• Does One Size Fit All? Drug Resistance and Standard Treatments: Results of Six Tuberculosis Programmes in Former Soviet Countries.

      Bonnet, M; Sizaire, V; Kebede, Y; Janin, A; Doshetov, D; Mirzoian, B; Arzumanian, A; Muminov, T; Iona, E; Rigouts, L; et al. (International Union Against TB and Lung Disease, 2005-10)
      SETTING: After the collapse of the Soviet Union, countries in the region faced a dramatic increase in tuberculosis cases and the emergence of drug resistance. OBJECTIVE: To discuss the relevance of the DOTS strategy in settings with a high prevalence of drug resistance. DESIGN: Retrospective analysis of one-year treatment outcomes of short-course chemotherapy (SCC) and results of drug susceptibility testing (DST) surveys of six programmes located in the former Soviet Union: Kemerovo prison, Russia; Abkhasia, Georgia; Nagorno-Karabagh, Azerbaijan; Karakalpakstan, Uzbekistan; Dashoguz Velayat, Turkmenistan; and South Kazakhstan Oblast, Kazakhstan. Results are reported for new and previously treated smear-positive patients. RESULTS: Treatment outcomes of 3090 patients and DST results of 1383 patients were collected. Treatment success rates ranged between 87% and 61%, in Nagorno-Karabagh and Kemerovo, respectively, and failure rates between 7% and 23%. Any drug resistance ranged between 66% and 31% in the same programmes. MDR rates ranged between 28% in Karakalpakstan and Kemerovo prison and 4% in Nagorno-Karabagh. CONCLUSION: These results show the limits of SCC in settings with a high prevalence of drug resistance. They demonstrate that adapting treatment according to resistance patterns, access to reliable culture, DST and good quality second-line drugs are necessary.
    • Examples of tropical disease control in the humanitarian medical programmes of MSF and Merlin.

      Balasegaram, M; Dejene, S; Tinnemann, P; Perkins, S; Davidson, R N; Médecins Sans Frontières-UK, 67-74 Saffron Hill, London EC1N 8QX, UK. manica.balasegaram@london.msf.org (Elsevier, 2006-04)
      Humanitarian medical programmes in the tropics have the opportunity to provide beacons of good practice. The use of modern drugs and diagnostics, a lack of bureaucracy, adequate budgets, motivated staff and well-functioning supply lines all contribute to the success of this approach. At a joint meeting of the Royal Society of Tropical Medicine, the London School of Hygiene and Tropical Medicine, Médecins Sans Frontières and Merlin, new data were presented on the outcomes of recent humanitarian programmes to control malaria (Ethiopia), human African trypanosomiasis (south Sudan), Lassa fever (Sierra Leone) and tuberculosis (Tomsk, former USSR).