Post on 21-Mar-2016
description
Diagnostic algorithms of TB case finding and their effect on TB epidemiology in Russian
Regions
Andrey Maryandyshev, Elena Nikishova
Northern State Medical UniversityArkhangelsk, Russia
Arkhangelsk region of the Russian Federation
Area: 578,000 square km
Population: 1, 117, 096 people
24 municipal districts
11282 in penal system
TB service of the area
Arkhangelsk Clinical Antituberculosis Dispensary reference laboratory and
3 in-patient departments for 100 patients:Sensitive TB SS+ 35
MDR/XDR TB SS+ 35Sensitive, MDR TB SS- 30Out-patients department
27 municipal tuberculosis ambulatory
TB Colony for continuation
treatment
Regional hospital of penitentiary system - bacteriological laboratory
and 2 in-patient departmentsfor 140 patients (sensitive and MDR)
TB Incidence including penitentiary system (new cases and relapses ) and mortality in Arkhangelsk
Region 2001-2012 (per 100 000 population)
MDR TB burden among new cases and relapses consist 35,4% in 2013
Rapid Drug Susceptibility Tests implemented
• BacTAlert– 2004-2009• LPA (Hain Test) in 2009 – DST for 1
and 2 line drugs • Bactec MGIT - DST for first line drugs -
2010 DST for second line drugs - 2011
• Gene Xpert - 2011
Algorithm in Arkhangelsk region
TB registration in the civil sector of Arkhangelsk region, 2007 – 2013
572 568 533 562476 431 409
104 91 94 85 93 82 5918 24 13 4 5 7 51 3 4 4 3 5 4
2007 2008 2009 2010 2011 2012 2013
new case relapse
treatment after loss follow up treatment after failure
434 436 439372 392
348281
208 182 196 183 165 155 127
27 28 16 9 15 7 18
2007 2008 2009 2010 2011 2012 2013
Total MDR TB new MDR TB
new XDR TB
DST results of new TB cases2007 2008 2009 2010 2011 2012 2013
Sensitive 172 178 179 169 181 152 165H 38 37 39 34 41 23 22MDR 103 96 99 125 104 111 71R 4 5 2 2 1 1 3H R 55 58 67 92 86 67 47H R Km Am Cm 22 11 8 14 5 14 13
H R Fq 4 2 3 3 5 5 4XDR 3 2 1 1 3 4MDR clinical cases 15 20 17 13 6 21 26
No DST results (SS- Culture– and DST not done)
243 228 215 205 139 128 94
DST results of patients with relapse of TB 2007 2008 2009 2010 2011 2012 2013
Sensitive 15 23 24 11 25 11 19H 6 4 3 4 4 4MDR 15 42 39 44 52 42 25R 6 2 1 H R 55 30 31 34 44 28 18H R Km Am Cm 22 7 4 4 4 7 5
H R Fq 4 1 2 3 1XDR 3 2 1 2MDR-TB clinically 15 3 3 3 1 5No DST results (SS- Culture – and DST not done)
36 22 28 24 12 25 12
DST results of patients with category “treatment after loss to follow-up”
2007 2008 2009 2010 2011 2012 2013Sensitive 8 15 4 1 1 4 5H 3 2 2 2 2
MDR 6 6 4 1 1R H R 5 5 1 1 1H R Km Am Cm 1 1 3
H R Fq XDR No DST results
1 1 3 2 1 1
DST results of patients with category “treatment after failure”
2007 2008 2009 2010 2011 2012 2013Sensitive 1 2 2 1 1
H 1 1 1 1 1
MDR 1 2 1 1 1 2 1
R
H R 1 1 1 1 1
H R Km Am Cm
1 1 1 1
H R Fq
XDR
MDR-TB clinically
No DST results
1 1 1
Standard regimens for treated all TB patients depending of the DST
Group of patients (new case, relapse, treatment after loss follow up, treatment after failure)
Intensive Phase
Continuation phase
Sensitive TB, SM and Culture negative
2 HREZ 4 HR
Isoniazid resistance TB, including combinations with other TB drugs except for rifampicin
3 R Z E Km Lfx 6 R Z E Lfx
Multidrug-resistant TB 8Z Km Lfx Pto Cs
12Z Lfx Pto Cs
Treatment outcomes of patients with sensitive TB
Registered 100%
Cured%
Failure%
Died from TB%
Died not from TB%
Loss to follow up%
Refused from treatment%
Transferred out%
TB not confirmed%
MDR-TB developed%
2007 195 66,7 9,7 1,5 16,4 1,5 4,1
2008 216 72,7 1,4 7,4 3,7 5,6 3,7 5,6
2009 208 74,5 1,4 8,2 1,9 6,3 2,4 5,3
2010 183 84,7 1,6 4,4 4,4 2,7 0,5 1,6
2011 209 86,1 0,5 6,2 1,9 3,3 0,5 1,4
2012 168 81,5 1,8 7,1 3,6 4,8 0,6 0,6
Treatment outcomes of patients with H resistance.
