zogierTi meore rigis preparatis zogierTi meore rigis preparatis mimarT tuberkulozis gamomwvevis mimarT tuberkulozis gamomwvevis

rezistentobis gansazRvra rezistentobis gansazRvra saqarTveloSisaqarTveloSi

kvlevis dagegmva, kvlevis dagegmva, mimdinareoba, Sedegebimimdinareoba, Sedegebi

samecniero-pedagogiuri samsaxuri samecniero-pedagogiuri samsaxuri II seminariII seminari

11.08.0911.08.09

tuberkulozisa da filtvis daavadebaTa erovnul centrSi mimdinare kvlevis

tipebi:

donori organizaciebis dafinansebiT tep-is farglebSi, qveynis masStabiT Catarebuli kvlevebi;mkvlevarTa individualuri jgufis iniciativiT ucxouri grantiT, an adgilobrivi dafinansebiT Catarebuli kvlevebi;

ucxouri dafinansebis Ziebis SemTxvevaSi ucxouri dafinansebis Ziebis SemTxvevaSi sawyis etapze sul mcire saWiroa:sawyis etapze sul mcire saWiroa:

kavSiri ucxoel kolaboratorebTan da maTi kavSiri ucxoel kolaboratorebTan da maTi interesi kvleva Catardes Cvens qveyanaSi;interesi kvleva Catardes Cvens qveyanaSi;

kvlevis ganmaxorcielebeli ZiriTadi organizaciebi kvlevis ganmaxorcielebeli ZiriTadi organizaciebi saqarTveloSi da sazRvargareT;saqarTveloSi da sazRvargareT;

doqtoris akademiuri xarisxis mqone ZiriTadi doqtoris akademiuri xarisxis mqone ZiriTadi mkvlevari saqarTveloSi da sazRvargareT;mkvlevari saqarTveloSi da sazRvargareT;

aqtualuri kvlevis dagegmva da proeqtis aqtualuri kvlevis dagegmva da proeqtis wardgena grantis gamcem organizaciaSi;wardgena grantis gamcem organizaciaSi;

adgilobrivi dafinansebis moZiebas Tavisi dadebiTi adgilobrivi dafinansebis moZiebas Tavisi dadebiTi da uaryofiTi mxareebi aqvsda uaryofiTi mxareebi aqvs

mocemuli kvlevis sawyisi etapebi:mocemuli kvlevis sawyisi etapebi:

2005-wels samoqalaqo kvlevis da 2005-wels samoqalaqo kvlevis da ganviTarebis fondis (ganviTarebis fondis (CRDFCRDF) da tfdec-is ) da tfdec-is iniciativiTiniciativiT, , b-ni sergo vaSakiZis b-ni sergo vaSakiZis ZalisxmeviT Catarda samuSao Sexvedra;ZalisxmeviT Catarda samuSao Sexvedra;

mklevarTa jgufma nata SublaZis mklevarTa jgufma nata SublaZis teqnikuri asistenciiT waradgina proeqtiteqnikuri asistenciiT waradgina proeqti ((proposal -proposal - N14577); N14577);

100 000 100 000 $$-iT dafinansda-iT dafinansda orwliani kvleva: orwliani kvleva: 2006-2006-2008 2008 CRDFCRDF, , GEXGEX1-002711-1-002711-TBTB-06-06 - - ““zogierTi zogierTi meore rigis preparatis mimarT meore rigis preparatis mimarT tuberkulozis gamomwvevis rezistentobis tuberkulozis gamomwvevis rezistentobis gansazRvra saqarTveloSi”;gansazRvra saqarTveloSi”;

kvlevis ganmxorcieleblebikvlevis ganmxorcieleblebi

saqarTvelos mxridan saqarTvelos mxridan ZiriTadi organizacia ZiriTadi organizacia _ tuberkulozisa da filtvis _ tuberkulozisa da filtvis

daavadebaTa erovnuli centri;daavadebaTa erovnuli centri; ZiriTadi mkvlevari ZiriTadi mkvlevari – F PI – – F PI – lamara vaSakiZe;lamara vaSakiZe; mkvlevarebi - mkvlevarebi - q. barbaqaZe, m. kikviZe, l. q. barbaqaZe, m. kikviZe, l.

