SUMMARY Setting National tuberculosis (TB) treatment facility, country of Georgia. Objective To determine the prevalence of diabetes mellitus (DM) and pre-DM among patients with TB using glycosylated-hemoglobin (HbA1c), and to estimate the association between DM and clinical characteristics and response to TB therapy. Design A cohort study was conducted (2011–2014) at the National Center for TB and Lung Disease in Tbilisi. Patients ≥35 years with pulmonary TB were included. HbA1c was used to define DM (≥6.5%), pre-DM (≥5.7%–6.4%), and no DM (<5.7%). Interviews and medical chart abstraction were performed. Regression analyses estimated associations between DM and 1) baseline TB characteristics and 2) TB treatment outcomes. Results A total of 318 newly diagnosed patients with TB were enrolled. Prevalence of DM was 11.6% and pre-DM prevalence was 16.4%. In multivariable analyses, patients with TB-DM had more cavitation (aOR 2.26), higher smear (aOR 2.37), and more MDR-TB (aOR 2.27) compared to patients without DM. Risk of poor TB treatment outcome was similar among patients with and without DM (28.1% vs. 23.6%). Conclusion Diabetes and pre-DM were common among adults with newly diagnosed pulmonary TB in Tbilisi, Georgia and DM was associated with more clinical symptoms at presentation including MDR-TB.

Our study presents important new information about the relationship between type 2 diabetes and primary multidrug resistant tuberculosis (MDR TB). Using a well-characterized patient population, we found diabetes was associated with delayed culture conversion among patients with and MDR TB.

SUMMARY SETTING Tuberculosis (TB) health care facilities throughout Georgia. OBJECTIVE To describe smoking behaviors among health care workers (HCWs) at TB facilities and determine HCWs’ knowledge and beliefs regarding the impact of tobacco use on anti-tuberculosis treatment. DESIGN Cross-sectional survey from May to December 2014 in Georgia. Adult HCWs (age ≥ 18 years) at TB facilities were eligible. We administered a 60-question anonymous survey about tobacco use and knowledge of the effect of smoking on anti-tuberculosis treatment. RESULTS Of the 431 HCWs at TB facilities who participated, 377 (87.5%) were female; the median age was 50 years (range 20–77). Overall, 59 (13.7%) HCWs were current smokers and 35 (8.1%) were past smokers. Prevalence of current smoking was more common among physicians than among nurses (18.6% vs. 7.9%, P < 0.0001). Among HCWs, 115 (26.7%) believed smoking does not impact anti-tuberculosis treatment, and only 25.3% of physicians/nurses received formal training in smoking cessation approaches. Physicians who smoked were significantly more likely to believe that smoking does not impact anti-tuberculosis treatment than non-smoking physicians (aOR 5.11, 95%CI 1.46–17.90). CONCLUSION Additional education about the effect of smoking on TB treatment outcomes is needed for staff of TB health care facilities in Georgia. Nurses and physicians need more training about smoking cessation approaches for patients with TB.

Background While rapid molecular diagnostic tests for tuberculosis (TB) have decreased detection time of M. tuberculosis and drug resistance, whether their use improves clinical care and outcomes is uncertain. To address these knowledge gaps, we evaluated whether use of the Xpert MTB/RIF assay impacts treatment and clinical outcome metrics among patients treated for sputum smear-negative multidrug-resistant (MDR)-TB. Methods A retrospective cohort of adult patients initiating treatment for sputum smear-negative MDR-TB at the National Center for Tuberculosis and Lung Diseases in Tbilisi, Georgia from 2011-2016. The Xpert MTB/RIF was introduced in Georgia in 2010 and implemented into programmatic use in 2014. Exposure was availability of an Xpert result at time of diagnosis. Time to second-line treatment initiation, sputum culture conversion, and end-of-treatment outcomes were determined from. Time to event was compared using a Cox proportional hazards model. Results Among 151 patients treated for sputum smear-negative MDR-TB (96% culture positive), the Xpert was utilized in the clinical management of 78 (52%) patients and not used in 73 (48%). An adjusted analysis controlling for potential confounders found that patients in the Xpert group had shorter median time to second-line treatment (13 vs. 56 days, adjusted hazard ratio [aHR]10.21, p&lt;0.0001) and culture conversion (61 vs. 93 days, aHR 1.93, p&lt;0.001). There was no difference in treatment outcomes. Conclusions Use of the Xpert in the management of sputum smear-negative MDR-TB decreases time to second-line therapy and sputum culture conversion, providing evidence of its clinical impact and supporting its programmatic utility.

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