Browsing by Author "Kliiman, Kai"

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    Highly drug-resistant tuberculosis in Estonia: risk factors and predictors of poor treatment outcome
    (2010-02-01T08:04:42Z) Kliiman, Kai
    After collapse of the Soviet Union, Estonia experienced substantial political, economic and societal changes associated with declines in many health indicators and resurgence of tuberculosis (TB). In 2000, Estonia was identified as one of the multidrug-resistant (MDR)-TB “hot spots” and has afterwards consistently had one of the highest proportion of MDR-TB and extensively drug-resistant (XDR)-TB in the world. Since 2000, the TB notification rate decreased 8% per year and is now showing a flat trend in proportions of MDR-TB among new cases, however, the proportions of MDR-TB and XDR-TB have remained still high. To characterize the factors behind high proportion of MDR-TB and XDR-TB in Estonia, a retrospective, cross-sectional study involving all patients with culture-confirmed pulmonary TB diagnosed from January 2003 to December 2005 was designed. Predictors for XDR-TB were previous TB treatment, HIV-infection, homelessness, and alcohol abuse. Determinants for MDR-TB were previous TB treatment and age ≤ 65 yr. Among the patients ≤ 24 yr of age, multidrug-resistance was associated with female gender and place of birth outside Estonia. The risk factors behind poor treatment outcome in MDR-TB were HIV-infection, previous TB treatment, resistance to ofloxacin, and AFB smear-positivity at the start of treatment. Predictors of poor treatment outcome in XDR-TB were urban residence and positive AFB smear at the start of treatment. The most common cause of treatment default was alcohol abuse and the independent risk factors for treatment default were alcohol abuse, unemployment, urban residence, and previous imprisonment. These findings indicate that interventions to reduce rate of highly drug-resistant TB should be centered on socially disadvantaged patients with special supportive attention to re-treatment cases and HIV-infected patients.