MICROBIOLOGICAL DIAGNOSIS OF TUBERCULOSIS IN PENITENTIARY INSTITUTIONS OF THE RUSSIAN FEDERATION IN 2020: RESULTS AND DEVELOPMENT PROSPECTS
Objective: to analyze the coverage and quality of microbiological diagnosis of tuberculosis (TB) in the institutions of the Russian Federal Penitentiary Service (FSIN) in 2020. Materials and methods: we used data from official statistical observations, specialized inquiries, and results of external quality assessment of laboratory studies. Results. The share of patients with pulmonary TB (new and relapse cases) detected by sputum microscopy in clinical diagnostic laboratories decreased to 3.7%. The coverage of new patients with pulmonary TB by sputum microscopy was 99.7%. The share of new patients with pulmonary TB with positive sputum results changed insignificantly and was 15.9% in 2020, which indicated that problems arose during studies. The low share of patients with positive sputum among patients with cavities (36.7%) also indicated the diagnostic problems. The percentage of laboratories with confirmed quality of Ziehl-Neelsen microscopy was 6.2%. The coverage of new pulmonary TB patients with culture studies was 97.9%. The share of new pulmonary TB patients with positive culture was not enough (24.2%). The percentage of laboratories with confirmed quality of cultural studies was 9.8%. Drug susceptibility testing (DST) coverage among new pulmonary TB patients was 90.7%. The coverage of rifampicin-resistant patients with DST to fluroquinolones was 88.6%, bedaquiline and linezolid - 1.2%. The percentage of laboratories with confirmed quality of DST to first-line drugs was 11.4%, and second-line drugs - 11.1%. Automated liquid culture systems were used by one laboratory; molecular genetic methods were used in 56 regions of Russia. The coverage of TB patients (new and relapse cases) with molecular genetic studies reached 41.4% (the target was 90%). Conclusion. The system of microbiological diagnosis of TB in Russian penitentiary institutions demonstrates unsatisfactory performance and needs to be reformed. It is advisable to establish well-equipped laboratories performing high-quality tests (including DST to bedaquiline and linezolid) at principal phthisiopulmonology centers. Regions, which do not have principal phthisiopulmonology centers at penitentiary institutions, should use outsourcing in civilian health institutions. It is advisable to introduce a system of supervision of microbiological laboratories by civilian health professionals.