How to cite this article: Bobokhojaev OI. Experience in optimizing the accessibility of services for tuberculosis in the Republic of Tajikistan.
Aim of the study: Conduct long-term monitoring of recovered patients with pulmonary TB and study the frequency of relapses of pulmonary TB and factors contributing to their development in the Republic of Tajikistan. Material and research methods: Of the total number of patients with pulmonary TB, 820 people in 2010-2011 after successful treatment, were transferred for further dispensary observation to PHC facilities, whose health status we monitored for 10 years (including 2020). Of the 820 patients, we were able to track the health status for 10 years in 622 patients (320 men and 302 women, age groups 19-44 years old - 330 people and 45-69 years old - 292 people). The rest - for various reasons were lost from further dispensary observation. All patients in PHC facilities annually during the period of dispensary observation underwent clinical, instrumental, laboratory, and X-ray examinations to exclude the recurrence of TB. Data for each patient were tracked using the National TB Registry OpenMRS data. Research results: The elimination of preventive anti-relapse measures in people with residual post-tuberculosis changes in the lungs led to an increase in the number of relapses of the disease. The analysis of the conducted studies shows that the incidence of relapses of pulmonary TB does not depend on the regions and the severity of TB burden, they often develop with insufficient follow-up after the end of treatment and inadequate preventive measures in dispensaries patients. The study of the reasons for the development of relapses makes it possible to timely identify a group of patients who need anti-relapse measures and prolongation of dispensary observation. Conclusion: Thus, the results of this observation revealed the occurrence of relapses within 10 years in 19.3% of cases. A retrospective analysis of the initial forms of the disease showed that relapses of pulmonary tuberculosis occurred more often in patients who had had fibrous-cavernous pulmonary tuberculosis, than in patients who had disseminated pulmonary TB, and less often after suffering infiltrative pulmonary TB. Relapses of the disease occurred more often in men aged 19-44 years. The results obtained indicate the development of relapses of pulmonary tuberculosis has a statistically significant dependence on the form of the initial disease, the presence of RPTCL, comorbid diseases such as HIV, diabetes mellitus, COPD, and the regularity of taking anti-TB drugs. At the same time, it turned out that the social status of all patients with relapses corresponds to the level of poverty, which should also be taken into account.
The objective: study of the burden and effectiveness of treatment of multiple drug resistant pulmonary tuberculosis (MDR TB) with different chemotherapy regimens in the Republic of Tajikistan.Subjects and Methods. To achieve this objective, the prevalence of drug resistant tuberculosis in 2009–2020 was studied by analyzing statistical documents on drug resistant tuberculosis, official reporting data from the Center for Medical Statistics and Republican TB Control Center by the Ministry of Health and Population Social Welfare of the Republic of Tajikistan.Results. The analysis of official statistics indicates a stable trend towards a decrease in tuberculosis incidence from 2014 to 2019, annually on average up to 1% – from 60,8 to 56,5 per 100,000 population. During the pandemic in 2019–2020, this trend increased, according to statistics the incidence made 39.7 per 100,000 population. From 2014 to 2019, tuberculosis mortality also declined steadily from 3,9 to 2,2 per 100,000 population. During the pandemic in 2019–2020, a rapid decline was noted – from 2,2 to 1,4, while in 2020–2022, it decreased from 1,4 to 1,0 per 100,000 population. From 2013 to 2020 treatment success reached 90%. The detection of drug resistant tuberculosis is close to 900 cases per year, and more than 90% of them were covered with treatment. In 2018–2020, successful treatment of drug resistant tuberculosis increased from 72,5% to 80,6% due to the introduction of new and repurposed anti-tuberculosis drugs.
Objective: to study the prevalence of latent tuberculosis infection (LTBI), risk factors for LTBI to develop into active tuberculosis, the efficacy of preventive treatment in those with LTBI among labor migrants, residing in the Republic of Tajikistan.Subjects and methods. In the Republic of Tajikistan, 500 residents were followed up as Main Group, they all were labor migrants for more than 3 months and returned to their homeland within one year before inclusion in this study. All of them participated in a questionnaire survey to identify risk factors for developing tuberculosis and had the examination that included Mantoux test with 2 TE and chest X-ray. Comparison Group (CG) consisted of 500 citizens of compatible gender and age who did not travel as labor migrants; they all participated in the same survey and had the same examination.Results. The positive results of Mantoux test with no abnormalities on X-ray were observed in 40% of people in Main Group and 33.4% of people in Comparison Group.The following factors were found to be more frequent in Main Group versus Comparison Group, respectively: frequent and continuous exposure to a TB case – 78.2 and 23.1% (p < 0.01); no tuberculosis prevention – 83.1% and 48.4% (p < 0.01); poor accommodation and work conditions 87.9 and 13.6% (p < 0.01); inadequate diet and lack of proper clothes – 79.4 and 24.3% (p < 0.01); limited access to medical care – 85.4 and 22.6% (p < 0.01). MG was found to have a higher summarized risk coefficient (r = 4.75) versus CG (r = 2.0), p < 0.01. During 2–3-year follow-up of those with LTBI who had no preventive treatment with isoniazod, tuberculosis was diagnosed in 44.4% of people from MG and 18.5% of people from CG. The introduction of the integrated approach to tuberculosis control among people preparing for labor migration allowed reducing the proportion (from 19.7 to 13.7%) of labor migrants in the structure of TB incidence.
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