Die Kontrolle der Tuberkulose in den Nachfolgestaaten der Sowjetunion am Beispiel Russlands

Zusammenfassung

Hintergrund: Die Tuberkulose bleibt ein ernst zu nehmendes Problem in den Nachfolgestaaten der ehemaligen Sowjetunion. Der Artikel beschreibt die gegenwärtige Situation der Tuberkuloseepidemie in Russland sowie die Besonderheiten der Tuberkulosekontrolle, die sich aus dem traditionellen sowjetischen Kontrollmodell ergeben. Aktuelle Herausforderungen der Tuberkulosekontrolle werden diskutiert.

Methodik: Es wurden Meldedaten der Weltgesundheitsorganisation (WHO) zur Tuberkulose in Russland und 14 weiteren Sowjet-Nachfolgestaaten ausgewertet. Im Rahmen einer Medline/Embase-basierten Analyse wurden 66 Original- und Übersichtsarbeiten zur Tuberkulosekontrolle in Russland untersucht. Zusätzlich wurden russische Berichte und Leitlinien ausgewertet.

Ergebnisse: Im Jahr 2006 wurden in Russland ca. 125 000 Tuberkulosefälle und 28 000 Sterbefälle registriert. Die Tuberkuloserate war 13-mal so hoch wie in Deutschland. Zu den Charakteristika des traditionellen Kontrollmodells zählen i) die Organisation der Diagnostik und Behandlung im Rahmen eines zentralisierten, krankheitsspezifischen Netzwerks; ii) landesweite Bevölkerungsscreenings mittels Fluorographie; iii) der Schwerpunkt auf Röntgenbefunden für die Diagnosestellung; iv) individualisierte und langfristige stationäre Behandlungen; v) hohe Medikamentenresistenzraten sowie vi) ineffiziente Finanzierungssysteme.

Schlussfolgerungen: Wichtigste Herausforderungen der Tuberkulosekontrolle in Russland sind derzeit der Ausbau einer qualitätsgesicherten mikrobiologischen Diagnostik und Resistenztestung; die Behandlung und Kontrolle der multiresistenten Tuberkulose; Prävention und Management von Tuberkulose/HIV und die Reform der Finanzierungssysteme. Dabei muss den Charakteristika des traditionellen Modells der Tuberkulosekontrolle Rechnung getragen werden.

Abstract

Background: Tuberculosis (TB) remains a serious threat to public health in Russia and other former Soviet Union Countries. The purpose of this paper is to describe the current trends of TB and MDR-TB in Russia and identify the characteristics of the traditional Russian TB control model inherited from the Soviet Union. We discuss current challenges to TB control in the country.

Methods: WHO tuberculosis notification data were analysed for Russia and 14 other former Soviet Union countries. To investigate the characteristics of TB control in Russia, we performed a systematic literature review using MEDLINE/EMBASE databases. 136 articles were initially identified of which 66 fulfilled the inclusion criteria. Full texts were reviewed. Additionally, we reviewed non-systematically Russian state reports, guidelines and legislations.

Results: In 2006, nearly 125 000 TB cases and 28 000 TB deaths were notified in the Russian Federation. The TB notification rate was 13 times higher than in Germany. The characteristics of the traditional Russian TB control model include: a centralised disease-specific inpatient network for diagnosis and treatment of TB, countrywide population screenings using fluorography, a strong focus on X-ray for diagnosis and disease classification, individualised and lengthy inpatient care, high rates of drug resistance, and inefficient financing systems.

Conclusions: Current challenges to TB control in Russia are: the implementation of a quality-assured laboratory network for sputum-smear microscopy, culture and drug susceptibility testing, ensuring MDR-TB treatment and control, prevention and management of TB/HIV, and reform of health care financing systems. For TB control to be successful in the Russian Federation, the characteristics of the traditional TB control model need to be taken into account.

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1 Per definitionem wird dann von einem multiresistenten Erreger gesprochen, wenn in vitro Resistenzen mindestens gegen die zwei Erstlinienmedikamente Isoniazid und Rifampicin nachgewiesen werden.

2 XDR- (extensively multidrug-resistant) Tuberkulose: Neben Isoniazid und Rifampicin (sowie weiteren Erstlinienmedikamenten) werden zusätzlich Resistenzen gegen ein Zweitlinienmedikament der Quinolonreihe sowie mindestens eines der Medikamente Kanamycin, Capreomycin oder Amikazin nachgewiesen.

3 Daten nicht publiziert, aber auf Anfrage erhältlich.