Comparison of the effectiveness of treatment of patients with pulmonary tuberculosis in conditions of TB system restructuring

Objective — to study the dynamics of the effectiveness of the treatment of patients with pulmonary tuberculosis in the Sumy region for 2011—2018.Materials and methods. The authors analyzed the effectiveness of the treatment of two groups of patients. Group I included 2973 patients with new cases of pulmonary tuberculosis with bacterial excretion, which was confirmed by microscopy of sputum smear or by bacteriological method. The second group consisted of 998 patients with relapses of pulmonary tuberculosis with bacterial excretion, which was confirmed by microscopy of sputum smear or bacteriological method. Each group has divided into subgroups «a», which includes patients registered during 2011—2014 and subgroup «b» registered during 2015—2018.Results and discussion. Over the past eight years, the effectiveness of treating patients with the first diagnosed bacillary tuberculosis has decreased from 72.3 % in 2011 to 58.1 % in 2018. Among the patients of the Ia subgroup died 75 (5.5 %) patients, which is less than 1.2 times than in the Ib subgroup — 106 (6.5 %) — (p > 0.05). Unsuccessful treatments (by smear or clinical and radiological findings) in patients with Ia and Ib subgroups were 8.7 and 8.9 % respectively (p > 0.05). The percentage of first identified patients transferred to category 4 increased from 6.5 % in 2011 to 25.7 % in 2018 (p < 0.05). Among 432 patients with recurrent bacillary tuberculosis of the IIa subgroup, effective treatment had recorded in 169 (39.1 %) people. In the studied group IIb, the effectiveness of treatment had established in 198 (35.0 %) (p > 0.05). Unsuccessful treatment (according to microbiological and clinical, radiological studies) among patients of IIa and IIb subgroups had recorded in 9.7 and 6.7 %, respectively (p > 0.05). In the IIa subgroup, 128 (29.6 %) patients had transferred to 4 categories, and four years later, 270 (47.7 %) in the IIb subgroup (p < 0.001).Conclusions. The effectiveness of the treatment of the first detected bacillary patients with pulmonary tuberculosis in the Sumy region in 8 years decreased by 1.2 times. The effectiveness of the treatment of patients with recurrent bacterial pulmonary tuberculosis has fluctuated within 40 % over the last decade. In the structure of «effective treatment» of patients with newly diagnosed tuberculosis and relapse of tuberculosis, the results of «treatment completed» prevail every year, which means that patients are transferred to category 5.1 only because they have just received all doses of drugs. Due to the increase of Mycobacterium tuberculosis resistance to anti tuberculosis drugs, patients are transferred to 4 categories of observation four times more often with the first detected tuberculosis, with recurrent — 1.9 times.It is evidence of a decrease in the effectiveness of the treatment of patients with newly discovered and recurrent bacillary tuberculosis in recent years.