngeal samples can be a predictive clinical marker and a reliable tool for improving COVID-19 surveillance using the proposed approach to assess average viral load in a local population