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dc.contributor.authorBlöndal, K
dc.contributor.authorViiklepp, P
dc.contributor.authorBlöndal, P
dc.contributor.authorAltraja, A
dc.date.accessioned2012-05-14T09:29:22Z
dc.date.available2012-05-14T09:29:22Z
dc.date.issued2011-07
dc.date.submitted2012-05-14
dc.identifier.citationInt. J. Tuberc. Lung Dis. 2011, 15(7):892-8en_GB
dc.identifier.issn1815-7920
dc.identifier.pmid21682961
dc.identifier.doi10.5588/ijtld.10.0601
dc.identifier.urihttp://hdl.handle.net/2336/223497
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links field.en_GB
dc.description.abstractOBJECTIVE: To evaluate the impact of countrywide management of tuberculosis (TB) and the availability of second-line drugs (SLDs) on the notification rates of pulmonary TB (PTB) overall and of multidrug-resistant TB (MDR-TB), taking into account human immunodeficiency virus (HIV) co-infection and the national economy in Estonia. DESIGN: Retrospective analysis of notification rates and treatment outcomes of PTB and MDR-TB during 1998-2006. RESULTS: The annual notification rates of both PTB and MDR-TB decreased significantly, by on average 3.3 (P = 0.007) and 1.7 (P = 0.008) cases per 100,000 population, respectively. The accelerating impact of SLD availability on the annual decline was significant for both PTB overall and MDR-TB (P = 0.003 and P = 0.025, respectively). During 1998-2006, an increase in TB-HIV co-infection (P = 0.009) significantly affected the notification rates of both PTB overall and MDR-TB (P < 0.001 and P < 0.001, respectively). The negative impact of TB-HIV co-infection was counterbalanced by the availability of SLDs, the decrease in the MDR-TB rate and the increase in gross domestic product (GDP) per capita, as confirmed by multivariate analysis. CONCLUSION: Countrywide access to SLDs and the coordinated effect of programmatic conditions can, in parallel with increasing GDP, reverse the increasing notification rates of PTB and MDR-TB in the context of an HIV epidemic.
dc.language.isoenen
dc.publisherThe Union : Paris, Franceen_GB
dc.relation.urlhttp://dx.doi.org/10.5588/ijtld.10.0601en_GB
dc.rightsArchived with thanks to The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Diseaseen_GB
dc.subject.meshAdulten_GB
dc.subject.meshAntitubercular Agentsen_GB
dc.subject.meshDisease Notificationen_GB
dc.subject.meshEstoniaen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHIV Infectionsen_GB
dc.subject.meshHumansen_GB
dc.subject.meshIncidenceen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshRetrospective Studiesen_GB
dc.subject.meshTreatment Outcomeen_GB
dc.subject.meshTuberculosis, Multidrug-Resistanten_GB
dc.subject.meshTuberculosis, Pulmonaryen_GB
dc.titleCountrywide management of pulmonary tuberculosis reverses increasing incidence.en
dc.typeArticleen
dc.contributor.departmentLung Clinic, Tartu University Clinics, Tartu, Estonia. kaivink@kodu.eeen_GB
dc.identifier.journalInternational journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Diseaseen_GB
html.description.abstractOBJECTIVE: To evaluate the impact of countrywide management of tuberculosis (TB) and the availability of second-line drugs (SLDs) on the notification rates of pulmonary TB (PTB) overall and of multidrug-resistant TB (MDR-TB), taking into account human immunodeficiency virus (HIV) co-infection and the national economy in Estonia. DESIGN: Retrospective analysis of notification rates and treatment outcomes of PTB and MDR-TB during 1998-2006. RESULTS: The annual notification rates of both PTB and MDR-TB decreased significantly, by on average 3.3 (P = 0.007) and 1.7 (P = 0.008) cases per 100,000 population, respectively. The accelerating impact of SLD availability on the annual decline was significant for both PTB overall and MDR-TB (P = 0.003 and P = 0.025, respectively). During 1998-2006, an increase in TB-HIV co-infection (P = 0.009) significantly affected the notification rates of both PTB overall and MDR-TB (P < 0.001 and P < 0.001, respectively). The negative impact of TB-HIV co-infection was counterbalanced by the availability of SLDs, the decrease in the MDR-TB rate and the increase in gross domestic product (GDP) per capita, as confirmed by multivariate analysis. CONCLUSION: Countrywide access to SLDs and the coordinated effect of programmatic conditions can, in parallel with increasing GDP, reverse the increasing notification rates of PTB and MDR-TB in the context of an HIV epidemic.


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