LAUSR

Objective: Of the total number of cases notified in prisons in the WHO European Region, almost ¾ cases of tuberculosis (newly diagnosed and relapses) are registered in the penitentiary facilities of the Russian Federation. Extensively drug-resistant tuberculosis (XDR-TB) is a major challenge in the former Soviet Union countries, including the Russian Federation. Epidemiology and treatment outcomes of XDR-TB in the penitentiary sector are not sufficiently studied. Methods: In the penitentiary facilities located in 61 regions of the Russian Federation, XDR-TB detection rates in a group of 1635 patients with multidrug-resistant tuberculosis (MDR-TB) and in the general prison population (463,025) were studied in the prospective cohort study. Treatment outcomes of 365 XDR-TB patients registered in 2012 and 2013 were studied in the retrospective cohort study. Results: The XDR-TB notification rate among MDR-TB patients was 11.0% (95% CI 9.5-12.5) ranging from 7.5% in new cases to 16.4% in patients with chronic tuberculosis. The incidence of new cases and relapses of XDR-TB was 126.8 per 100,000 prison population. The treatment success rate was 21.4%. The most frequent outcomes included: “treatment failure” (34.5%) and “outcome not evaluated” due to patients’ transfer (27.7%). Conclusion: XDR-TB is an epidemiological challenge in the penitentiary facilities of the Russian Federation, where XDR-TB among MDR-TB patients is reported more frequently than globally and in the WHO European region. The current XDR-TB treatment success rate in the penitentiary facilities requires strengthening the laboratory network and implementing a system for treatment outcomes monitoring in transferred patients.