papitaSvili, m. nonikaSvili, n. SublaZe, papitaSvili, m. nonikaSvili, n. SublaZe,

n. beJaniSvili, i. xurcilava. n. beJaniSvili, i. xurcilava.

aSS-s mxridan aSS-s mxridan ZiriTadi organizacia ZiriTadi organizacia _ veteranTa hospitali, _ veteranTa hospitali,

sirakuza, niu-iorkisirakuza, niu-iorki ZiriTadi mkvlevari ZiriTadi mkvlevari – – US PI – US PI – maikl sinamoni;maikl sinamoni;

grantis biujetidan gamoiyo Tanxa da grantis biujetidan gamoiyo Tanxa da SeZenil iqna kvlevisaTvis aucilebeli SeZenil iqna kvlevisaTvis aucilebeli teqnikuri aRWurviloba:teqnikuri aRWurviloba:

3 kompiuteri;3 kompiuteri;

skaneri;skaneri;

qseroqsis aparati;qseroqsis aparati;

proeqtori;proeqtori;

fotoaparati;fotoaparati;

aucilebeli sakancelario nivTebi da aveji.aucilebeli sakancelario nivTebi da aveji.

kvlevis aqtualoba:kvlevis aqtualoba: 2006 wlisTvis saqarTveloSi rezistentuli 2006 wlisTvis saqarTveloSi rezistentuli tuberkulozis marTva realur problemas tuberkulozis marTva realur problemas

warmoadgenda;warmoadgenda;

2005/VII-2006/V wlebSi 2005/VII-2006/V wlebSi DRS-DRS-is farglebSi qveynis is farglebSi qveynis masStabiT Catarebuli kvleviT masStabiT Catarebuli kvleviT dafiqsirda:dafiqsirda: ““axal SemTxvevebSi” 54 (6,8%) axal SemTxvevebSi” 54 (6,8%) DR-TBDR-TB““warsulSi namkurnaleb SemTxvevaSi” 141 warsulSi namkurnaleb SemTxvevaSi” 141 (27,4%) (27,4%) DR-TBDR-TB

saWiro iyo saqarTveloSi rezistentuli tuberkulozis saWiro iyo saqarTveloSi rezistentuli tuberkulozis gavrcelebis da formirebis Sesaxeb informaciis gavrcelebis da formirebis Sesaxeb informaciis

dagrovebadagroveba

kvlevis mizani:kvlevis mizani:

tuberkulozisa da filtvis daavadebaTa tuberkulozisa da filtvis daavadebaTa erovnul centrSi hospitalizirebul erovnul centrSi hospitalizirebul pacientebSi tubsawinaaRmdego pacientebSi tubsawinaaRmdego preparatebisadmi pirveladi da meoradi preparatebisadmi pirveladi da meoradi rezistentobis formirebis mizezebis rezistentobis formirebis mizezebis gamovlena-gaanalizeba gamovlena-gaanalizeba DR-TBDR-TB-is marTvis -is marTvis da kontrolis srulyofis mizniT.da kontrolis srulyofis mizniT.

