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The objective: to determine main directions for improving the epidemiological control over socially important infectious diseases (tuberculosis, HIV infection, viral hepatitis B and C) based on the study of epidemic signs and its determinants from 2010 to 2021.Subjects and Methods. The main Rosstat Forms no. 8, 33, 61, 4, 2, 12, C51 were studied. Epidemiological and statistical analysis and content analysis of publications were applied. Calculations and graphical data analysis were performed using Microsoft Excel 10.0 software package.Results. Epidemiological trends of socially important infectious diseases differ: in tuberculosis, acute hepatitis B and C, there is a decrease in morbidity and mortality; in chronic viral hepatitis B and C, there is stabilization with a slight decrease in morbidity rates (both chronic viral hepatitis B and chronic viral hepatitis C) and mortality (from chronic viral hepatitis B). Mortality caused by chronic viral hepatitis C increased, while HIV morbidity and mortality stabilized. Measures for improving the system of epidemic control over socially important infections include the timely detection of the disease, early start of etiotropic therapy, increase in the coverage with preventive examinations and vaccination, improvement of detection in the families exposed to infections and infection control activities in such families, and health education of the population.

The article analyzes changes in the epidemic tuberculosis situation in children and factors influencing it. Data from tuberculosis statistical surveillance forms and on-line monitoring data for the biggest available period were studied. It was found that in 2021, tuberculosis incidence increased in children of 0-14 years old, and this increase was statistically significant (p < 0.05) in the group of children of 7-14years old (from 5.6 to 6.3 per 100,000 children of 7-14 years old), which may be related to the COVID-19 pandemic: increased epidemic risk of tuberculosis infection sources and increased exposure of children primarily of school age, who were switched to distant learning.The increase in tuberculosis incidence among children exposed to tuberculosis patients from 143.8 to 183.0 per 100,000 exposed children may be further attributed to decreased dissociating of contacts by hospitalizing children to tuberculosis sanatoria. Theepidemic tuberculosis situation in children is expected to deteriorate due to increased migration from the country with an unfavorable tuberculosis situation, i.e. Ukraine. Tuberculosis mortality in children continued to decline; there were no signs that it would increase in 2022.

The objective: evidence-based study of the factors influencing tuberculosis mortality in the Kamchatskiy Kray as a territory withlow population density.Subjects and Methods. A retrospective cohort study of the unfavorable course of tuberculosis in 512 patients with tuberculosis (new cases and relapses) was carried out. A univariate and multivariate analysis of risk factors for a lethal outcome of tuberculosis was performed.Results. In a univariate analysis, the incidence of death from tuberculosis among increased in older patients (p < 0.0001), among the unemployed, pensioners and disabled (p = 0.02), homeless (p = 0.01), persons who failed to undergo fluorography for 2 years or more (p = 0.004), patients with a positive result of sputum smear test at registration (p = 0.003), and those suffering from alcoholism (p = 0.03), and decreased in patients who were actively detected (p < 0.0001 ). There was no influence on the probability of death from tuberculosis in the registration group by such parameters as new cases/relapses (p = 0.2), male/female (p = 0.09), urban/rural area of residence (p = 0.7), belonging to the indigenous population (p = 0.6), resistance to rifampicin (p = 1), cardiovascular diseases (p = 0.5), and smoking (p = 0.3). In multivariate analysis, an independent factor that reduced the risk of death was the active detection of tuberculosis patients (aOR = 0.2, p = 0.02).Conclusion. To reduce the risk of death from tuberculosis in an area with low population density (Kamchatskiy Kray), the priority should be given to improvement of active detection of tuberculosis cases; the proportion of tuberculosis patients detected during preventive screening should be used as an parameter of this improvement.

Reporting of the «transferred out» outcome leads to significantly worse treatment results of tuberculosis patients treated in the institutions of the Federal Penitentiary Service of Russia.The objective: to investigate the patients’ routes that led to reporting of the «transferred out» outcome, and propose measures to reduce the risk of this outcome.Subjects and Methods. We studied the places of registration and routes of 1,496 pulmonary tuberculosis patients registered for treatment in 2019 (new cases and relapses) with the outcome of «transfered out».Results. In the structure of transferred out patients, in 631/1,496 (42.2%) patients, the «transferred out» outcome was associated with their transfer between institutions within the penitentiary system. Additionally 462/1,496 (30.9%) patients were released in the region where they continued their treatment, 85/1,496 (5.7%) were released and moved to a different region, 301/1,496 (20.6%) were released from pre-trial detention , and 10/1,496 (0.6%) left Russia and moved abroad.Conclusion: the procedure should be developed to transfer the information about patients moving within the penitentiary system and beyond it. To motivate the patient immediately after the detection of tuberculosis, it is necessary to conduct individual conversations explaining the nature of the disease, importance and necessity of treatment. Tuberculosis patients in pre-trial detention centers should be provided with leaflets containing information about medical organization where patients can continue treatment, patients released from penitentiary units should be informed about the system of social adaptation and services available for tuberculosis patients.

