Treatment effectiveness of TB patients from different groups of population in Moscow

Abstract

Introduction: Moscow has one of the lowest tuberculosis (TB) epidemiological rate in Russia. At the same time, the impacts of significant migration from CIS countries and Russian regions (MG), homeless (HML) and HIV are the major challenges of TB control in the megapolis. Differentiation of treatment outcomes evaluation for these groups of patients in depend on history of previous treatment are needed for targeted measures.

Methods: Treatment outcomes for 2013 cohort (2803 not-MDR TB patients) were analyzed in the Moscow in the beginning of 2015. Cohorts of HIV-negative (HIVn) and HIV-positive (HIVp) residents (RS), as well as HML and MG were evaluated separately for new TB cases (NC), TB relapses (RLC) and retreatment TB cases (RTC).

Results: Treatment success rate (TSR) of NC was highest in 1398 HIVn RS: 84.6% (95% CI: 82.6-86.5) in comparison with201 HIVp RS patients (54.7%, 47.6-61.7), 623 MG: (56.0%, 52.0-60.0) and 97 HML (48.5%, 38.2-58.8), p<0.01.

NC from HIVp RS had predictably the highest level of death rate: 27.9% (21.8-34.6) vs. 3.9%, 8.2% and 2.7% for NC from RS, HML and MG, accordingly (p<0.01).

TSR for 194 RLC from RS (69.1%, 59.7-73.1) was higher (p<0.05) than TSR for 33 RLC from HIVp RS and 48 RLC from MG: 51.5% and 39.6%, accordingly.

Both MG cohorts: 623 NC and 48 RLC, showed high level of “not evaluated” outcomes: 37.1% (33.3-41.0) and 50.0% (35.2-64.8), defined particularities of the moving population, in contrast of RS cohorts (1.5% -1.6%).

74 RTC patients from RS showed TSR: 39.2% (28.0-51.2).

Conclusions: Evaluations of treatment effectiveness for patients from different strata of population allows define directions of purposeful activities to improvement of TB control in Moscow.