ORGANIZATION OF MICROBIOLOGICAL DIAGNOSTICS OF TUBERCULOSIS IN THE POST-COVID PERIOD AND PROSPECTS FOR ITS DEVELOPMENT

Significance. The COVID-19 pandemic has had a significant impact on the healthcare system, including the laboratory diagnostics system. It is advisable to assess the current state of the tuberculosis laboratory diagnostics system to develop solutions for its optimization. Purpose: to analyze the state of organization (coverage and quality) of microbiological diagnostics of tuberculosis in the post-pandemic period. Material and methods. The resources and results of the activities of bacteriological laboratories of medical organizations of civil health care and prisons, obtained during the analysis of official forms of monitoring and additional requests, were studied. Results. Identification of smear-positive pulmonary tuberculosis patients in primary healthcare facilities remains insufficient. The indicator “the proportion of newly diagnosed sputum smear-positive pulmonary tuberculosis patients” increased during the COVID-19 pandemic and began to decrease after its end. The proportion of prison laboratories participating in the quality control system is lower compared to civilian health care. There was an increase in cultural confirmation of diagnosis in public health care to 56.7%, while it decreased in prisons to 24.8%, which, along with the relatively low coverage of rapid molecular genetic methods (93.6% in public health care and 38.0% in prisons), as well as lower coverage of drug susceptibility testing for fluoroquinolones, bedaquiline and linezolid, reflects a violation of the principle of equivalence. Defects in the pre-analytical stage in public health laboratories, as well as significant unevenness in a number of indicators across the subjects of the Russian Federation, have been identified. Conclusions and scope of application of the results. The results of the study allowed us to define measures to improve the microbiological diagnostics of tuberculosis, including multi-level supervision with control of the preanalytical and analytical stages, reorganization of the microbiological diagnostics system of tuberculosis in prisons taking into account the possibility of observing clinical recommendations in order to implement the principle of equivalence, the introduction of tests for drug susceptibility to bedaquiline and linezolid. Keywords: tuberculosis; microbiological diagnostics; quality of medical care; principle of equivalence.