MDR-TB in Belarus, the role of outpatient care strengthening and social support. (March 2015)

• Record Type: Journal Article
• Authors: Skrahina, Alena; Rusovich, Valiantsin; Dara, Masoud; Zhylevich, Liudmila; Hurevich, Hennadz
• Is Part Of: International journal of mycobacteriology. Volume 4 (2015: Mar.)Supplement 1
• Page Start: 79
• Publication Date: 2015-03
• Subjects: MDR-TB -- Treatment outcomes -- Outpatient care strengthening -- Social support; Mycobacteria -- Periodicals; Mycobacterial diseases -- Periodicals; Mycobacteriaceae; Mycobacteria; Electronic journals; Periodicals; 579.374
• DOI: 10.1016/j.ijmyco.2014.10.041
• Languages: English
• ISSNs: 2212-5531

Abstract

Abstract: TB incidence and mortality in Belarus has been progressively falling from 54 to 41 and from 12.1 to 6.8 per 100000, accordingly, for the last 7 years. Nevertheless, the number of HIV/TB co-infected rises dramatically. According to a recent nationwide drug resistance survey, MDR-TB was found in 32.3% of new and in 75.6% of previously treated TB cases. Results of treatment of MDR-TB are far from satisfactory (51% treatment success, 11% deaths). Risk factors for MDR-TB acquisition and unfavorable treatment outcome are the following: young age, drug and alcohol abuse, HIV, history of imprisonment, unemployment, and homelessness. Most of such events as treatment failure and loss to follow-up occur at the outpatient treatment phase, particularly in patients from the above-mentioned risk groups. One of the key elements of outpatient care strengthening is social support. Two operational research studies were conducted. One study with 40 MDR-TB patients included showed that treatment cost can be reduced by more than 5200 US dollars per patient using outpatient care with social support instead of existing care based on long-term hospitalization. Another study showed that MDR-TB patients with social support ( n = 1057) had better treatment outcomes compared with conventionally managed patients ( n = 3514): treatment success 70% vs. 53%; mortality 2% vs. 6%; treatment failure 27% vs. 40%. Along with adequate diagnostics and therapy, outpatient care strengthening and social support are important elements in achieving good treatment outcomes and reducing the cost of treatment of MDR-TB.