Goncharova O, Denisiuk O, Zachariah R, Davtyan K, Nabirova D, Acosta C, Kadyrov A
National Center of Phthisiology, Bishkek, Kyrgyz Republic.
Alliance for Public Health, Kyiv, Ukraine.
Public Health Action. 2017 Sep 21;7(3):218-223. doi: 10.5588/pha.17.0002.
Twenty-two first-line, two second-line and one tertiary health facility in Bishkek, the capital of Kyrgyzstan. Among migrants, a marginalised population at risk for acquiring and transmitting tuberculosis (TB), we determined the proportion with TB among all registered TB cases. For those registered at primary-level facilities, we then reported on their demographic and clinical profiles and TB treatment outcomes. This was a retrospective cohort analysis of 2012-2013 programme data. Of 2153 TB patients registered in all health facilities, 969 (45%) were migrants, of whom 454 were registered in first-line facilities. Of these, 27% were cross-border migrants, 50% had infectious TB and 12% had drug-resistant TB. Treatment success was 74% for new cases and 44% for retreatment TB (the World Health Organization target is ⩾85%). Failure in new and retreatment TB patients was respectively 8% and 25%. Twenty-six individuals started on a first-line anti-tuberculosis regimen failed due to multidrug-resistant TB. Eight (25%) of 32 individuals on a retreatment TB regimen also failed. Loss to follow-up was 10% for new and 19% for retreatment TB. Migrants constituted almost half of all TB patients, drug resistance is prevalent and treatment outcomes unsatisfactory. Fostering inter-country collaboration and prioritising rapid TB diagnostics (Xpert MTB/RIF) and innovative ways forward for improving treatment outcomes is urgent.
吉尔吉斯斯坦首都比什凯克的22家一线、2家二线和1家三级医疗机构。在移民这一面临感染和传播结核病风险的边缘化人群中，我们确定了所有登记的结核病病例中患结核病的比例。对于在基层医疗机构登记的患者，我们随后报告了他们的人口统计学和临床特征以及结核病治疗结果。这是一项对2012 - 2013年项目数据的回顾性队列分析。在所有医疗机构登记的2153例结核病患者中，969例（45%）是移民，其中454例在一线医疗机构登记。在这些患者中，27%是跨境移民，50%患有传染性结核病，12%患有耐药结核病。新病例的治疗成功率为74%，复治结核病的治疗成功率为44%（世界卫生组织的目标是≥85%）。新病例和复治结核病患者的治疗失败率分别为8%和25%。26名开始一线抗结核治疗方案的患者因耐多药结核病而治疗失败。32名接受复治结核病治疗方案的患者中有8名（25%）也治疗失败。新病例的失访率为10%，复治结核病的失访率为19%。移民几乎占所有结核病患者的一半，耐药情况普遍，治疗结果不尽人意。促进国家间合作并优先开展快速结核病诊断（Xpert MTB/RIF）以及探索改善治疗结果的创新方法迫在眉睫。