The article describes the current tuberculosis epidemiological situation in institutions of the penitentiary system including the combination of tuberculosis and HIV infection. The epidemic consequences of increased coverage of people living with HIV infection (PLHIV) with antiretroviral therapy (ART) were analyzed. By 2020, tuberculosis incidence dropped to 621 per 100,000. Tuberculosis mortality dropped to 6.8 per 100,000. The incidence of tuberculosis among PLHIV decreased from 3,490.6 per 100,000 population in 2014 to 2,014.2 per 100,000 population in 2020, while coverage of PLHIV with ART increased from 21.7 to 89.6%. The proportion of TB patients among PLHIV decreased from 10.4% in 2014 to 7.2% in 2020. The proportion of PLHIV among newly diagnosed TB patients remained high (34.4% in 2020). The prevalence of multiple drug resistant tuberculosis decreased to 557.6 per 100,000. Thus, in 2020, the epidemiological tuberculosis situation in the Russian penitentiary institutions continued to improve. The strategy to increase coverage of PLHIV with ART proved to be effective for prevention of tuberculosis in penitentiary settings. Multiple drug resistant tuberculosis presents a serious problem which forms the grounds for introduction of modern treatment protocols with innovative drugs to the Russian penitentiary institutions.

In order to understand problems, resources, and ways of improving TB epidemic situation, it is important to analyze stafng of TB Services.Subjects and Methods. The number of phthisiologists, full-time and employed positions of phthisiologists in 2011-2020 was assessed based of Federal Statistical Surveillance Form no. 30, and for the period of 2005-2014, Form no. 17 was additionally used. The number of phthisiologists was calculated as the ratio of the number of phthisiologists (Form no. 30) to the population at the end of the reporting year multiplied by 10,000. The physician workforce capacity was additionally analyzed based on audit reports of on-site visits in 10 regions of the Russian Federation (RF) in 2021.Results. As of late 2020, the stafng level with physical persons amounted to 52.5%, the shortage of personnel was more than 4,000 phthisiologists. The provision of the population with phthisiologists ranged from 0.49 (2014) to 0.47 per 10,000 population (2020). In 2011-2020, the coefcient of part-time employment varied from 1.6 to 1.7, exceeding the regulatory value (no more than 1.5) but for 2019. The sampling analysis in 10 regions of the Russian Federation demonstrated that the proportion of phthisiologists of retirement age among physicians was 37.2%. In 2011-2020, the number of tuberculosis patients per one phthisiologist position decreased from 19.0 to 7.8, the number of patients with multiple drug resistant tuberculosis - from 2.7 to 2.1. There is a significant decrease in the number of staff positions and occupied positions of phthisiologists providing medical care in out-patient settings (by 14.0%), while the number of phthisiologists in in-patient facilities remained the same.Conclusion. Challenges in stafng of TB Services are as follows: shortage of personnel, high level of phthisiologists working part-time, insufcient stafng of out-patient and polyclinic services, high proportion of physicians of pre-retirement and retirement age and insufcient level of professional competence of young specialists.

The objective: to determine risk factors of lethal outcomes (predictors) in tuberculosis patients treated with chemotherapy regimens I, II, III during confinement in the Russian penitentiary system.Subjects and Methods: data on 6,069 patients registered for treatment in 2019 and 2020 were studied. Univariate and multivariate analyses were performed.Results. The following factors were found to have effect on mortality: age (aOR = 1.05; 95% CI 1.03-1.06), multiple localizations of tuberculosis (aOR = 11.08; 95% CI 5.12-24.20), concurrent HIV infection (aOR = 9.13; 95% CI 6.90-12.24), and positive sputum microscopy at registration (aOR = 5.18; 95% CI 3.93-6.81). The patient gender was found to have no effect (OR = 0.9; 95% CI 0.4-1.9; p = 1).

