SESSION TYPE: Respiratory Infections Posters I
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: At the country level, the growing problem of drug-resistance is undesirable for most NTPs, many of which are still struggling to control drug-sensitive TB. Spurred by the rapid increase in MDR-TB and XDR-TB observed globally, programs are trying to come to terms with their drug-resistant TB epidemics.
METHODS: In 2004, the National TB Program (NTP) of Romania was approved by the Green Light Committee (GLC) for multidrug resistant TB (MDR-TB) for the treatment of an initial cohort of 200 MDR-TB patients. The cohort was expanded in 2005 with 200 additional patients and in October 2008 with 320 additional patients, which brings the total number of 720 patients approved by GLC. Application GLC was done in 2008 for 320 new MDR-TB patient, 160 to be enrolled in the first phase of the 6th round, and 160 in the second one. Until now more than 500 MDR patients were discussed during the MDR-committees sessions and over 50 already begun the treatment in DOTS-PLUS system. There will be made another application for 160 more patients, to be enrolled in the second phase, meaning a total of 320 patients in the 6th Round ( rounds 2 & 6 = 880 patients treated with GLC drugs, between 2004 and 2011).
RESULTS: Treatment of the GLC cohort has shown acceptable success rate in the first 400 cases 2004 - 2008 (cohorts 1 and 2), with 61% success, 14% failure, 12% default and 13% deaths (and 10% still on treatment).
CONCLUSIONS: DOT-plus strategy is more crucial in the treatment of MDR TB because of the extended duration and the potential for greater side effect. The occurrence of serious adverse effect is rare and does not compromise treatment outcome. The understanding of the different factors that influence outcome and determine optimal management in MDR-TB and XDR-TB is currently limited by the significant lacks in the evidence base (lack of National Register of MDR TB cases).
CLINICAL IMPLICATIONS: The management of these cases should be supported by drug sensitivity testing and close monitoring of patients. In some cases, the required clinical and laboratory expertise may not even exist within the public sector; in many countries, human resources for the actual delivery of care and systems of care delivery themselves are lacking. All of this is exacerbated by weak health systems in many settings and by the challenges of delivering treatment to poor and marginalized patients who often face many social and economic barriers to receiving adequate care.
DISCLOSURE: The following authors have nothing to disclose: Constantin Marica, Paraschiva Postolache, Cristian Didilescu, Mihaela Tanasescu
No Product/Research Disclosure InformationInstitute of Pneumology "Marius Nasta", Bucharest, Romania