Tuberculosis control in the Caucasus: successes and constraints in DOTS implementation

SETTING: The pilot projects for tuberculosis (TB) control, supported by the World Health Organization (WHO) and based on the WHO recommended control s trategy, directly-observed treatment, short-course (DOTS) in the Caucasian countries (Armenia, Azerbaijan, Georgia). OBJECTIVE: To evaluate the results 2 years after the implementation of the pilot projects. METHODS: Analysis of data on case detection, sputum conversion and treatmen t outcome reported quarterly to the WHO from the Ministries of Health in ea ch country. RESULTS: Since the establishment of the project, 1330, 764 and 4866 new cas es and relapses, respectively, of TB have been detected in the pilot areas of Armenia, Azerbaijan and Georgia. In Armenia and Azerbaijan, respectively 46% and 57% of all cases were smear positive, whilst in Georgia, the corre sponding figure was only 12%. After 3 months' treatment, 93% of new smear-p ositive patients had become smear-negative. The sputum conversion rate for relapses and other retreatment cases (failure, treatment interrupted) was 8 5%. In Armenia, 78.1% of new smear-positive patients were treated successfu lly (cured or completed treatment). The corresponding percentages for Azerb aijan and Georgia were 87.9% and 59.6%. Treatment success rates among retre atment cases was generally low, at respectively 46%, 64%, and 35%, in Armen ia, Azerbaijan, and Georgia. CONCLUSION: The results of the implementation of the WHO TB control pilot p rojects in Armenia, Azerbaijan and Georgia suggest that the DOTS strategy i s feasible in emergency situations in general, and in the Caucasus in parti cular.