Bulletin of the World Health Organization

Multidrug-resistant tuberculosis in Belarus: the size of the problem and associated risk factors

Alena Skrahina, Henadz Hurevich, Aksana Zalutskaya, Evgeni Sahalchyk, Andrei Astrauko, Sven Hoffner, Valiantsin Rusovich, Andrei Dadu, Pierpaolo de Colombani, Masoud Dara, Wayne van Gemert & Matteo Zignol

Objective

To assess the problem of multidrug-resistant tuberculosis (MDR-TB) throughout Belarus and investigate the associated risk factors.

Methods

In a nationwide survey in 2010–2011, 1420 tuberculosis (TB) patients were screened and 934 new and 410 previously treated cases of TB were found to meet the inclusion criteria. Isolates of Mycobacterium tuberculosis from each eligible patient were tested for susceptibility to anti-TB drugs. Sociobehavioural information was gathered in interviews based on a structured questionnaire.

Findings

MDR-TB was found in 32.3% and 75.6% of the new and previously treated patients, respectively, and, 11.9% of the 612 patients found to have MDR-TB had extensively drug-resistant TB (XDR-TB). A history of previous treatment for TB was the strongest independent risk factor for MDR-TB (odds ratio, OR: 6.1; 95% confidence interval, CI: 4.8–7.7). The other independent risk factors were human immunodeficiency virus (HIV) infection (OR: 2.2; 95% CI: 1.4–3.5), age < 35 years (OR: 1.4; 95% CI: 1.0–1.8), history of imprisonment (OR: 1.5; 95% CI: 1.1–2.0), disability sufficient to prevent work (OR: 1.9; 95% CI: 1.2–3.0), alcohol abuse (OR: 1.3; 95% CI: 1.0–1.8) and smoking (OR: 1.5; 95% CI: 1.1–2.0).

Conclusion

MDR-TB is very common among TB patients throughout Belarus. The numerous risk factors identified for MDR-TB and the convergence of the epidemics of MDR-TB and HIV infection call not only for stronger collaboration between TB and HIV control programmes, but also for the implementation of innovative measures to accelerate the detection of TB resistance and improve treatment adherence.

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