Treating multidrug-resistant tuberculosis in Tomsk, Russia - Developing programs that address the linkage between poverty and disease
Treating multidrug-resistant tuberculosis in Tomsk, Russia - Developing programs that address the linkage between poverty and disease
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DOI：
10.1196/annals.1425.009
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发表时间：
2008-01-01
期刊：
影响因子：
--
通讯作者：
Shin, S. S.
中科院分区：
文献类型：
--
作者：
Keshavjee, S.;Gelmanova, I. Y.;Shin, S. S.
结核病和耐多药结核病是贫穷造成的疾病。由于结核分枝杆菌主要存在于一个社会空间，通常由贫困及其并存病定义-过度拥挤或聚集的生活条件，药物依赖或滥用，以及缺乏获得适当的卫生服务，仅举几例-这种生物体和结核病耐药性的生物学与患者生活的社会世界密切相关。这种关联在俄罗斯得到了证明，1990年代的政治变革导致社会经济不平等加剧，卫生服务崩溃。对结核病和耐多药结核病的影响反映在结核病和耐多药结核病发病率上升以及与该疾病有关的发病率和死亡率上升两个方面。我们以托木斯克州为例，说明贫困是如何导致耐多药结核病流行的，并增加了成功治疗的社会经济障碍，即使是在有条件的情况下。在托木斯克实施的耐多药结核病试点项目解决了与不利结果相关的方案和社会经济因素。其结果是加强了该地区的总体结核病控制方案，并改善了最脆弱患者的病例保持情况。托木斯克的耐多药结核病护理模式适用于面临结核病和耐多药结核病控制挑战的其他资源贫乏环境。
Tuberculosis (TB) and multidrug-resistant TB (MDR-TB) are diseases of poverty. Because Mycobacterium tuberculosis exists predominantly in a social space often defined by poverty and its comorbidities-overcrowded or congregate living conditions, substance dependence or abuse, and lack of access to proper health services, to name a few-the biology of this organism and of TB drug resistance is intimately linked to the social world in which patients live. This association is demonstrated in Russia, where political changes in the 1990s resulted in increased socioeconomic inequality and a breakdown in health services. The effect on TB and MDR-TB is reflected both in terms of a rise in TB and MDR-TB incidence and increased morbidity and mortality associated with the disease. We present the case example of Tomsk Oblast to delineate how poverty contributed to a growing MDR-TB epidemic and increasing socioeconomic barriers to successful care, even when available. The MDR-TB pilot project implemented in Tomsk addressed both programmatic and socioeconomic factors associated with unfavorable outcomes. The result has been a strengthening of the overall TB control program in the region and improved case-holding for the most vulnerable patients. The model of MDR-TB care in Tomsk is applicable for other resource-poor settings facing challenges to TB and MDR-TB control.