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The effectiveness of tuberculosis control is associated with efficacy of treatment of TB patients and above all patients with multiple and extensive drug resistance (MDR/XDR MTB). Patients with TB/HIV co-infection providethe significant impact on the situation.The objective of the studyis to assess outcomes of chemotherapy regimens containing bedaquiline in patients with MDR/XDR TB including those with concurrent HIV infection.Subjects and methods. The efficacy and safety of the regimes containing bedaquiline were assessed in the intensive phase of chemotherapy in 80 patients with MDR/XDR TB: Group1 consisted of 46 patients with negative HIV status (ICD10 code A15-A19); Group 2 – 34 HIV positive patients at the advanced stage with manifestations of a mycobacterial infection (ICD10 code B20.0).Results. Treatment outcomes in the groups were as follows: the effective treatment was statistically significantly more frequent in Group 1 versus Group 2 (80.4 and 52.9%, respectively, p = 0.0088). Treatment failure was registered in 3 patients from each group; treatment defaults were statistically significantly more frequent in Group 2 compared to Group 1: in 8/34 versus 2/46 (p = 0.011). 3 patients were transferred out in both Group 1 and Group 2 (3/46 and 3/34, p = 0.69). During treatment, only 1 patient from Group 2 developed an adverse event, most likely associated with the in-take of bedaquiline, a heart rhythm disorder (ventricular arrhythmia) and prolongation of QTcF > 450 ms.

Human immunodeficiency virus (HIV) and tuberculosis with multiple drug resistance (MDR TB) are becoming the major problem for national tuberculosis control programs. Conclusions made by various studies investigating the association of HIV infection and multiple drug resistance of tuberculous mycobacteria in tuberculosis patients are not always unambiguous and evident. The objective: to summarize data on the correlation between HIV infection and MDR TB among new cases through the systematic review of published results of studies. Research methods. The quality, accuracy and authenticity of the initial data were assessed. Approximating functions of changes in HIV-TB-MDR and TB-MDR were built for new cases basing on the data of 11 selected studies. The general effect of HIV infection impact factor on TB-MDR was assessed for the studies included into the analysis. Results. Data analysis for the consolidated group of new cases showed that the assessment of the risk of MDR detection was higher in those with TB/HIV co-infection (OR 2.76; 95% CI 2.35-3.24) versus HIV negative tuberculosis patients, which provided the evidence of the existing positive epidemiological correlation between the positive HIV status and MDR TB.

The article presents results of multi-dimensional analysis of 83 rates, calculated on the basis of federal and sectoral reports on tuberculosis in 21 regions of Siberian and Far Eastern Federal Districts, which were collected from 2006 to 2016. For statistic processing of data, a distance matrix was used with its consecutive analysis by principal coordinates analysis, which allowed detecting the closest correlations between rates. It has been proved that main factors of successful tuberculosis control are the following: improvement of the organizational quality of treatment and diagnostics, provision with qualified medical personnel, early detection through expansion of coverage of population with fluorography screening. The principal coordinates method also allowed performing a multilateral evaluation of epidemic situation in all regions and defining the ones with the most favorable tuberculosis situation.

The article describes the changes in the main tuberculosis rates in Khanty-Mansiysky Autonomous Region for the last 10 years. The main areas requiring major efforts and bottlenecks in tuberculosis control are highlighted, and the results achieved in the treatment of multiple drug resistant tuberculosis in this Russian region are presented. The article presents preliminary analysis of treatment efficiency of multiple drug resistant tuberculosis and changes in the epidemics of this most dangerous form of the disease given the introduction and active use of a new generation of anti-tuberculosis drugs.

In the Arkhangelsk Region, the prevalence of multiple dru g-r esistant tuberculosis is one of the highest in the world. In 2016, the portion of multiple drug resistant tuberculosis made 33.1% among new cases and 59.5% among relapses. Using new molecular genetic diagnostic techniques allows reducing the time for diagnostics of tuberculosis and drug resistance and should result in the earlier start of adequate treatment. The goal of the study is to assess the impact of new diagnostic molecular genetic methods on the time period from the first referral for medical care till the start of MDR-TB treatment. It was assumed that the introduction of molecular genetic tests would lead to early initiation of treatment in MDR TB patients (the research project of the International Union Against Tuberculosis and Lung Diseases and Tuberculosis Control Program of Arkhangelsk Region on The PROVE-IT LPA ; Policy Relevant Outcomes from Validating Evidence on Impact of Line Probe Assays). Subjects and Methods . The results of the diagnostic procedure using cultures were compared with the results of the procedure based on molecular genetic tests aimed to detect MDR-TB . 295 MDR TB patients were enrolled into the study, of them, 163 had culture and 132 had molecular genetic tests. Result s. The use of molecular genetic tests in smea r-p ositive patients ( AFB +) resulted in the reduction of the time period before initiation of MDRTB treatment by 50 and 66 days (median) versus culture by Bac TA lert and absolute concentration on Lowenstei n-J ensen medium respectively ( p < 0.001). Patients with a negative smear ( AFB -), in whom MDR TB was detected by molecular genetic methods started treatment by 78 days earlier (median) versus patients who had culture (Lowenstei n-J ensen, p < 0.001). Despite the significant reduction in the time period, even using molecular genetic methods, it took 24 days for cases with AFB + and 62 days for cases with AFB - to be notified and start treatment of MDR TB .