The article presents the analysis of changes in preliminary and estimated epidemiological rates: tuberculosis (TB) incidence, TB mortality, and clinical and social structure of new TB cases. It has been found that against the background of continuing improvement of the epidemic situation (reduction of TB incidence and mortality), the clinical structure of TB cases detected in 2020-2021 deteriorated compared to 2015-2019 which was manifested by higher frequency of pulmonary tissue destruction, massive bacterial excretion (by smear), and fibrous cavernous pulmonary TB. The number of TB cases detected post mortem has increased, as well as one-year mortality. These changes indicate low detection of TB cases in 2020. Changes in the incidence of TB/HIV co-infection and the number of new cases with bacterial excretion and multiple drug resistant TB essentially repeat the changes in TB incidence in the resident population during this period.

The objective: to identify promising directions for prevention of HIV incidence mortality on the basis of analysis of changes in HIV situation assessing the effectiveness of interventions in penitentiary units.HIV infection has traditionally been a critical issue for the penitentiary system worldwide and in Russia particularly. Recently, Russia has managed to achieve positive changes in the epidemic situation: by 2020, HIV incidence reduced to 852.8 per 100,000 (including 2,433.6 in remand prisons and 122.8 in correctional institutions); HIV prevalence was 10,512.8 per 100,000; HIV mortality was 98.3 per 100,000; HIV lethality was 0.9 per 100,000 people living with HIV.The proportion of HIV infection as a cause of death decreased from 32.0 in 2016 to 20.5 in 2020. The positive changes developed faster compared to civilian health care and occurred during the growing coverage with antiretroviral therapy which increased from 21.7% in 2014 to 89.6% in 2020. The following problems persist: high prevalence of HIV infection among female inmates (19,275.0 versus 9,769.2 among male inmates per 100,000), the high proportion of HIV/hepatitis C co-infection (49.0%; 95% CI 48.6-49.5), and the low coverage with hepatitis C treatment (0.5% of the total number of persons with co-infection). Promising directions for the prevention of HIV incidence and mortality are related to stable supply of antiretroviral drugs, improved patient adherence to treatment, and expanding treatment for HIV/hepatitis C co-infection.

The objective: to develop proposals to improve the effectiveness of the tuberculosis immunodiagnosis system in children by analyzing potential losses of patients for registration.Materials: data from primary medical records of 605 children in 5 regions of Russia, results of the survey in 513 legal guardians and 27 experts.Results. 13.9% of the children subject for screening were not examined, tests were administered in 1.1% of children who had contraindications to them, errors in the test administration were expected in 1.5% of children, and in 6.2% of children, antihistamine medications were used leading to errors in the detection of tuberculosis infection. In 3.7% of children, results of the test were not assessed, 3.1% of eligible children were not referred to the phthisiologist, and 6.5% were lost to follow-up by the phthisiologist.Conclusions. The cumulative loss during immunodiagnosis of tuberculosis made 68.7%. The main reasons for the losses are medical exceptions and refusals to have immunodiagnosis of tuberculosis by legal guardians, incomplete follow-up by the phthisiologist, and the use of antihistamines.To reduce these losses, it is advisable to consider the following: organizing consultation with the phthisiologist at children's polyclinics and large children's groups; legal guardians should be able to have a paid sick leave on the days when the child has an appointment with the phthisiologist; specifying indications for desensitizing therapy and prohibiting it outside the indications; organizing internal and external quality control system for immunodiagnostics.

The objective of the study: to assess tuberculosis treatment outcomes in children of 0-14 years old following up changes over the time Subjects and Methods: A retrospective cohort analysis of tuberculosis outcomes in 15,794 children of 0-14 years old was performed, those children were registered for treatment from 2011 to 2018.Results. The percentage of children switched to MDR regimens increased from 1.3% to 12.0%. The rate of successful treatment of new TB cases in children varied from 93.2% to 96.6% in different years. In children registered for treatment in 2016-2018, 95.7% of new cases with negative or undocumented sputum smear microscopy, 87.8% with positive sputum smear microscopy, and only 83.3% of children with TB relapse were successfully treated. From 2015 to 2018, the percentage of children with treatment failures increased from 0.6% to 1.5%.Conclusion. Compared to other countries, Russia has a high rate of successful treatment in children with tuberculosis which may be due to their active detection. Nevertheless, there are certain defects in drug susceptibility testing of index cases. Treatment outcomes for children registered in 2020 are expected to be less favorable because of later detection due to the COVID-19 pandemic. The spread of HIV infection among children as well poses a threat of increased mortality in children ill with tuberculosis. To reduce the level of unfavorable outcomes, it is necessary to consider the treatment of children at the age of 0-14 years old ill with tuberculosis in federal centers.

