DOTS IMPACT TO TUBERCULOSIS IN LITHUANIA NATIONAL TUBERCULOSIS AND INFECTIOUS DISEASES HOSPITAL, VILNIUS, LITHUANIA E.Davidavičienė, D.Gaidamonienė, A.Sosnovskaja, R.Steigvilienė, I.Demšienė, A.Petraškaitė, E.Aleksaitė

THE LITHUANIA IS THE BIGGEST OF THE 3 BALTIC COUNTRIES THE LITHUANIA IS THE BIGGEST OF THE 3 BALTIC COUNTRIES. THE TOTAL POPULATION IS OVER 3.5 MILION. THERE ARE 10 COUNTIES AND 44 REGIONS. THE CAPITAL IS VILNIUS.

MAIN REASONS FOR THE INCREASE OF TUBERCULOSIS: MAIN REASONS FOR THE INCREASE OF TUBERCULOSIS: * SOCIAL AND ECONOMICAL CHANGES AND DETERIORATION * ECONOMICAL AND SOCIAL DETERIORATION * UNEMPLOYMENT * ALCOHOLISM * DRUG ABUSE *PATIENTS ATTITUTE TO THEIR DISEASE

THE PROGRAMME OF TUBERCULOSIS CONTROL AND PROPHYLAXIS WAS APPROVED ON THE 12 th OF MARCH 1998

THE MAIN PRIORITY OF TUBERCULOSIS PROGRAMME IS FOCUSED ON DOTS STRATEGY IMPLEMENTATION (5 DOTS ELEMENTS)

DURING FOUR YEARS OF WORK THE NATIONAL TUBERCULOSIS CONTROL PROGRAMME OUTLOOK HAS HAD SEVERAL OBJECTIVES: * DOTS STRATEGY HAVE EXPENDED AND WILL BE COVER ALL POPULATION UNTILL 2005 YEAR; * INTEGRATION WITH PRIMARY HEALTH SECTOR IN TUBERCULOSIS CASE FOR EARLY DETECTION AND TREATMENT OF TUBERCULOSIS PATIENTS. * 14 MICROSCOPIES TUBERCULOSIS CENTRES PROVIDING PRIMARY HEALTH CARE; * THE AMBULATORY TREATMENT HAVE STRENGTHEN FOR TB PATIENTS; * STRENGHTENING SUPERVISION, MONITORING AND EVALUATION.

NEW CASES AND RELAPSES OF TUBERCULOSIS IN LITHUANIA (abs. n.)

INCIDENCE OF TUBERCULOSIS IN LITHUANIA (new cases and relapses)

NEW CASES OF TUBERCULOSIS IN LITHUANIA (abs. n.)

INCIDENCE OF TUBERCULOSIS IN LITHUANIA (new cases)

NEW CASES OF PULMONARY TB IN LITHUANIA (abs. n.)

INCIDENCE OF PULMONARY TB IN LITHUANIA (new cases)

INCIDENCE OF CHILDREN’S TB IN LITHUANIA

NEWCASES AND RELAPSES OF TUBERCULOSIS IN LITHUANIA IN 1998 (abs.n.) Age Males Females All 0-4 6 5 11 5-14 79 78 157 15-24 162 125 287 25-34 288 172 460 35-44 436 194 630 45-54 461 136 597 55-64 349 132 481 <65 318 235 553 2099 1077 3176

NEW CASES AND RELAPSES OF TUBERCULOSIS IN LITHUANIA IN 2002 (abs.n.) Age Males Females All 0-4 11 7 18 5-14 61 60 121 15-24 87 91 178 25-34 228 132 360 35-44 370 137 507 45-54 378 107 485 55-64 259 80 339 <65 241 170 411 unknown 1 - 1636 784 2420

NEW CASES OF PULMONARY TB IN LITHUANIA IN 1998 (abs.n.) Age Males Females All 0-4 - 2 5-14 15-24 124 83 207 25-34 241 128 369 35-44 148 517 45-54 353 86 439 55-64 245 72 317 <65 215 150 365 1547 669 2216

NEW CASES OF PULMONARY TB IN LITHUANIA IN 2002 (abs.n.) Age Males Females All 0-4 - 5-14 2 1 3 15-24 59 68 127 25-34 178 108 286 35-44 104 390 45-54 262 63 325 55-64 185 40 225 <65 173 300 unknown 1146 511 1657

PULMONARY TB NEW CASES BACTERIOLOGICAL CONFIRMED Years Smear positive Culture negative/ not done Culture positive Smear negative/not done Culture negative/not done 1998 368 792 1056 2000 341 751 735 2002 266 778 613

MORTALITY OF TUBERCULOSIS IN LITHUANIA (abs. n.)

MORTALITY OF TUBERCULOSIS IN LITHUANIA

TUBERCULOSIS DETECTION METHODS IN LITHUANIA (new cases and relapses)

TREATMENT OUTCOMES IN LITHUANIA IN 1998   Pulmonary TB new cases Pulmonary TB relapses TM+ sm- cult- abs.n. % 1. Cured 795 68,5 - 150 52,1 2. Completed 824 78,0 13 61,9 3. Defaulted 208 17,9 132 12,5 63 21,9 5 23,8 4. Failed 47 4,1 4 0,4 24 8,3 5. Died 110 9,5 96 9,1 51 17,7 3 14,3 6. Transferred 7. Still on treatment Total 1160 100 1056 288 21

TREATMENT OUTCOMES IN LITHUANIA IN 2001   Pulmonary TB new cases Pulmonary TB relapses TM+ sm- cult- abs.n. % 1. Cured 853 73,8 - 193 51,7 2. Completed 508 82,3 3. Defaulted 134 11,6 50 8,1 61 16,4 4. Failed 30 2,6 1 0,2 34 9,1 5. Died 118 10,2 65 17,4 6. Transferred 4 0,3 7. Still on treatment 14 1,2 17 4,6 8. Not treatment 7 1,1 2 0,5 Total 1157 100 617 373

CONCLUSION: DOTS IMPACT TO TUBERCULOSIS SITUATION: CONCLUSION: DOTS IMPACT TO TUBERCULOSIS SITUATION: * INCIDENCE TB NEW CASES ARE DECREASING FROM 76,3:100.000 (1998) TO 60,4:100.000 (2002); FROM 2826 (abs.n., 1998) TO 2097 (abs.n., 2002); * TB INCIDENCE (NEW CASES AND RELAPSES) FROM 81,4:100.000 (1998) TO 69,7:100.000 (2002); FROM 3176 (abs.n., 1998) TO 2420 (abs.n., 2002) * PULMONARY TUBERCULOSIS NEW CASES BACTERIOLOGICAL CONFIRMED 1998-52%; 2002-63%

* THE SUCCESS RATE OF TREATMENT IN 2000 WAS NEW CASES OF PULMONARY TUBERCULOSIS – MORE 75%, BUT SUCCESS RATE TREATMENT OF RELAPSES – ONLY 60%; * MDR TB PREVALENCE – 9% MDR TB AMONG TB NEW PATIENTS; * INTENSIVE NATIONAL TRAINING SESSIONS OF GP AND NURSES.