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# Public health advocacy for the Berlin Declaration on tuberculosis in the former Soviet Union: the view of Médecins Sans Frontières

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### Abstract

To assist international efforts to address major gaps in the availability and accessibility of quality diagnosis and treatment for multi-drug resistant tuberculosis, Médecins Sans Frontières has adapted an approach combining three sets of interlinked strategies: direct provision of medical care, operational research, and public health advocacy. The activities undertaken are reviewed each in turn, with stress on the ways that they impact upon and consolidate each other. In spite of new opportunities, including technologies which significantly improve diagnosis and new, more patient-centred approaches, a much broader international mobilization is needed in order to confront MDR-TB. It is also questionable as to whether existing technologies are successful enough to provide a solid basis for expanded national programs.

### Most cited references7

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### Multidrug-Resistant Tuberculosis Treatment Outcomes in Karakalpakstan, Uzbekistan: Treatment Complexity and XDR-TB among Treatment Failures

(2007)
Background A pilot programme to treat multidrug-resistant TB (MDR-TB) was implemented in Karakalpakstan, Uzbekistan in 2003. This region has particularly high levels of MDR-TB, with 13% and 40% among new and previously treated cases, respectively. Methodology This study describes the treatment process and outcomes for the first cohort of patients enrolled in the programme, between October 2003 and January 2005. Confirmed MDR-TB cases were treated with an individualised, second-line drug regimen based on drug susceptibility test results, while suspected MDR-TB cases were treated with a standardised regimen pending susceptibility results. Principal Findings Of 108 MDR-TB patients, 87 were started on treatment during the study period. Of these, 33 (38%) were infected with strains resistant to at least one second-line drug at baseline, but none had initial ofloxacin resistance. Treatment was successful for 54 (62%) patients, with 13 (15%) dying during treatment, 12 (14%) defaulting and 8 (8%) failing treatment. Poor clinical condition and baseline second-line resistance contributed to treatment failure or death. Treatment regimens were changed in 71 (82%) patients due to severe adverse events or drug resistance. Adverse events were most commonly attributed to cycloserine, ethionamide and p-aminosalicylic acid. Extensively drug resistant TB (XDR-TB) was found among 4 of the 6 patients who failed treatment and were still alive in November 2006. Conclusions While acceptable treatment success was achieved, the complexity of treatment and the development of XDR-TB among treatment failures are important issues to be addressed when considering scaling up MDR-TB treatment.
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### Health care reform in the former Soviet Union: beyond the transition.

(2012)
To assess accessibility and affordability of health care in eight countries of the former Soviet Union. Primary data collection conducted in 2010 in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Moldova, Russia, and Ukraine. Cross-sectional household survey using multistage stratified random sampling. Data were collected using standardized questionnaires with subjects aged 18+ on demographic, socioeconomic, and health care access characteristics. Descriptive and multivariate regression analyses were used. Almost half of respondents who had a health problem in the previous month which they viewed as needing care had not sought care. Respondents significantly less likely to seek care included those living in Armenia, Georgia, or Ukraine, in rural areas, aged 35-49, with a poor household economic situation, and high alcohol consumption. Cost was most often cited as the reason for not seeking health care. Most respondents who did obtain care made out-of-pocket payments, with median amounts varying from $13 in Belarus to$100 in Azerbaijan. Access to health care and within-country inequalities appear to have improved over the past decade. However, considerable problems remain, including out-of-pocket payments and unaffordability despite efforts to improve financial protection. © Health Research and Educational Trust.
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### The Beijing genotype and drug resistant tuberculosis in the Aral Sea region of Central Asia

(2005)
Background After the collapse of the Soviet Union, dramatically increasing rates of tuberculosis and multidrug-resistant tuberculosis (MDR-TB) have been reported from several countries. This development has been mainly attributed to the widespread breakdown of TB control systems and declining socio-economic status. However, recent studies have raised concern that the Beijing genotype of Mycobacterium tuberculosis might be contributing to the epidemic through its widespread presence and potentially enhanced ability to acquire resistance. Methods A total of 397 M. tuberculosis strains from a cross sectional survey performed in the Aral Sea region in Uzbekistan and Turkmenistan have been analysed by drug susceptibility testing, IS6110 fingerprinting, and spoligotyping. Results Fifteen isolates showed mixed banding patterns indicating simultaneous infection with 2 strains. Among the remaining 382 strains, 152 (40%) were grouped in 42 clusters with identical fingerprint and spoligotype patterns. Overall, 50% of all isolates were Beijing genotype, with 55% of these strains appearing in clusters compared to 25% of non-Beijing strains. The percentage of Beijing strains increased with increasing drug resistance among both new and previously treated patients; 38% of fully-susceptible isolates were Beijing genotype, while 75% of MDR-TB strains were of the Beijing type. Conclusion The Beijing genotype is a major cause of tuberculosis in this region, it is strongly associated with drug resistance, independent of previous tuberculosis treatment and may be strongly contributing to the transmission of MDR-TB. Further investigation around the consequences of Beijing genotype infection for both tuberculosis transmission and outcomes of standard short course chemotherapy are urgently needed.
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### Author and article information

###### Journal
1886
122234
European Journal of Microbiology and Immunology
EuJMI
2062-509X
2062-8633
1 December 2012
: 2
: 4
: 282-286
###### Affiliations
[ 1 ] Médecins Sans Frontières (MSF), Berlin, Germany
[ 2 ] Médecins Sans Frontières (MSF), London, UK
###### Article
6
10.1556/EuJMI.2.2012.4.6
###### Categories
Original Articles