One of the essential problem sisthelack of continuity of medical follow-up and treatment of tuberculosis patients released from the penitentiary units and transferred tocivilian medical services. Mostly it is due to the fact that patients released from prisons are reluctant to continue medical follow up needed for their disease of tuberculosis or risk of its reactivation.The objective of the study: to find out the predictors of avoidance behavior in tuberculosis patients released from the penitentiary system of Russia resulting in reluctance to continue medical follow-up.Subjects and methods. During the case-control study, the information about 75 patients was investigated; those patients were detected in the penitentiary system in the period with 2014 2018 and released by the moment when the study was conducted. Ofthem, 62 referred to TB dispensary to continue follow-up and 13 didn't. The following predictors of the failure to continue medical follow-up were found out: the lackofa regular place of residence or foreign citizen ship; tuberculosis with minimal lesions and the negative result of the sputum test; clinically cured tuberculosis at the moment of release (Group III of dispensary follow-up). The regular place of residence, certain concurrent somatic conditions, and virus hepatites contributed to the willingness of patients to continue follow-up in the civilian medical system including due to tuberculosis.

The objective: to identify and rank the predictors of lethal outcome in patients with tuberculosis resistance to at least rifampicin and concurrent HIV infection (TB-R/HIV).Subjects and methods. 130 cases TB-R/HIV notified in Rostov Region in 2017-2018 were included in an observational retrospective cohort study. Two cohorts were formed: cohort A consisted of 31 patients with a documented fatal outcome within 12 months after registration for treatment, cohort B included 99 patients didn't die at least during the first year after registration for treatment. At the first stage of the study, the statistical significance of differences of certain signs in patients of cohorts A and B was determined. The signs with confirmed statistical significance of differences were included in the second stage of the study, during which their sensitivity as predictors of lethal outcome was determined. For this, automated artificial neural networks were used.Results. The following can be used as predictors of lethal outcome for TB-R/HIV patients (in decreasing order of significance): homelessness (people who have no place of residence), addiction to alcohol or drugs, interruption of anti-TB chemotherapy in the past, low body mass index, low hemoglobin level, including anemia (but not severe), low level of CD4 T-lymphocytes (the prognosis is especially unfavorable with less than 100 cells/μl). The level of total protein may also be a potential predictor, however, the selection criteria for this indicator require further clarification.

The objective: to study the reasons for the refusal of legally authorized representatives of children to conduct mass immunodiagnosis of tuberculosis using a representative sample of population and to outline possible ways to change this negative situation.Subjects and methods: A cross-sectional multi-center study was conducted. In 8 regions of the Russian Federation, the survey was conducted in 1,059 legally authorized representatives of children refusing to undergo mass immunodiagnostics of tuberculosis. The following main reasons for refusal were found out: fear of side effects and complications (32.6%), distrust in the quality of the test (29.7%), lack of understanding of the need to examine a child for tuberculosis. 72.2% of respondents demonstrated poor awareness of the problem of tuberculosis – they denied this problem or associated it with a different social environment, which was fertile ground for negative information received through various channels. To solve this problem, it is necessary to intensify health education in various groups of the population, including work with religious communities. Additional resources can be used such as targeted social advertisements, which will allow covering with health education propaganda of 33.1% of people who do not want to receive information about tuberculosis, expanding the regulation for the use of alternative methods of screening for tuberculosis.The authors state that they have no conflict of interests.

Malignant tumors of the trachea, bronchi, lungs represent a serious medical and social problem. Most cases of cancer of the trachea, bronchus, and lung are detected at stage IV, and therefore, to improve the survival of patients, a new treatment strategy is proposed based on modern data on mutagenesis and receptor status of tumor cells, which has a personalized approach for each specific case. To make managerial decisions about the introduction of innovative drugs, a forecast of expected results is required which should be improved indicators of the State Program On Healthcare Development. It has been found out that the transition to a new strategy for lung cancer chemotherapy will reduce mortality from malignant tumors by 1.2-0.7%, including lung cancer by 3.9%, as well as one-year case fatality by 3% for all malignant tumors, including 15% for lung cancer. At the same time, within 5 years after the introduction of the new strategy for lung cancer treatment, the indicator reflecting the proportion of patients with malignant tumors registered for 5 years or more is expected to decrease, which is related to specific parameters of the calculation method.The authors state that they have no conflict of interests.

