mdr-tb in belarus, the role of outpatient care strengthening and social support

TB incidence and mortality in Belarus has been progressively falling from 54 to 41 and from 12.1 to 6.8 per 100000, accordingly, for the last 7 years. Nevertheless, the number of HIV/TB co-infected rises dramatically. According to a recent nationwide drug resistance survey, MDR-TB was found in 32.3% of new and in 75.6% of previously treated TB cases. Results of treatment of MDR-TB are far from satisfactory (51% treatment success, 11% deaths). Risk factors for MDR-TB acquisition and unfavorable treatment outcome are the following: young age, drug and alcohol abuse, HIV, history of imprisonment, unemployment, and homelessness. Most of such events as treatment failure and loss to follow-up occur at the outpatient treatment phase, particularly in patients from the above-mentioned risk groups. One of the key elements of outpatient care strengthening is social support. Two operational research studies were conducted. One study with 40 MDR-TB patients included showed that treatment cost can be reduced by more than 5200 US dollars per patient using outpatient care with social support instead of existing care based on long-term hospitalization. Another study showed that MDR-TB patients with social support (n = 1057) had better treatment outcomes compared with conventionally managed patients (n = 3514): treatment success 70% vs. 53%; mortality 2% vs. 6%; treatment failure 27% vs. 40%. Along with adequate diagnostics and therapy, outpatient care strengthening and social support are important elements in achieving good treatment outcomes and reducing the cost of treatment of MDR-TB.