On 28 June at 12 Elmira Gurbanova will defend her doctoral thesis „Specific characteristics of tuberculosis in low default, but high multidrug–resistance prison setting“.
Professor Alan Altraja (dr. med), Institute of Clinical Medicine
Dr Kai Blöndal (dr. med. (meditsiin), Division of Communicable Disease Control, Reykjavik Health Care Services, Reykjavik, Island).
Professor Peter F. O. Davies (PhD), Liverpool Heart and Chest Hospital, Liverpool, UK.
The burden of tuberculosis (TB) in prisons is many times higher than that in the civilian population. A lack of evidence on the impact of rapid diagnostic tests to the burden of TB/rifampicin-resistant (RR)-TB in prisons contributes to sustained obsolete screening practices. The TB programs face with the discordant rifampicin (RIF)-susceptibility results. High cure rates from RR-TB are rarely achieved and there is a lack of evidence on the key determinants of this.
Our aim was to evaluate the impact of the currently recommended systematic screening (I), diagnostics (II), and treatment (III) to the TB/RR-TB burden in high-burden and low-default prison settings. The study was performed in the prisons of Azerbaijan, which is among the 30 high RR-TB-burden countries in the world with the TB notification rate in prisons being 18 times of the rate among the civilian population.
Introduction of rapid diagnostic tests into the prison screening lead to 3-, 10-, and 5-fold decrease in the annual rates of all notified, smear-positive, and RR-TB cases, respectively, within four years, and improved the treatment outcomes (I).
Analyses on sputum specimens by both Xpert MTB/RIF and liquid culture showed 6% discrepancy in the RIF-susceptibility results (II). Genotyping of discrepant isolates revealed that the L511P mutation significantly contributed to the discrepancy, although the treatment outcomes were associated with neither certain mutations nor the type of discrepant resistance. The finding that the proportion of discordant RIF-susceptibility results is equal regardless of whether both the Xpert MTB/RIF and the liquid culture were applied on the same sputum sample or on sequential samples is practical for building diagnostic algorithms.
The RR-TB patients were diagnosed and treated in Azerbaijan prisons with a 78.4% cure rate (III). The key factor favoring cure from RR-TB is maintenance of the higher number of bactericidal drugs throughout the course of treatment.