kvlevis masala da meTodebi:kvlevis masala da meTodebi:sakvlevi jgufi Seadgina sakvlevi jgufi Seadgina tfdec-istfdec-is stacionaris stacionaris 605/972-ma 605/972-ma pacientmapacientma, romlebmac xeli , romlebmac xeli moaweres pacientis informirebul Tanxmobas; moaweres pacientis informirebul Tanxmobas;

specialurad SemuSavebuli kiTxvaris specialurad SemuSavebuli kiTxvaris daxmarebiT Segrovda maTi sruli socialuri, daxmarebiT Segrovda maTi sruli socialuri, klinikuri da baqteriologiuri monacemebi; klinikuri da baqteriologiuri monacemebi;

laboratoriuli kvleva tardeboda im droisTvis laboratoriuli kvleva tardeboda im droisTvis arsebuli SesaZleblobebis gaTvaliswinebiT;arsebuli SesaZleblobebis gaTvaliswinebiT;

masala statistikurad damuSavda programa masala statistikurad damuSavda programa Epi Epi Info-Info-ss 3.3.2 3.3.2 versiiT. versiiT.

kvlevis Sedegebi:kvlevis Sedegebi:““axali SemTxveva”axali SemTxveva” _ 222(36,7%);_ 222(36,7%);““warsulSi namkurnalebi”warsulSi namkurnalebi” _ 383(63,3%);_ 383(63,3%);STBSTB _ 114(18,8%) _ 114(18,8%)

73 (12,1%) “axali”, 73 (12,1%) “axali”, 41 (6,8%) “warsulSi namkurnalebi”;41 (6,8%) “warsulSi namkurnalebi”;

MDRTB -MDRTB - 261(43,1%) 261(43,1%) 51 (8,4%) pirveladi,51 (8,4%) pirveladi,210 (34,7%) meoradi rezistentoba; 210 (34,7%) meoradi rezistentoba;

XDRTB -XDRTB - 33(5,5%) 33(5,5%) 6 (0,99%) pirveladi, 6 (0,99%) pirveladi, 27 (4,5%) meoradi rezistentoba.27 (4,5%) meoradi rezistentoba.

rezistentoba “axali SemTxveva”

n=222 (36,7%)

“Zveli SemTxveva”n=383 (63,3%)

suln=605 (100%)

Mono DR-TB 69 (11,4%) 61 (10,1%) 130 (21,5%)

Poly DR-TB 23 (3,8%) 44 (7,3%) 67 (11,1%)

MDR-TB 51 (8,4%) 210 (34,7%) 261 (43,1%)

XDR-TB 6 (0,99%) 27 (4,5%) 33 (5,5%)

DR-TB 149 (24,6%) 342 (56,5%) 491(81,2%)

S-TB 73 (12,1%) 41 (6,8%) 114 (18,8%)

0,00%

5,00%

10,00%

15,00%

20,00%

25,00%

30,00%

35,00%

1 2 3 4

monoDR PDR MDR XDR

DRTB-i s si xSi r e

"axal i "

"Zvel i "

SS-is-is mimarT monorezistentobis maCvenebeli mimarT monorezistentobis maCvenebeli bevrad aRemateboda bevrad aRemateboda HH, , RR da da EE-is mimarT -is mimarT rezistentobis maCveneblebs;rezistentobis maCveneblebs;

SS-is-is mimarT pirveladi rezistentobis monacemebi mimarT pirveladi rezistentobis monacemebi ufro maRali iyo, vidre meoradi rezistentobis;ufro maRali iyo, vidre meoradi rezistentobis;

H+SH+S PDR-TBPDR-TB-is da -is da H+R+SH+R+S, , H+R+S+EH+R+S+E kombinaciebiT kombinaciebiT MDR-TBMDR-TB-is SemTxvevaSi -is SemTxvevaSi pirveladi rezistentobis monacemebi ufro maRali pirveladi rezistentobis monacemebi ufro maRali iyo, vidre meoradi rezistentobis;iyo, vidre meoradi rezistentobis;

meore rigis preparatebidanmeore rigis preparatebidan Eth-Eth-isis dada Ofx-Ofx-isis mimarT dafiqsirda rogorc pirveladi (mimarT dafiqsirda rogorc pirveladi (EthEth--37(6,1%) da 37(6,1%) da OfxOfx-14(2,3%)) ise meoradi -14(2,3%)) ise meoradi rezistentobis (rezistentobis (EthEth-104(17,2%), -104(17,2%), OfxOfx- 61(10,1%)) - 61(10,1%)) yvelaze maRali maCveneblebi;yvelaze maRali maCveneblebi;

