Management of multi- and extensively drug-resistant tuberculosis in Ukraine: how well are we doing?

Abstract

A tertiary care facility in Ukraine, a high multiand extensively drug-resistant tuberculosis (MDR/ XDR-TB) burden country. Objectives: To assess the management and treatment outcomes of MDR, pre-XDR-TB and XDR-TB. Design: Cohort study using programme data, 2006-2011. Results: Of 484 individuals with drug-resistant TB, 217 (45%) had MDR-, 153 (32%) pre-XDR-and 114 (24%) XDR-TB. Of all resistant types completing the intensive phase of treatment, 322 (67%) were alive and had culture converted. This included 157 (72%) with MDR-and 61 (54%) with XDR-TB. At the end of the continuation phase of treatment, 106 (22%) had treatment success and 378 (78%) had unfavourable outcomes, including 110 (23%) failures, 21 (4%) deaths, 71 (15%) losses to follow-up and 176 (36%) with an unknown outcome. This was associated with more than one lung cavity being affected, a history of treatment with second-line anti-tuberculosis drugs, poor adherence and XDR-TB. A total of 226 (47%) patients reported at least one adverse drug reaction, the most common being gastrointestinal and vestibular toxicity. Conclusion: Outcomes of MDR-and XDR-TB were satisfactory in the intensive phase; however, this was not sustained during the ambulatory period. If we are to do better, urgent measures are needed to improve ambulatory management, including making safer, shorter and more effective drug regimens available. * Percentage calculated using all patients starting treatment as denominator. SD = standard deviation.

Pediatric Multidrug-resistant Tuberculosis in Kyiv City, Ukraine

“…Compared with adults with MDR-TB in Ukraine, the children in our cohort had much better treatment outcomes [11,12]. This finding is consistent with those conducted in other settings that have reported higher rates of MDR-TB treatment success in children compared with adults [3].…”

“…Despite the country's high MDR-TB burden, few reports have described the treatment of this disease in Ukraine [11,12]. Two recent studies showed that only 18-22% of adults treated for MDR-TB achieved treatment success, defined as cured or treatment completion [11,12]. This rate is far lower than the global treatment success rate of 54% among adults [7].…”

A Step towards Control of Multidrug Resistant Tuberculosis: Hospital Based Study from Nashik India

“…5 As per N. Lytvynenko et al (Ukraine), Cured (19%), treatment completed (1%), failure (16%), died (2%), and lost to follow up (16%). 6 Most of the studies have similar findings except treatment failure. The difference may be because of study design, place and implementation of program.…”

Shifting from an inpatient to outpatient centered model through transforming the TB financing in ex-Soviet countries

“…Doing so will also limit disruptions related to frequent turnover of government officials which was highlighted as a perceived challenge. Of recent Ukraine has articulated "what must change" in terms of current management approaches [21][22][23].…”