West meets East - WHO tuberculosis treatment

August 09, 2001

N.B. Please note that if you are outside North America, the embargo for Lancet press material is 0001 hours UK time Friday 10th August 2001.

Results of a tuberculosis trial, published in this week's issue of THE LANCET, suggest that a WHO strategy could make a valuable contribution to tuberculosis control in Russia.

There has been a resurgence of tuberculosis in Russia in the past decade, mainly due to the collapse of the health-care infrastructure in the 1980s and early 1990s. Traditional Russian services for treatment of tuberculosis are very different from those in the West. Patients suspected of having the disease are referred to specialist tuberculosis hospitals or sanatoria. Treatment methods combine chemotherapy with a range of additional treatments, some of which predate the chemotherapy era (10% of patients undergo surgery); long periods of hospitalisation are common. Nicholas Banatvala and colleagues from Merlin (a UK-based international health-care agency) compared the effects of WHO short-course chemotherapy with standard Russian antituberculous treatment.

New adult tuberculosis patients were included in a trial and allocated to receive either traditional Russian tuberculosis treatments or WHO short-course chemotherapy in the two largest tuberculosis diagnostic and treatment centres of Tomsk Oblast, western Siberia. Standard WHO tuberculosis outcomes and rates of sputum conversion were used as primary outcomes.

646 patients took part in the trial; 356 patients were given Russian tuberculosis treatment (155 smear positive) and 290 were given WHO short-course chemotherapy (155 smear positive). There was no statistical difference between the proportion cured or completing treatment (63% for both groups), or in the proportion of patients who died (8% WHO, 11% Russian treatment).

In an accompanying Commentary (p 434), Richard Coker from the London School of Hygiene and Tropical Medicine, UK, states that the benefits of the WHO strategy (such as reduced health-care costs from decreased hospitalisation) has not so far resulted in a transformation of tuberculosis care in western Siberia, even though the trial was completed five years ago. He comments on the profound cultural differences between western and Russian approaches to health care: "many patients in Russia continue to undergo long periods of hospital admission (especially for the early stages of treatment), and although the number of beds dedicated to long-term treatment of patients with tuberculosis has fallen by about a fifth since 1994, staff numbers in hospital facilities have hardly altered. Why has there been such a resistance to change? Because changing health structures requires more than evidence from clinical trials and cost-effectiveness analyses. Structural impediments are commonly extremely difficult to overcome. Funding of tuberculosis services in Russia is linked to bed numbers, and those people responsible are understandably reluctant to shrink their budgets voluntarily. Likewise, professional authority is intimately allied to hospital capacity. Insecure, vulnerable clinicians are, not surprisingly, wary of change and generally reluctant to embrace modifications to work patterns that potentially threaten them professionally and financially. A complex web of perverse incentives means organisational changes are difficult to initiate and sustain."
-end-
Contact: Dr Nicholas Banatvala, Department of Public Health, Suffolk Health PO Box 55, Foxhall Road, Ipswich, Suffolk IP3 8NN, UK; T) 44-1473-323-373; M 07887 855216 F) 44-1473-323420; E) nick.banatvala@hq.suffolk-ha.anglox.nhs.uk

Dr Richard Coker, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK; T) 44-20-7927-2926; F) 44-20-7612-7812; E) richard.coker@lshtm.ac.uk

Lancet

Related Tuberculosis Articles from Brightsurf:

Scientists find new way to kill tuberculosis
Scientists have discovered a new way of killing the bacteria that cause tuberculosis (TB), using a toxin produced by the germ itself.

Blocking the iron transport could stop tuberculosis
The bacteria that cause tuberculosis need iron to survive. Researchers at the University of Zurich have now solved the first detailed structure of the transport protein responsible for the iron supply.

Tuberculosis: New insights into the pathogen
Researchers at the University of W├╝rzburg and the Spanish Cancer Research Centre have gained new insights into the pathogen that causes tuberculosis.

Unmasking the hidden burden of tuberculosis in Mozambique
The real burden of tuberculosis is probably higher than estimated, according to a study on samples from autopsies performed in a Mozambican hospital.

HIV/tuberculosis co-infection: Tunneling towards better diagnosis
1.2 million people in the world are co-infected by the bacteria which causes tuberculosis and AIDS.

Reducing the burden of tuberculosis treatment
A research team led by MIT has developed a device that can lodge in the stomach and deliver antibiotics to treat tuberculosis, which they hope will make it easier to cure more patients and reduce health care costs.

Tuberculosis: Commandeering a bacterial 'suicide' mechanism
The bacteria responsible for tuberculosis can be killed by a toxin they produce unless it is neutralized by an antidote protein.

A copper bullet for tuberculosis
Tuberculosis is a sneaky disease, and the number one cause of death from infectious disease worldwide.

How damaging immune cells develop during tuberculosis
Insights into how harmful white blood cells form during tuberculosis infection point to novel targets for pharmacological interventions, according to a study published in the open-access journal PLOS Pathogens by Valentina Guerrini and Maria Laura Gennaro of Rutgers New Jersey Medical School, and colleagues.

How many people die from tuberculosis every year?
The estimates for global tuberculosis deaths by the World Health Organisation (WHO) and the Institute for Health Metrics and Evaluation (IHME) differ considerably for a dozen countries, according to a study led by ISGlobal.

Read More: Tuberculosis News and Tuberculosis Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.