0,00%

5,00%

10,00%

15,00%

20,00%

1 2 3 4

HR HRS HRE HRSE

MDRTB "axal " da "war sul Si namkur nal eb" SemTxvevebSi

"axal i "

"Zvel i "

0,00%

5,00%

10,00%

15,00%

20,00%

1 2 3 4 5 6

Amk Cpm Eth PAS CS Ofx

II r i gi s pr epar at ebi s mi mar T r ez i st ent oba

"axal i "

"Zvel i "

Cveni monacemebiT, riskis miuxedavad, Cveni monacemebiT, riskis miuxedavad, DR-TBDR-TB-is ganviTarebis xelSemwyob -is ganviTarebis xelSemwyob faqtorebad ar dafiqsirda: faqtorebad ar dafiqsirda:

pacientis asaki, ojaxuri mdgomareoba, pacientis asaki, ojaxuri mdgomareoba, ganaTleba, dasaqmeba, yovelTviuri ganaTleba, dasaqmeba, yovelTviuri Semosavali, sacxovrebeli pirobebi;Semosavali, sacxovrebeli pirobebi;

Tambaqos moweva, alkoholizmi, Tambaqos moweva, alkoholizmi, narkomania, patimroba, an iZulebiT narkomania, patimroba, an iZulebiT gadaadgileba;gadaadgileba;

Tanmxlebi daavadebebis: aiv/Sidsis, Tanmxlebi daavadebebis: aiv/Sidsis, hepatitis, Saqriani diabetis, Tormetgoja hepatitis, Saqriani diabetis, Tormetgoja nawlavis da kuWis wylulis arseboba. nawlavis da kuWis wylulis arseboba.

uni da multivariabeluri analizis Sedegad uni da multivariabeluri analizis Sedegad miviReT, rom: miviReT, rom:

MDR-TB-MDR-TB-is ganviTarebis gamoxatul risks is ganviTarebis gamoxatul risks warsulSi Catarebuli mkurnaloba warsulSi Catarebuli mkurnaloba warmoadgens;warmoadgens;

MDR-TB-MDR-TB-is ganviTarebis riskTan is ganviTarebis riskTan asocirebulia:asocirebulia:

mdedrobiTi sqesi;mdedrobiTi sqesi;mWidrod dasaxlebul qalaqSi cxovreba;mWidrod dasaxlebul qalaqSi cxovreba;ojaxuri ojaxuri TB TB kontaqti.kontaqti.

Term Odds Ratio 95% C.I.

Middle age 0,9790 0,6611 1,4499

Female gender 2,3983 1,4430 3,9859

Living in densely populated capital

1,5248 1,0532 2,2075

Secondary education

0,9068 0,4399 1,8696

Family TB contact 1,3682 0,8373 2,2358

Previous TB treatment

5,1182 3,3933 7,7200

kvlevis Sedegebis analizikvlevis Sedegebis analizi

vinaidan Cveni kvleva hospitalizirebul vinaidan Cveni kvleva hospitalizirebul pacientebze Catarda kvlevaSi CarTuli pacientebze Catarda kvlevaSi CarTuli pacientebis 63,3% warsulSi namkurnalebi pacientebis 63,3% warsulSi namkurnalebi iyo, rac bevrad aRemateboda iyo, rac bevrad aRemateboda DRS DRS kvlevaSi CarTuli warsulSi namkurnalebi kvlevaSi CarTuli warsulSi namkurnalebi SemTxvevebis ricxvs (39,2%). amiT SemTxvevebis ricxvs (39,2%). amiT aixsneba aixsneba DRS DRS kvlevasTan SedarebiT kvlevasTan SedarebiT Cvens kvlevaSi pirveladi da meoradi Cvens kvlevaSi pirveladi da meoradi rezistentobis gacilebiT maRali rezistentobis gacilebiT maRali maCveneblebis dafiqsireba maCveneblebis dafiqsireba (6,8%/27,4% - (6,8%/27,4% - 24,6%/56,5%);24,6%/56,5%);