To solve the problems of tuberculosis (TB) in penitentiary institutions, it is advisable to conduct a retrospective analysis, to find the most successful ways to prevent the spread of the infection in this system.Objective: to study the historical aspects of tuberculosis control in the penitentiary system of the Russian Federation.Methods. Information analysis methods were used. Data from 61 sources were studied.Results. The most significant attention was given to tuberculosis control in the penitentiary units at the beginning of the XXI century, which resulted in the significant improvement of the situation. In recent years, less attention has been paid to this problem, which is capable of stagnating positive changes. It is proposed, along with the continued implementation of proven measures, to intensify research activities, the interaction between civil and penitentiary health care and social communication.

The article outlines the principles and contradictions inherent in the activities of medical tuberculosis control organizations within the system of mandatory medical insurance. The objective of the study: to investigate the efficacy and cost-effectiveness of the introduction of mandatory health insurance into tuberculosis control. Subjects and methods. The following indicators were compared and analyzed: rate of reduction of tuberculosis incidence and mortality, abacillation, the number of hospital admissions per patient, the number of visits per patient, the coverage of population with TB doctors, wages and salary per doctor, the cost of abacillation of one patient with multiple drug resistant tuberculosis. Results. The hypothesis about the influence of mandatory medical insurance system on the analyzed indicators was not confirmed. It was proved that it was not expedient to transfer funding of tuberculosis control activities into the mandatory health insurance system.

Despite the growing level of tuberculosis cases with extensive drug resistance and failing treatment of such patients, treatment outcomes of extensive drug resistant tuberculosis in the penitentiary system have never been studied. The objective of the study is to investigate treatment outcomes of extensive drug resistant tuberculosis in the penitentiary system of the Russian Federation. It was observed that treatment success of extensive drug resistant tuberculosis was poor (21.4%), which was first of all due to treatment failures (34.5%) and patients transferred out (27.7%). Relatively low mortality (6.0%) was typical of treatment outcomes. In order to enhance treatment effectiveness of extensive drug resistant tuberculosis in the penitentiary system of the Russian Federation, it would be reasonable to expand quality laboratory diagnostics and use of collapse therapy and to introduce the Federal Register of TB cases.

The article presents the data on the prevalence of tuberculosis in the penitentiary units in the countries of the WHO European Region compared to theRussian Federation.It lists factors providing an impact on the risk of the disease and notification rate of tuberculosis cases in prisons.Monitoring of tuberculosis in the penitentiary units is described including the formation of notification rates and treatment outcomes. It presents information on the comparatively high quality of tuberculosis monitoring in the penitentiary units of theRussian Federation.Potential causes of differences between the incidence of tuberculosis in different countries of the WHO European Region are analyzed.

The objective of the study: to estimate the age and gender-related and standardized incidence of tuberculosis in migrants versus incidence of tuberculosis in the countries of their origin and resident population.Subjects and Methods. Age and gender-related and standardized incidences of tuberculosis in the migrants were compared as well as incidence in the countries of their origin and among the resident population in Kaliningrad Region.Results. The standardized incidence of tuberculosis in the migrants is compatible with the incidence in the countries of their origin but it is two-fold higher versus the incidence among resident population. Tuberculosis incidence is higher in migrants compared to the population in the countries of their origin and residents of Kaliningrad Region in the age of 7-14 and 18-24 years old which is related to screening deficiencies in the countries of origin. No gender-related specific features of tuberculosis incidence were found in migrants.Conclusions. The standardized incidence in migrants corresponds to the standardized incidence in the countries of their origin, however, it is twice higher compared to the resident population of Kaliningrad Region. It would be appropriate to consider screening for tuberculosis in migrants in the age of 7-14 and 18-24 years old. Data on age and gender of migrants allow accurate estimation of their contribution to incidence of tuberculosis.

