Background: The World Health Organisation (WHO) defines Russia as one of the 22 highest-burden countries
for tuberculosis (TB). The WHO Directly Observed Treatment Short Course (DOTS) strategy employing a
standardised treatment for 6 months produces the highest cure rates for drug sensitive TB. The Russian TB
service traditionally employed individualised treatment.
The purpose of this study was to implement a DOTS programme in the civilian and prison sectors of Samara
Region of Russia, describe the clinical features and outcomes of recruited patients, determine the proportion of
individuals in the cohorts who were infected with drug resistant TB, the degree to which resistance was attributed
to the Beijing TB strain family and establish risk factors for drug resistance.
Methods: prospective study
Results: 2,099 patients were recruited overall. Treatment outcomes were analysed for patients recruited up to
the third quarter of 2003 (n = 920). 75.3% of patients were successfully treated. Unsuccessful outcomes occurred
in 7.3% of cases; 3.6% of patients died during treatment, with a significantly higher proportion of smear-positive
cases dying compared to smear-negative cases. 14.0% were lost and transferred out. A high proportion of new
cases (948 sequential culture-proven TB cases) had tuberculosis that was resistant to first-line drugs; (24.9%
isoniazid resistant; 20.3% rifampicin resistant; 17.3% multidrug resistant tuberculosis). Molecular epidemiological
analysis demonstrated that half of all isolated strains (50.7%; 375/740) belonged to the Beijing family. Drug
resistance including MDR TB was strongly associated with infection with the Beijing strain (for MDR TB, 35.2%
in Beijing strains versus 9.5% in non-Beijing strains, OR-5.2. Risk factors for multidrug resistant tuberculosis were:
being a prisoner (OR 4.4), having a relapse of tuberculosis (OR 3.5), being infected with a Beijing family TB strain
(OR 6.5) and having an unsuccessful outcome from treatment (OR 5.0).
Conclusion: The implementation of DOTS in Samara, Russia, was feasible and successful. Drug resistant
tuberculosis rates in new cases were high and challenge successful outcomes from a conventional DOTS
programme alone