West meets East - WHO tuberculosis treatment

N.B. Please note that if you are outside North America, the embargo for Lancet press material is 0001 hours UK time Friday 10th August 2001.

Results of a tuberculosis trial, published in this weeks issue of THE LANCET, suggest that a WHO strategy could make a valuable contribution to tuberculosis control in Russia.

There has been a resurgence of tuberculosis in Russia in the past decade, mainly due to the collapse of the health-care infrastructure in the 1980s and early 1990s. Traditional Russian services for treatment of tuberculosis are very different from those in the West. Patients suspected of having the disease are referred to specialist tuberculosis hospitals or sanatoria. Treatment methods combine chemotherapy with a range of additional treatments, some of which predate the chemotherapy era (10% of patients undergo surgery); long periods of hospitalisation are common. Nicholas Banatvala and colleagues from Merlin (a UK-based international health-care agency) compared the effects of WHO short-course chemotherapy with standard Russian antituberculous treatment.

New adult tuberculosis patients were included in a trial and allocated to receive either traditional Russian tuberculosis treatments or WHO short-course chemotherapy in the two largest tuberculosis diagnostic and treatment centres of Tomsk Oblast, western Siberia. Standard WHO tuberculosis outcomes and rates of sputum conversion were used as primary outcomes.

646 patients took part in the trial; 356 patients were given Russian tuberculosis treatment (155 smear positive) and 290 were given WHO short-course chemotherapy (155 smear positive). There was no statistical difference between the proportion cured or completing treatment (63% for both groups), or in the proportion of patients who died (8% WHO, 11% Russian treatment).

In an accompanying Commentary (p 434), Richard Coker from the London School of Hygiene and Tropical Medicine, UK, states that t

Contact: Richard Lane

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