The article presents the data on the formation of the WHO global statistics on tuberculosis with concurrent HIV infection, which is given in the Global TB Reports. The information published on this issue in the WHO Global Reports for the WHO regions and countries of the world is compared to the data in the relevant reporting forms in the Russian Federation. The article contemplates the estimate of the main rates reflecting HIV infection prevalence among TB patients and mortality in TB/HIV patients in the countries of the world and registration of cases of TB/HIV co-infection and deaths of TB/HIV patients due to manifestations of tuberculous infection. The data presented in this article include the comparison of the values estimated by WHO, which are needed for organization of control over TB/HIV transmission, and their registered values in the Russian Federation, various countries of the world and countries of the WHO European Region. The article analyzes the data of the WHO Global Reports on the coverage with regular screening and preventive TB treatment of the people living with HIV and coverage of TB/HIV patients with antiretroviral therapy. When studying the data on treatment outcomes in TB/HIV patients in the WHO regions and the world, it was supposed that obtained results greatly depended on the way of the cohort formation in different countries of the world.

The article presents data on one of the main epidemiological rates defining the burden of tuberculosis in the system of WHO global statistics – tuberculosis mortality. The article describes in detail the WHO assessment of this rate and provides main data on the evaluation and notification of lethal cases due to tuberculosis in certain countries, WHO regions and worldwide. Data presented in the article include the comparison of definitions of mortality and values of registered mortality due to tuberculosis, obtained in Russia, worldwide and countries of WHO European Region. The article discusses if it is possible to achieve indicators set up in the WHO Stop TB Strategy (1990-2015) and WHO End TB Strategy (2016-2035).

The article presents data on two of the main epidemiological rates defining the burden of tuberculosis in the system of WHO global statistics tuberculosis incidence and mortality.The article specifies the formation of WHO assessment of tuberculosis incidence and provides main data on the evaluation and notification of new cases in certain countries, WHO regions and worldwide.Data presented in the article include the comparison of definitions of incidence and values of registered incidence of tuberculosis, obtained in Russia, worldwide and countries of WHO European Region.The article speculates on the tuberculosis detection in WHO understanding, in particular on the use of systematic screening. The explanation is given why the rate of prevalence is not commonly used in the latest WHO publications.

The purpose of the article is to inform national specialists involved in tuberculosis control about methods for compilation of WHO global tuberculosis statistics, which are used when developing strategies and programmes for tuberculosis control and evaluation of their efficiency. The article explains in detail the notions of main WHO epidemiological rates, used in the international publications on tuberculosis along with the data on their registered values, new approaches to making the list of country with the highest burden of tuberculosis, drug resistant tuberculosis and tuberculosis with concurrent HIV infection. The article compares the rates in the Russian Federation with global data as well as data from countries within WHO European Regions and countries with highest TB burden. It presents materials on the achievement of Global goals in tuberculosis control and main provisions of WHO End TB Strategy for 2015-2035 adopted as a part of UNO Sustainable Development Goals.

The tendency of tuberculosis prevalence reduction observed in the Russian Federation is mostly related to the cases without multiple drug resistance (MDR). In general the number of MDR TB cases still tends to be increasing in the Russian Federation. Confident long-term reduction is registered only in the Central and North-Western Districts with relatively low level of MDR TB prevalence. From 2017 MDR TB patients are expected to prevail in the structure of the sputum positive cases which surely provides negative impact on the treatment efficiency and epidemic trends. The system of dispensary follow-up allows evaluating the annual number of MDT TB cases and following the ways of its increase and reduction. Taking MDR TB sources on and off the register is less intensive compared to the same flows of non-MDR infectious cases. The number of MDR TB sources is increasing mostly due new tuberculosis cases however acquired MDR TB makes significant contribution to the growth of MDR TB sources number. The increase in the ratio of respiratory MDR TB patients with sputum conversion to those died reflects the success in the improvement of the treatment strategy of MDR TB patients.

It has been hypothesized and investigated that seasonal factors provide impact on the treatment interruptions. Treatment outcomes of 19 923 new pulmonary tuberculosis cases with the positive result of sputum tests have been studied. Patients registered for treatment during the cold seasons (Quarters I, IV) interrupt treatment, including interruption of the intensive phase, rarer compared to the warm seasons (Quarters II, III). The least relative risk of treatment interruption is observed in the patients registered during Quarter IV compared to the other Quarters. Also chemotherapy was interrupted more often and patients migrated less when registered in Quarter III compared to the patients registered in Quarter II. The observed consistent pattern should be taken into account when planning measures aimed to increase patients' motivation for treatment adherence.

