Prognosis for Tuberculosis Relapses

Objective — to re-evaluate the problem of tuberculosis relapses (RTB) based on the results of pre-war studies with correction for modern conditions. Materials and methods. Analysis of official statistical data (2015—2022) and data from the Register of tuberculosis (TB) patients — a sample of 569 patients with relapsed pulmonary tuberculosis (RPTB). A questionnaire of 80 phthisiology doctors regarding the seriousness of the causes of RPTB. Generally accepted statistical methods, including correlation analysis. Results and discussions. The incidence of RTB in 2015—2020 gradually decreased, in 2021—2022 it began to increase. The effectiveness of treatment of patients with newly diagnosed tuberculosis (NDTB) gradually increased in 2015—2019 and began to decrease in 2020—2021. The number of cases of multiple drug resistance in TB (MDR-TB) and human immunodeficiency virus (HIV)/acquired immuno­deficiency syndrome (AIDS) in patients with pulmonary tuberculosis (PTB) per 100,000 population in 2015—2020 decreased, in 2021—2022 positive trend in MDR-TB stopped. An inverse correlation between the incidence of RTB and the effectiveness of NDTB treatment (r = –0.42) and a direct correlation with MDR-TB (r = 0.99) and HIV infection (r = 0.85) were established. It has been established that the medical reasons for the development of RPTB are deficiencies in the treatment of NDTB (inadequate regimens, untimely started treatment, short-term main course, incomplete or interrupted treatment, insufficient duration of treatment in a hospital and uncontrolled treatment), immunodeficiency states, the presence of HIV infection and concomitant diseases, lack of antiretroviral therapy (ARVT), abandoned NDTB (destruction, bacterial isolation, MDR-TB), organizational — low coverage by fluorography, lack of active detection and prevention of TB in risk groups, financial and infrastructural difficulties, social and psychological support of TB patients, unavailability of rapid diagnosis of TB, insufficient awareness of the population about TB, inadequate treatment of concomitant diseases, social — unsatisfactory social and living conditions and working conditions, migration of the population, social insecurity, non-adherence to treatment. Conclusions. Since there is a trend towards an increase in the incidence of TB, the number of cases of MDR-TB and HIV/AIDS in patients with PTB against the background of a decrease in the effectiveness of treatment of patients with NDTB, and the negative effect of the causes of the occurrence of RPTB (especially social and organizational) during the war will naturally increase, it should be expected not only an increase in the number of TB cases in the coming years, but also the worsening of the TB epidemic situation in general. The problem of the impact of the war in Ukraine on the epidemic situation with TB requires an immediate and comprehensive study, which will make it possible to develop a set of measures to restore the full provision of medical care for this disease. Establishing the determinants of TB risk caused by the war will allow to offer health care measures that should reduce the negative impact of the war on the situation with TB in Ukraine.