THE SITUATION OF TUBERCULOSIS IN BULGARIA

1
THE SITUATION OF TUBERCULOSIS IN BULGARIA

• D. Stefanova
• Bulgaria

D. Stefanova 2005
2
Republic of Bulgaria Area- 110,987 sq.km.Till
31.12.2001- 7,845,841 population (In 1989 the
population was about 9 mln. people)
D. Stefanova 2005
3
BACKGROUND

• Bulgaria is in the buffer zone between countries
  in Western Europe with lower incidence of
  tuberculosis and countries in Eastern Europe with
  higher incidence. During the last decade, the
  problem of TB in Bulgaria acquired again a high
  medical and social importance. By the end of
  April 2003 the DOTS strategy was expanded to all
  of Bulgaria. We describe the
  epidemiological situation of TB in Bulgaria.

D. Stefanova 2005
4
THE INCIDENCE AND MORTALITY OF TUBERCULOSIS IN
EUROPE (PER 100,000 POPULATION)
D. Stefanova 2005
5
TB INCIDENCE IN BULGARIA(PER 100,000 POPULATION)
D. Stefanova 2005
6
DISTRIBUTION OF THE REGISTERED TB PATIENTS IN
2003 (N3,263) BY SEX AND AGE
D. Stefanova 2005
7
DISTRIBUTION OF THE REGISTERED TB PATIENTS IN
2003 BY LOCALIZATION
D. Stefanova 2005
8
SMEAR-POSITIVE PATIENTS IN BULGARIAPER 100,000
POPULATION
SMEAR () - 36.5 CULTURE () - 38.9
D. Stefanova 2005
9
PERCENTAGE OF SMEAR- AND CULTURE-POSITIVE
PATIENTS IN 2003
?. ????????? 2005
10
DOTS IN BULGARIA

• Since 01.04.2003 the whole country was covered by
  DOTS Strategy but improvement in quality of DOTS
  work is still imminent in order to achieve
  maximum treatment results as well as reduce
  relapse frequency. Assuring of complete timely
  and precise tuberculosis cases registration
  through introducing of accepted by WHO
  definitions and criteria for its diagnostic.
  Another problem is the involvement of physicians,
  operating in pre-hospital aid, for the
  supervision of patients during the second
  (prolonged) stage of DOTS treatment in the
  regions located far way from dispensaries.

D. Stefanova 2005
11
DOTS- OUTCOME OF TREATMENT IN 2003
D. Stefanova 2005
12
RESISTANCE IN BULGARIA 2000-2003
D. Stefanova 2005
13
MONORESISTANCE TO ANTI-TUBERCULOUS DRUGS IN
BULGARIA 1993-2002 (IN )
D. Stefanova 2005
14
MDR-TB IN BULGARIA
D. Stefanova 2005
15
TB AND HIV/AIDS IN BULGARIA

• HIV control and the increase of tuberculosis
  morbidity and mortality relevant to this, is
  dependent on the collaboration between the two
  respective National Programs. Up to 2003 the
  burden of HIV in Bulgaria is still low and
  tuberculosis burden is moderate compared to
  European countries. At the end of 2003 active
  tuberculosis is found among 31.9 of all AIDS
  cases. Tuberculosis morbidity among HIV infected
  people is 32 times higher then among all the rest
  of the population.

D. Stefanova 2005
16
COUNTRIES IN THE EUROPEAN REGION ACCORDING TO
PRIORITY FOR THE NEED TO PREVENT AND CONTROL
HIV/AIDS AND TO CONTROL TB
D. Stefanova 2005
17
TB AND HIV/AIDS IN BULGARIA

• Between 465 HIV-positive Bulgarian citizens
  (men 68, women 28, children 4) 113 are
  AIDS stricken. 105 patients receive ARVT.
  Transmission 83- through sexual intercourse,
  8- through blood, 9-vertically.
• Active TB was detected in 36 patients.
• In 12 of these TB was first clinic manifestation
  of HIV- infection.
• TB was the cause of death for 15 of the
  patients.
• Every newly detected HIV- positive patient is
  included in a 9-month chemoprophylaxis with
  Hydroniazide.

D. Stefanova 2005
18
ACTIVITIES AND MONITORING INDICATORS WITH RESPECT
TO TUBERCULOSIS POLICIES
D. Stefanova 2005
19
SPECIFIC TASKS

• 1. Improvement of the quality of bacteriological
  laboratories.
• 2. Improvement of the flow of information from
  the periphery to the center.
• 3. Reduction of the proportion of relapses and
  interrupted treatment in order to reverse the
  prevalence of the disease.
• 4. Prevention of multidrug-resistant tuberculosis
  by means of providing the correct type of
  treatment for all patients and monitoring the
  progress of all patients up to the end of the
  treatment.

D. Stefanova 2005
20
CONCLUSIONS

• Despite the nationwide expansion of DOTS and
  recent progress in TB control, some important
  constraints remain in Bulgaria. Progress in case
  detection rate has been accelerating but not all
  DOTS elements are satisfactorily implemented.
  Laboratory confirmation of cases needs to be
  strengthened.

D. Stefanova 2005