The article describes the results of the correlation analysis of the standardized rate of treatment defaulters and rates reflecting the interaction between the doctor and the patient, medical and economic rates and the rates reflecting the tuberculosis epidemic situation. The correlation has been found between the part of treatment defaulters and the number of doctors per one patient and regularity of the meetings of the doctor and patients, tuberculosis mortality rates, prevalence of tuberculosis with bacillary excretion, rate of reduction in the prevalence of multiple drug resistant tuberculosis and the number of rates reflecting the treatment efficiency. No correlation has been found between the part of patients defaulting from treatment with medical and economic rates, incidence, frequency of relapses and primary multiple drug resistance. Reduction of the part of treatment defaulters will promote the implementation of the tasks of the Russian state health care policy.

Treatment outcomes have been studied for 1,372 children with pulmonary tuberculosis of 0-14 years old, notified in 2011 and 2012. It has been found out that the high cure rates (94.5%) are related to a lower number of forms with massive bacillary excretion (7.0%). The lower frequency of some other unfavorable outcomes also makes its contribution (but for the ineffective course of chemotherapy). The massive bacillary excretion increases the risk of chemotherapy failure by 13.2 fold and the risk of lethal outcome by 8.9 times.

The chemotherapy results have been analyzed in tuberculosis patients suffering from multiple drug resistance registered for treatment in the Russian Federation in 2011-2012 compared with the treatment outcomes of MDR patients registered for treatment in the world, BRICS and countries of the former Soviet Union in 2011. Treatment outcomes of XDR TB patients have been analyzed for the first time. Chemotherapy efficiency in MDR TB patients in the Russian Federation in the cohort of 2011 made 37.1%, and in the cohort of 2012 made 39.1%, which significantly lower than in the world in general (47.5%), in BRICS and countries of the former Soviet Union; this low treatment efficiency is mostly due to treatment failures (18.3%) and those died (19.1%). The treatment efficiency of XDR TB patients registered for treatment in the Russian Federation in 2012 made 26.2% versus 22.0% in the cohort of 2011. Considering the significant financial costs spent on the treatment, the chemotherapy efficiency of M/XDR TB patients in the Russian Federation is too low to improve the epidemic situation and some additional measures are to be taken for its improvement.

Cross screening study of the body composition in 240 adult tuberculosis patients found out significantly lower rates of weight and height, lean and fat mass indices and the value of phase diwerence compared to the population of clinically healthy people examined in health centers. 46 (19.2%) patients out of all examined had cachexia defined basing on the criteria of World Health Organisation (WHO). In addition, 75 (31.7%) of tuberculosis patients had protein debilitation and 39 (16.3%) had lipid debilitation. Diagnostic sensitivity of WHO criteria of cachexia by body mass index when defining protein debilitation made 56%, and when defining lipid debilitation it made 61.5%. Among women the rates of protein and lipid debilitation were similar (29.1% and 26.6%), and among men protein debilitation prevailed (32.9% against 11.2%). Protein debilitation were most often detected in case of multiple drug resistance (in 54.7% of cases), in those receiving repeated treatment after chemotherapy failure (45.9%) and in disseminated forms of pulmonary tuberculosis (44.3%). Examination results of 55 workers of anti-tuberculosis medical units in general corresponded to the reference data of the health centers.

Регулярная контролируемая химиотерапия – необходимое условие для успешного лечения туберкулеза, предотвращения развития лекарственной устойчивости возбудителя, обеспечения санитарно-эпидемического благополучия населения. Возможность ее проведения зависит, с одной стороны, от наличия достаточного количества ресурсов, включая обеспечение противотуберкулезными препаратами, с другой – от приверженности пациентов к лечению. Приверженность подразумевает соблюдение рекомендаций, предписанных медицинским работником пациенту, включая частоту обследований, прием препаратов, соблюдение режима лечения и т. д. Недостаточный контроль химиотерапии и досрочное ее прекращение – основные причины снижения эффективности лечения [1, 5]. Среди эпидемически опасных впервые выявленных больных, зарегистрирован­ ных в 2011 г., досрочно прекратило курс химиотерапии (КХТ) 7,2%, среди случаев повторного лечения – 14,8%, а среди случаев лечения туберкулеза с множественной лекарственной устойчивостью возбудителя (МЛУ-ТБ) – 20,4% пациентов [3]. Указанная проблема актуальна не только в Роcсии, но и во всем мире. По данным глобального отчета Всемирной организации здравоохранения, прерывают лечение 5% впервые выявленных больных, 12% больных, проходящих повторное лечение, и 28% больных МЛУ-ТБ [8].