Registered
Cured failure Died from TB
Died not from TB
Loss to follow up
Refused from treatment
Transferred out
TB not confirmed
MDR-TB developed
2007 47 46,8 2,1 10,6 6,4 10,6 4,3 19,1
2008 44 45,5 6,8 11,4 4,5 4,5 6,8 2,3 18,2
2009 45 68,9 4,4 4,4 17,8 4,4
2010 39 66,7 12,8 5,1 7,7 2,5 5,1
2011 47 76,6 2,1 12,8 2,1 4,3 2,1
2012 30 83,3 3,3 6,7 3,3 3,3
MDR-TB treatment outcomesRegistered
Still on treatment
Cured failure Died from TB
Died not from TB
Loss to follow up
Refused from treatment
Transferred out
TB not confirmed
XDR-TB developed
2007157 42,7 3,2 21,7 8,3 20,4 1,3 1,3 0,0 1,3
2008 146 47,3 3,4 13,0 6,8 23,3 2,1 2,1 0,0 2,1
2009 143 50,3 2,8 11,9 7,7 22,4 1,4 3,5 0,0 0,0
2010 171 57,9 3,5 11,7 6,4 12,9 2,3 2,3 0,0 2,9
2011 158 0,6 60,1 3,2 10,8 5,1 13,9 1,9 1,3 0,0 2,5
2012 154 37,0 27,3 5,2 5,2 10,4 8,4 3,9 3,9 0,6
Results of treatment of TB with resistance to R / H R
Registered
Still on treatment
Cured
Failure
Died from TB
Died not from TB
Loss to follow up
Refused from treatment
Transferred out
TB not confirmed
XDR-TB developed
2007 93 40,7 2,2 22,6 9,7 20,6 1,1 1,1
2008 101 42,6 4,0 15,8 7,9 23,8 2,0 2,0 2,0
2009 102 52,0 2,9 13,7 6,9 21,6 1,0 2,0
2010 130 60,0 4,6 11,5 7,0 13,1 0,8 2,3 0,8
2011 133 0,8 60,2 2,3 11,3 6,0 15,0 1,5 2,3 0,8
2012 97 38,1 19,6 6,2 6,2 12,4 8,2 2,1 7,2
Treatment outcomes of clinical cases of MDR-TB. Registered
Still on treatment
Treatment completed
Failure
Died from TB
Died not from TB
Loss to follow up
Refused from treatment
Transferred out
TB diagnosis removed
MDR/XDR developed
2007 18 77,8 11,1 5,6 5,6
2008 23 73,9 4,3 17,4 4,3
2009 20 65,0 10,0 15,0 10,0
2010 16 50,0 6,3 6,3 18,8 18,8
2011 7 71,4 28,6
2012 26 37,0 44,4 3,7 11,1 3,7
Treatment results of patients without MTB confirmation (Radiology confirmation)
Registered
Treatment completed
Failure
Died from TB
Other reasons of death
Loss to follow up
Refused from treatment
Transferred out
TB diagnosis was removed
Development of MDR/XDR
2007 236 78,8 4,7 4,2 4,2 2,1 3,4 2,5
2008 208 85,6 7,2 1,9 2,9 0,5 1,9
2009 204 87,3 2,9 4,4 2,5 1,0 1,0 1,0
2010 202 84,7 1,0 2,5 2,5 3,5 4,5 1,5
2011 143
88,1 0,7 2,1
4,2 0,7 3,5 0,7
2012 135 85,6 2,2 1,5 2,2 6,5 1,5 1,5
Treatment outcomes of Sm (+) patients with no DST data.
Registered
Cured Failure
Died from TB
Other reasons of death
Loss to follow up
Refused from treatment
Transferred out
TB diagnosis was removed
Development of MDR/XDR
2007 4445,5 25,0 6,8 4,5 2,3 15,9
2008 43 37,2 34,9 7,0 4,5 2,3 2,3 11,6
2009 43 60,5 25,6 4,7 4,7 2,3 2,3 2,3
2010 2944,8 24,1 13,8 6,9 6,9 3,4
2011 9 77,8 11,1 11,1
2012 2045,0 35,0 10,0 5,0 5,0
Results of treatment all registered (508) TB cases in civil sector in 2012
Treatment success (preliminary data)• New cases– 67,4% (279/414), 11,1% (46/414) – treatment
continue• Relapses ––52,4% (43/82), 13,4% (11/82) – treatment
continue• «treatment loss follow up» –– 57,1% (4/7)• «failure treatment» –60,0% (3/5)• Among all registered cases in 2012 – treatment success
64,8% (329/508), 13,8%- (57/414) – treatment continue
Conclusion
• Everyone tuberculosis patient before of treatment should have the Rapid Drug Susceptible Test
• WHO Standards of treatment according DST cured more than 80 % tuberculosis patients
Thank you for attention!