The objective: to determine factors influencing treatment efficacy in patients with multiple (MDR) and extensive (XDR) drug resistant tuberculosis. Subjects and methods. The medical files of 107 tuberculosis patients (men – 75, women – 32) were analyzed, 17 of them were HIV positive. Those 107 patients were registered for treatment as per chemotherapy (CT) regimens IV-V in 2017 in Kaluga Region. 99 (92.5%) patients suffered from tuberculosis with lung tissue destruction. 60.7% (65 patients) had MDR, while 20.8% (22 patients) had XDR. Only 58.2% of patients had MDR TB confirmed by polymerase chain reaction before treatment start.Results. In 24 months, the effective course of treatment was registered in 64/107 (59.8%). The highest level of effective treatment was expectedly registered among new cases – 21/30 (70%); and the lowest level was among patients starting chemotherapy again after treatment interruption – 4/10 (40%), p > 0.05. Among 64 patients with effective treatment course, 25 (39.1%) had surgery and 39 (60.9%) had chemotherapy only. Surgical activity among the cohort of 2017 made 26/107 (24.3%). The effective treatment outcome was achieved in 8 (47%) out of 17 patients with TB/HIV co-infection, and among HIV negative patients it was reached in 56/90 (62.2%), p > 0,05.

Significance. A high level of coverage with preventive examinations of labor migrants arriving to work at enterprises in the Kaluga region makes it possible to detect tuberculosis (TB) at an early stage, which is characterized by an asymptomatic course, and with timely treatment it it possible to achieve its effective cure and thereby prevent the TB spread both among migrants and permanent population of the region. However, the majority of TB patients among labor migrant avoid treatment or interrupt the therapy due to lack of funds to pay for treatment. Undertreated patients continue to be sources of infection, often spreading resistant forms of tuberculosis with multidrug resistance of the pathogen. In addition, it is not possible to identify whereabouts of such patients, which fraught with TB spreading among the general population of the region. The purpose of the study: to analyze demographic and clinical factors influencing TB treatment outcomes in labor migrants. Material and methods. The study used information about 357 patients with tuberculosis, newly detected among the resident population of the Kaluga region, and 118 TB patients detected among labor migrants in 2019-2020. For the analysis, a questionnaire was developed, consisting of 9 demographic and clinical factors influencing outcomes of TB treatment. The analysis used information from the federal statistical surveillance forms No. 8 and No. 33 and Rosstat data on the average annual population of the Kaluga region in 2011-2020. To analyze TB treatment outcomes in labor migrants, data of the cohort analysis for 2016-2020 were used. Statistical analysis methods were used for the analysis. Results. In the Kaluga region in 2016-2020, 406 patients with tuberculosis were detected among 142,763 labor migrants examined by fluorography, or 0.3% of the total number. Analysis of a number of factors that affect TB treatment outcomes in labor migrants and the resident population of the Region in 2019-2020 showed that 90.7% of TB cases among labor migrants were detected at an early stage, which is asymptomatic, therefore in epidemic terms, they were much less dangerous compared to those detected among the resident population. However, only 123 patients were signed up for treatment, which accounted for 30.3% of the total number of TB patients among labor migrants, while the remaining 283 patients could not afford to pay for TB treatment and dropped off the TB service radar. Among patients with tuberculosis who started treatment, only 50% were effectively cured, while every third had to interrupt the treatment due to lack of funds to pay for the full course of chemotherapy. Conclusion. In order to reduce TB incidence among labor migrants and ensure free TB treatment in the Russian TB care facilities for labor migrants diagnosed with tuberculosis during their stay in Russia, there is an urgent need to find sources to finance costs associated with their treatment and to develop reimbursement mechanisms through introducing additions to legal documents on provision of medical care to labor migrants in those states where they have a permanent residency.

1 ГБУЗ Калужской области «Областная клиническая туберкулезная больница», г. Калуга, Россия 2 ФГБОУ ВО «Казанский государственный медицинский университет» МЗ РФ, г. Казань, Россия 3 ФГБОУ ВО «Смоленский государственный медицинский университет» МЗ РФ, г. Смоленск, Россия Цель исследования: изучить влияние миграционных процессов на эпидемическую ситуацию по туберкулезу в Калужской области. Материалы и методы. Проанализирована генеральная совокупность мигрантов, обследованных на туберкулез в 2009-2017 гг. в Калужской области, а также совокупность мигрантов с выявленным во время обследования туберкулезом.Результаты. Представлены данные анализа обследования на туберкулез мигрантов в Калужской области. Установлено возрастающее влияние больных туберкулезом иностранных граждан на региональную эпидемическую ситуацию по данному заболеванию. Изучена этническая, половозрастная структура мигрантов, больных туберкулезом, а также клинические особенности течения туберкулеза у иностранных граждан.Ключевые слова: туберкулез, трудовые мигранты, заболеваемость туберкулезом Для цитирования: Лапшина И. С., Марапов Д. И., Костромцов С. В., Мякишева Т. В., Салихов Б. У. Вклад трудовой миграции в эпидемическую ситуацию по туберкулезу в Калужской области // Туберкулёз и болезни лёгких.

Over the past 20 years, there has been a steady decline in the incidence of tuberculosis (TB) among resident population in Russia. However, the growth in the number of labor migrants in recent years in Russia increases the risk of the spread of tuberculosis in Russia, imported by migrants from countries with high TB prevalence. Further development of such situation may jeopardize achievement of the TB Control Program targets in the Russian regions with the highest inflow of labor migrants. Purpose: to analyze incidence of tuberculosis among labor migrants in the Kaluga region in dynamics for the period from 2010 to 2019. Material and methods: information from the Rosstat statistical surveillance forms No. 8 and No. 33, Rosstat data on the average annual population of the Kaluga region for 2001-2020, data from the Department of the Ministry of Internal Affairs in the Kaluga region on the number of labor migrants in 2017-2019. Pearson’s chi-square test (χ2) was used for comparative analysis. Results: The decline rate in the overall TB incidence in the Kaluga region over the past decade (2010-2019) equaled to 47%, which is 16.4% lower compared to the rate in the resident population of 56.2%. A slowdown in the decline in the overall TB incidence, which is the key indicator of the TB control program, may compromise achievement of the Program targets in the Kaluga region. A comparative analysis of TB incidence among resident population and labor migrants showed higher values among labor migrants compared to resident population: 7.2-fold in 2017, 4.9-fold in 2018 and 7.4-fold in 2019 (p<0.0000001). Conclusion. A significantly higher TB incidence among labor migrants poses a serious threat to its spread in resident population of the region. To reduce TB incidence among labor migrants, it is necessary to introduce changes into regulatory documents to ensure treatment of labor migrants diagnosed with TB in Russia at TB health facilities.

Objective. Analysis of the main epidemiological indicators characterizing the situation of tuberculosis combined with HIV infection in the Kaluga region for the period from 2015 to 2019.Materials and methods. For the analysis, was used information on 1159 newly diagnosed patients with tuberculosis, those who arenot infected with HIV infection, and 106 newly diagnosed patients with tuberculosis combined with HIV infection in the Kaluga region for the period from 2015 to 2020.Results. In the constituent entities of the Russian Federation, where the incidence of tuberculosis is declining annually, the registration of cases of tuberculosis combined with HIV infection is due to the spread of tuberculosis among HIV-infected contingents registered in AIDS centers.The main reasons for this situation are the late detection of tuberculosis among patients with HIV infection, when the course of the disease becomes widespread and low adherenceofpatients with HIV infectionto treatment antiretroviral drugs.