Development of new methods of immune diagnostics of tuberculous infection and their introduction into tuberculosis control practice have changed approaches to diagnostics of tuberculosis in Russia. Along with world recognized IGRA-tests the test with tuberculous recombinant allergen (TRA) developed by Russian researchers is also widely used. High diagnostic value of each of the methods is proved by multiple national and international trials however there is no research comparing results of these methods in the diagnostics of tuberculous infection in children, including those with concurrent conditions. During the study data of testing in 654 children in the age from 0 to 14 years old with positive sensitivity to tuberculin as per Mantoux test with 2 TU were analyzed. All patients had modern immunological tests done: TRA and IGRA-tests (QuantifeRON® Gold ELISA (QFT) and T-SPOT.TB). The study confirmed the low value of Mantoux test with 2 TU as a method of early tuberculosis detection in children; it detected underdiagnosis (10-50%) and overdiagnosis (78%) of latent tuberculous infection in the children with different sensitivity level as per data of Mantoux test with 2 TU. Comparing the results of TRA and IGRA tests it is possible to state that they are compatible for 76-81% of cases. The group of children was detected who had allergic and endocrine disorders (obesity), for whom IGRA tests were recommended to exclude chances of false-positive results of TRA tests.

Goal : to investigate specific methods of tuberculosis control teaching to students of Pediatric and General Medicine Department at Phthisiology and Pulmonology Department of Siberian State Medical University subordinated to the Russian Ministry of Health. Materials and methods . Main training curricula and teaching programmes for professional lines of 31.05.01 on General Medicine and 31.05.02 on Pediatrics, students' questionnaires. Results . The article presents the experience of self-tuition of students while preparing to practical training in tuberculosis control in order to enhance the efficiency of mastering this topic, to form positive motivation to have training and productive activities, to develop the skills of information collection and its compilation for public presentation; it describes the task teachers face when implementing Federal State Educational Standard of Higher Education. Conclusions . It is necessary to optimize the training in order to enhance the self-tuition of students when preparing for practical training in tuberculosis control; new forms of training are to be introduced.

Primorsky Kray has one of the highest tuberculosis incidence in Russia and one of the highest HIV incidence among the regions of the Far Eastern Federal District. Understanding of interfacing mechanisms of two epidemics is necessary for planning tuberculosis control activities in the regions with high speed of increase and high prevalence of HIV infection. Applying this integrated approach allows detecting presence of such correlations when they are manifested on the population level during epidemic development. This interfaced epidemiological analysis of tuberculosis and HIV incidences resulted in concluding that current epidemic of tuberculosis is assessed as emergency and HIV epidemic as unstable. It has been proved that dissemination of HIV infection promotes tuberculosis epidemic in Primorsky Kray and mechanism of formation of tuberculosis and HIV incidences is interdependent.

Despite that the turning point was achieved in tuberculosis control in the world, still there is on-going interest to this social disease. Goal: to evaluate changes of main epidemiological rates, to publish achievements and prospects of the implementation of National tuberculosis control programme for the period after 2015. Materials and methods. Comparative analysis included evolution of tuberculosis in various localizations in 2011-2015. Results. Tuberculosis situation has been gradually improving in the Republic of Moldova for the last 5 years. The data evidence about the number of tuberculosis cases going down but the global burden of the disease remains fairly high. The success in tuberculosis control supported by WHO and other international organizations is also related to certain Moldavian research achievements. Conclusion. Due to diversity of clinical forms of tuberculosis and the growing problem of comorbidity the cross-disciplinary approach to tuberculosis control can assure success of these activities.

Basing on the data about achievement of targeted rates for efficiency evaluation of the actions aimed at tuberculosis mortality reduction in 2015 and statistic rates for 2014-2015 in 12 regions within Siberian Federal District, the impact of organizational medical activities performed by primary medical services and tuberculosis control services was analyzed in the respect of tuberculosis mortality rate. The article presents results of ranging of regions within Siberian Federal District as per tuberculosis mortality rate and indicators providing impact on the number of those died of tuberculosis.

Costs of out-patient patient-centered activities introduced into the existing standard model of the tuberculosis treatment have been evaluated in Tomsk TB Service. Additional measures enhancing compliance in the patients included the following: timely detection and management of side effects of chemotherapy, social support to the patients, treatment at home, psychological support and treatment by the Sputnik team of most socially vulnerable patients. The average additional costs for the patient-centered activities per 1 patient treated as per regimens I, II, III made 1367 RUR a month; per 1 PR TB patient – 2978 RUR; and per regimen IV – 4865 RUR. Patient-centered activities performed during the out-patient stage of treatment made 7% out of the total treatment costs for regimens I, II, III; 14% when treating polyresistant TB; and 16% for regimen IV.

Given the stabilization of tuberculosis epidemiological situation in Saratov Region, there is reduction of tuberculosis incidence both in children and adolescents, which is due to the performed tuberculosis control activities aimed at early detection and prevention of tuberculosis. Cases of 150 children and 125 adolescents treated at the Saratov RTBD from 2009 to 2013 were analyzed. It was found out that preventive detection of tuberculosis was equally efficient in children and adolescents (p = 0.3024). Wide introduction of computer tomography and Diaskintest into practice increased the number of persons followed up as Group 0 twice in 2013 compared to 2009 (p = 0.0038) and it caused the increase in the frequency of tuberculous intoxication (p = 0.0422) and focal tuberculosis in the structure of clinical forms of tuberculosis in children. Exposure to tuberculosis was found in 48.7% of followed-up cases among children and in 25.6% among adolescents. The father was the most common source of infection. The lack of quality immune prevention in children during first 2 years of life promoted the development of local tuberculosis.