BACKGROUND: In Russia, compared with other countries, at least 65% of the population must undergo an annual fluorographic examination for early tuberculosis detection. AIM: This study aimed to assess the impact of mass fluorographic examinations of the adult population on the main epidemiological factors and indicators of prompt tuberculosis detection. MATERIALS AND METHODS: The morbidity and mortality from tuberculosis have been analyzed along with the efficiency of its detection during preventive examinations, the proportion of destructive forms of the disease, and the 1-year mortality rate in four federal districts from 2014 to 2019. RESULTS: For all districts, low efficiency of preventive examinations was registered (1 patient per 2,0005,000 people examined), as well as its strong correlation with morbidity and, in case of its absence, with the coverage of examinations. The change in morbidity and mortality rates over time was independent of the mass screening volume of the adult population. The relative risk indicators of increased morbidity and mortality with a decreased number of examinations were 0.4 and 0.3, respectively. The increased coverage of the population with examinations was not accompanied by an improved indicator of detection timeliness, namely a decreased incidence of destructive forms and 1-year mortality rate. The incidence of tuberculosis is determined by socioeconomic factors, which influence the level and living conditions of the population. CONCLUSIONS: This study established the low efficiency of mass fluorographic examinations of the population, lack of influence of coverage with examinations on the epidemiological situation, and the timeliness of tuberculosis detection.
The dynamics, characteristics of prevalence of HIV-infection combined with tuberculosis during last 5 years were investigated on the territory of the Republic of Karelia. The sampling of 107 medical records of patients with HIV-infection combined with tuberculosis during 2001-2014 was analyzed. It is established that against the background of wide prevalence of strains of mycobacteria of tuberculosis with multiple medicinal resistance in the region (primary multiple medicinal resistance - 46.5%) occurs late diagnostic of HIV-infection combined with tuberculosis in the Republic of Karelia (IV-V stage of HIV-infection - 72.9%). This situation, along with significant annual influx of patients with combined infection from the system of Federal penitentiary service of Russia into civil sector, facilitates further prevalence of this infection on the territory of the Republic of Karelia. The revealed characteristics of social structure and prevalence of combined infection require development of special programs of accurate monitoring of risk groups including measures of social support concerning persons without fixed address and persons leaving Federal penitentiary service of Russia into civil sector. With regard to frequent addition of other consecutive infections and atypical clinical radiologic picture of tuberculosis. frequent detection of multiple medicinal resistance of mycobacteria of tuberculosis it is necessary, for accelerated etiologic diagnostic, implementing molecular genetic diagnostic (Gene X-pert) in case of suspicion of occurrence of this disease in individuals with combined pathology (tuberculosis and HIV-infection).
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