PURPOSE: To evaluate the epidemiological 20-year trend of tuberculosis (TB) in the south-eastern region of Romania,Constantza, before and after DOT-management started in 2000.
METHODS: Retrospective descriptive analyzes of annual TB notifications from 01 Jan 1988 to 31 Dec 2007, before and after strategy of DOT was implemented. Internationally agreed definitions and TB epidemiological indicators were used.
RESULTS: Since 1989, Constanta experienced the greatest TB rates per 100,000 population. The incidence of pediatrical TB increased dramatically from 8.8%ooo in 1988 to 54.3%ooo in 1990 and slowly decreased to 28.7%ooo in 1998, being related to HIV epidemic. The greatest values of TB+AIDS morbidity in children were in 1990 (19%ooo) and 1997 (14.9%ooo). Since 2000, TB rates were higher than Romania national values, slowly decreasing from 161.1%ooo to 152.6%ooo in 2007 (mean 7.5%). The rate of therapy success increased progressively after DOTS implementation, having its highest value in 2004 (82.3%). More cases were treated under DOT over time, so relapse rates decreased from 8.7% in 2000 to 2.2% in 2005, death rate from 7.7% to 4.2%. The rate of abandoned treatment was 19.5% in 2002, decreasing to 9.1 % in 2006. Multidrug resistance remains rare (2.4% in 2004) but possible undiagnosed, DST being not sistematically done. The highest success rate for standard anti-TB therapy (70.5%) was obtained in the fourth year of DOT-managed TB new cases. In the same year, 2004, the rate of new cases unemployed was 40%. A consistent downward trend of local endemic TB was observed after 2004.
CONCLUSION: The epidemiological trend of TB was influenced by HIV epidemic in the beginning of ’90s, reversed after 2004. The slight decreasing trend was noticed starting after 4 years of DOTS implementation in a burden area of TB.
CLINICAL IMPLICATIONS: The reduction in TB notifications is due to an increase in surveillance and control of social and health conditions. The DOTS success suggests that any middle-income country with a TB high-incidence might be able to reach the World Health Assembly Targets.
DISCLOSURE: Oana Arghir, No Financial Disclosure Information; No Product/Research Disclosure Information