The characteristics of patients receiving tuberculosis retreatment cycles, including those with recurrent tuberculosis, treatment after an ineffective chemotherapy cycle or discontinuation of a chemotherapy cycle, and other retreatment cases were studied. Only a portion of the total number of cases to be treated was established to be registered for treatment. A category of patients receiving treatment after a previous ineffective chemotherapy cycle is most difficult to treat. Among them, there are a very large proportion of cases with positive sputum smear microscopy results and that of patients with multidrug-resistant tuberculosis. The most common cause of a poor outcome was the detection of multidrug-resistant pathogen in patients with recurrent pulmonary tuberculosis and poor compliance in other retreatment cases.

Studying the targets and indicators of the Public Health Development Program up to 2020 concerning antituberculosis (anti-TB) care to the population may lead to the conclusion that they may be fulfilled in the Russian Federation as a whole. The difficulties in fulfilling the indicators are associated with the low level of tuberculosis detection in a number of subjects of the Russian Federation; the continuing development of the HIV epidemic; the inadequate development of bacteriological diagnosis of the drug sensitivity of the tuberculosis pathogen to anti-TB drugs; the nonuniform funding of anti-TB measures in the subjects of the Russian Federation – the annual financing per tuberculosis patient differs by 40 times, including that of the purchase of anti-TB drugs by 63 times. Having no federal financial assistance in purchasing reserve anti-TB drugs and consumables for microbiological tests, it is impossible to diagnose multidrug resistance and to cure patients with multidrug-resistant tuberculosis at the expense of the budgets of the Russian Federation’s subjects.

In 2012, the tuberculosis epidemic situation continued to be stable in the penitentiaries. Tuberculosis morbidity and mortality rates were 1085.5 and 86.8 per 100,000 average listed patients, respectively. The rate of a reduction in the above indicators was 7.9 and 23.9%, respectively. Among the patients, the proportion of young people declined. The higher incidence of tuberculosis and human immunodeficiency virus co-infection and the spread of antituberculosis drug-resistance in the pathogen are a threat to the stabilization of the tuberculosis epidemic situation in the penitentiaries of Russia. In 2012, the proportion of tuberculosis and human immunodeficiency virus-coinfected patients was 16.3% and that of patients with multidrug-resistant patients was 22.1%. Some released prisoners with active tuberculosis are not registered in the civil health facilities; in this connection, it is relevant to establish a total registry of patients with tuberculosis.

The paper gives the characteristics and outcomes of a chemotherapy cycle in new-onset tuberculosis patients registered for treatment in 2011. It shows a further reduction in the efficiency of treatment in both all first detected patients taken together and sputum smearpositive patients at registration. The main reason for lowering the efficiency of treatment in patients with tuberculosis is its higher drug resistant pathogen. Inadequate chemotherapy control and poor treatment adherence remain relevant. More than half of the first detected patients with positive sputum smear microscopy results discontinue a treatment cycle in the periods for up to 3 months. Bacterial excretion or lung tissue decay is a poor predictor requiring a multiprofessional approach to treating the patient.

The paper analyzes the results of treatment in 5,396 patients with multidrug-resistant tuberculosis who were treated in the regions of the Russian Federation under the Global Fund Round 4 project based on the recommended World Health Organization principles in the software management of drug-resistant tuberculosis. In the patients with multidrug-resistant tuberculosis, the total efficiency of chemotherapy was 49.6% and the efficiency of treatment in new multidrug-resistant tuberculosis cases was 59.5%. The main poor outcome of chemotherapy was its discontinuation that was 21.8%. The efficiency of chemotherapy in patients with multidrug resistant tuberculosis in the regions of the Russian Federation corresponds to that of treatment in the countries of the world and Europe.

The paper compares the results of treatment in patients with multidrug-resistant tuberculosis who were treated within the project based on the World Health Organization (WHO) principles in the software management of drug-resistant tuberculosis and those who are treated only in the framework of national programs and resources for the treatment of tuberculosis. It has been ascertained that the recommended WHO principles in the software management of multidrug-resistant tuberculosis, by preserving the existing structure of patients, allow the efficiency of treatment to be enhanced by 14.8%. At the same time, mortality rates may be expected to be reduced by 45.3% and, if there are no effective social support programs for patients with tuberculosis, the proportion of patients who discontinue a treatment cycle may increase by 40.1%.