Introduction: WHO End TB Strategy aims at achieving targets of 90% mortality reduction and 80% reduction in tuberculosis (TB) incidence by 2030, recommending better addressing TB and multidrug-resistant TB (MDR-TB) issues in key populations. Aim: The study aimed at having a snapshot of the epidemiological characteristics of the key populations among the new TB patients, registered in Tajikistan during 2017. Methodology: A cross-sectional study was conducted, using official TB registration data for all new TB case notification in Tajikistan in 2017. Results: The key population included 1,029 (19.8%) patients among all 5,182 new TB cases registered in 2017. The following selected sub-populations were identified: migrant workers – 728 (70.7%), diabetics – 162 (15.7%), HIV-positive – 138 (13.4%), heavy drinkers – 74 (7.2%), drug users – 50 (4.8%), ex-prisoners – 50 (4.8%), and homeless – 9 (0.9%). Among the key population, 307 (29.8%) patients were smear-positive, 145 (14.1%) were drug-sensitive and 116 (11.3%) had MonoDR/MDR-TB. Time to treatment initiation for smear-positive cases was ≤ 5 days for 303 (98.7%) patients. Being a key population was inversely related to gender (female) (OR = 0.25, 95% CI (0.21, 0.29)) and population type (rural) (OR = 0.64, 95% CI (0.55, 0.74)). Conclusion: Among the key population the identified overlaps of selected sub-populations would enable more efficiently reaching the certain groups. TB case detection at PHC levels needs to be targeted for improved rates for key population detection. In the key population sub-group of migrant workers’ special migration destinations are recommended to be explored and find out possible associations with drug resistance.
Introduction: Approximately 3% of all pediatric TB cases develop MDR-TB, with only 3–4% of such children receiving MDR-TB treatment. In Tajikistan, children as a proportion of all DR-TB in the country increased from 4.3 to 7.5% during 2013-2018. Despite limited evidence on the use of new anti-TB drugs in children, WHO has updated its guidelines for DR-TB treatment for children, and Tajikistan did so in 2013 and 2017. Novel and adapted regimens included individual regimens for RR/MDR, XDR (with and without Bedaquiline and Delamanid) and short treatment regimens with and without injectables. It is important to document the outcomes of the treatment regimens. Therefore, the aim of this study was to describe characteristics of children receiving different treatment regimens for DR-TB, the culture conversion and treatment outcomes. Methodology: Cohort study of children enrolled in DR-TB treatment by the National Tuberculosis Program in Dushanbe, Tajikistan, January 2013 to July 2019. Results: The study included 60 DR-TB children. The male to female ratio was 1:2 and mean age 13.6 years. Median time to culture conversion was 66 days [IQR:31-103; Range:2-232]. In children with treatment outcomes (N = 58), 93% had favorable outcomes. There were four children (7%) with unfavorable treatment outcomes, all of whom were female 15-17 years, on standard (RR/MDR) treatment during 2013-2015. Favorable outcomes by DR-TB type were 91%, 90%, and 100% in RR/MDR, PreXDR, and XDR-TB patients, respectively. Conclusions: All children enrolled after the introduction of modified guidelines for novel and adapted regimens for DR-TB showed positive TB treatment outcomes.
Aim. To assess the informativeness and acceptability of the use of the annual reporting form No. 8 on tuberculosis in the Republic of Tajikistan. Materials and methods. This article studied the formation of the TB annual reporting form (form No. 8), assessment of dependence of TB indicators from TB annual reporting form in the Republic of Tajikistan. Results. The data indicate that the form of annual reporting on tuberculosis (form 8) cannot provide complete and reliable information about the incidence and prevalence of tuberculosis, does not note the migration processes inside of country and changing trends in the TB and DR TB epidemic which were calculated in the basis of Dushanbe data. Conclusion. The authors recommend to revise the annual reporting form on tuberculosis according to World Health Organization recommendation.
Objective: To assess an implementation study (IS) aimed at improving the epidemiological surveillance of tuberculosis (TB) and drug-resistant TB (DRTB) in Dushanbe during the COVID-19 pandemic. Methods: IS assessment was carried out according to the RE-AIM framework and WHO recommendations for reporting on IS. To assess the effectiveness of the action taken, official statistics and reports from the City Center for Protection of Population from Tuberculosis were used. Results: IS was a qualitative study. The study was supported by the WHO Special Program for Research and Training in Tropical Diseases (TDR). A multidisciplinary team led by the Dushanbe City Health Department has undertaken the following measures: introduction of a system of weekly epidemiological surveillance for TB at the primary health care (PHC) level from the second week of 2021; involvement of students of basic and advanced field epidemiology programs (FETP) in the assessment of the TB epidemiological surveillance system; tracking of registered patients with laboratory confirmation of TB; application of data from the quarterly reports in tracking the diagnostic trends and evaluation of the effectiveness of DR-TB treatment. All materials received were documented and used to train TB doctors and PHC workers. Only 66% of TB doctors were involved in capacity building in Dushanbe PHC: 24.4% of PHC workers were trained in the basics of TB diagnosis and treatment. Stabilization of TB and DR-TB rate was achieved in 2021 compared to 2020 (morbidity growth rates were 2.7% and 11.9%, respectively); effectiveness of treatment of TB with preserved sensitivity of M. tuberculosis (MBT) to anti-TB drugs in the 2020 cohort increased, but efficacy of DR-TB treatment in the 2019 cohort decreased. Conclusion: IS has identified major barriers to achieving the TB elimination goals. Although the data indicate stabilization of TB and DR-TB incidence rates and increased effectiveness of drug-sensitive TB treatment in Dushanbe, further monitoring and achievement of sustainable results are required. Keywords: COVID-19, tuberculosis, drug resistance, implementation study, TDR.
Aim. To evaluate the shifts in demographic, clinical, and epidemiological characteristics of patients with multidrugresistant tuberculosis (MDR TB) amidst the COVID-19 pandemic.Materials and Methods. A cross-sectional study was conducted on patients with MDR TB registered in Dushanbe, before (2017-2019) and during the COVID-19 pandemic (2020-2021).Results. The average age of patients prior to the COVID-19 pandemic was 36.5±16.9 years (1.7-79.4), whereas during the COVID-19 period, it was 34.4±17 years (2.9-80.2). The pandemic era witnessed a statistically significant rise in the proportion of workers among MDR TB patients compared to the unemployed (OR = 1.4; 95% CI 1.02-1.91; p = 0.05). Furthermore, an increase was observed in the proportion of patients with lung destruction in both newly diagnosed (OR 3.4; 95% CI 1.99–5.87; p<0.001) and previously treated patients (OR 4.2; 95% CI 1.38–12.99; p =0.002). There was also an increase in extrapulmonary tuberculosis registration (OR=1.7; 95% CI 1.34-2.22; p<0.001), indicating an unfavorable epidemiological situation in terms of MDR-TB. However, there were no statistically significant changes in the registration of concomitant diseases.Conclusion. We recommend the improvement of TB infection prevention and control measures at all levels, as well as the enhancement of early detection of TB and MDR TB patients by primary health care workers.
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