The objective of the study: To evaluate the clinical and economic efficacy of chemotherapy in patients with newly diagnosed multiple drug resistant tuberculosis (MDR).Subjects and methods. The number and structure of MDR tuberculosis patients living on the territory of the Republic of Karelia from 2008 to 2017 were studied. The clinical and economic efficacy of treatment of MDR tuberculosis patients was assessed.Results. In 2011-2017, decrease in the number of MDR patients in the Republic of Karelia was mainly due to enhanced treatment efficacy of new MDR tuberculosis cases. The introduction of social support methods (food parsels) and express drug sensitivity testing to rifampicin using the Gene Xpert MTB/RIF was associated with higher treatment efficacy – from 37.2% (2013) to 58% (2014), the lower rate of treatment defaults, and significant decrease in mortality, as well as reduction of costs for curing of one MDR tuberculosis patient from1.68 million rubles in 2012 up to 0.77 million rubles in 2014.

Objective: to study the clinical and economic efficiency of mass fluorographic examinations of the population for tuberculosis (TB).Subjects and methods. The study used the data of fluorographic examinations for TB among 2,632,169 people and in its risk groups (n = 44,597) in the Republic of Karelia in 2008–2018.Results. It was found that the increased efficiency of detection of TB could not reduce its one-year mortality in firstly identified patients. The average cost of detecting one TB case during mass examinations was more than 500,000 rubles for this period.Conclusion. Mass fluorographic examinations of the population cannot reduce TB mortality rates and are extremely expensive. To lower the mortality rate and to improve the detection of TB, there is a need for screening high-risk groups for this disease at least once every 6 months.

The purpose of this study was to study the clinical and radiological forms of TB in patients with HIV and the possibilities of etiologic diagnosis-the detection of MBT using various methods for determining and the effect of immunosuppression on the results of etiologic diagnosis. Materials and methods. The materials for the study were the analysis of clinical x-ray examination data and the results of etiological diagnosis of the Office in the Republic of Karelia for the period from 2001 to 2016 among 159 patients with a co-infection of HIV+TB in the bacteriological laboratory of the Republican TB Dispensary of the Karelia. Results of the research. The peculiarities of clinical and radiological forms of tuberculosis (TB) and infomativity of various methods of etiologic diagnosis of TB among 159 patients with combined HIV+TB infection for the period 2001–2016 in the Republic of Karelia were studied. It was revealed that the PCR diagnostics significantly reduced the likelihood of a lethal outcome of patients with a co-infection, as it allowed us to quickly identify not only the presence of the MBT, but also to identify MDR and appoint adequate chemotherapy on the first day of detection, which significantly reduced the risk of death. The frequency of bacterial excretion most often (69%) occurred in the group of patients with the most severe immunosuppression with an amount of CD4 cells less than 100 in 1 ml. It was found that among the patients with co-infection with HIV + pulmonary TB, cavities of disintegration in the lung tissue (38,5%) are significantly less likely to be detected, but bacteriovirus (68,5%) is detected more frequently than among patients with pulmonary TB in the territory of the Republic of Karelia (form 33). It has been established that improving the organization of sputum collection can significantly increase (at least 20%) the incidence of MBT in patients with pulmonary TB and HIV, which is important in the rapid diagnosis of TB and the appointment of adequate therapy, especially considering that among patients with co-infection 1⁄2 (52,8%) had MDR. The conclusion. For the timely diagnosis of pulmonary TB in HIV-infected patients, with frequent atypical clinical and radiological picture of TB and the possibility of rapid progression with lethal outcome, and also taking into account the results obtained (in 56% of patients with TB+HIV-MBT+), etiologic diagnosis of TB has priority value. The most affordable, cheap and epidemiologically significant method for detecting TB is sputum smear microscopy. The epidemiological danger was aggravated by the detection in 52,8% of patients with HIV+TB strains of multidrug-resistant and extensively drug-resistant MBT.