saqarTveloSisaqarTveloSi TB TB pacientebis ZiriTadi pacientebis ZiriTadi momvlelebi mdedrobiTi sqesis momvlelebi mdedrobiTi sqesis warmomadgenlebi arian, riTac SeiZleba aixsnas warmomadgenlebi arian, riTac SeiZleba aixsnas qalebSiqalebSi MDR-TB- MDR-TB-isis maRali maCvenebeli. maRali maCvenebeli. am am logikiT maRali unda yofiliyo logikiT maRali unda yofiliyo TB TB kontaqtSi myofi kontaqtSi myofi qalebis pirveladi rezistentobis maCvenebeli, rac qalebis pirveladi rezistentobis maCvenebeli, rac kvlevis Sedegad ar dafiqsirda, mizezi kvlevis Sedegad ar dafiqsirda, mizezi savaraudod stigma (kontaqtebis didi savaraudod stigma (kontaqtebis didi umravlesoba formdeboda rogorc “ucnobi”) da umravlesoba formdeboda rogorc “ucnobi”) da gasul wlebSigasul wlebSi DST- DST-ze arasakmarisi ze arasakmarisi xelmisawvdomoba iyo (wina wlebSi SesaZlebeli xelmisawvdomoba iyo (wina wlebSi SesaZlebeli rom yofiliyo rom yofiliyo DSTDST-is Catareba, qalebis -is Catareba, qalebis umravlesobaSi dafiqsirdeboda pirveladi umravlesobaSi dafiqsirdeboda pirveladi rezistentoba). rezistentoba).

SS-is, -is, HH-is, -is, RR-is da gansakuTrebiT -is da gansakuTrebiT OflOfl-is -is mimarT gamovlenili rezistentobis maRali mimarT gamovlenili rezistentobis maRali maCveneblebi maCveneblebi jandacvis qselSi am jandacvis qselSi am preparatebis araadeqvaturi gamoyenebiT preparatebis araadeqvaturi gamoyenebiT aixsnebaaixsneba da seriozul problemebs qmnis da seriozul problemebs qmnis rogorc rogorc DOTSDOTS, ise , ise DOTS+DOTS+ strategiis strategiis Sesabamisi standartuli mkurnalobisas.Sesabamisi standartuli mkurnalobisas.

kompaqturad dasaxlebul did qalaqSi kompaqturad dasaxlebul did qalaqSi cxovrebis, ojaxuri cxovrebis, ojaxuri TBTB kontaqtis da kontaqtis da mdedrobiTi sqesis rezistentuli mdedrobiTi sqesis rezistentuli tuberkulozis ganviTarebis risk-faqtorebad tuberkulozis ganviTarebis risk-faqtorebad dafiqsireba miuTiTebs dafiqsireba miuTiTebs daavadebis da misi daavadebis da misi transmisiis Sesaxeb rogorc pacientis, ise transmisiis Sesaxeb rogorc pacientis, ise misi ojaxis wevrebis arasrulyofil misi ojaxis wevrebis arasrulyofil informirebaze da tubdawesebulebis gareT informirebaze da tubdawesebulebis gareT infeqciis araswor kontrolze. infeqciis araswor kontrolze.

daskvna:daskvna:kvlevis Sedegebidan gamomdinare rekomendire-kvlevis Sedegebidan gamomdinare rekomendire-

bulia:bulia:I da II rigis tubsawinaaRmdego preparatebis I da II rigis tubsawinaaRmdego preparatebis mxolod specifiuri procesebis samkurnalod mxolod specifiuri procesebis samkurnalod gamoyeneba;gamoyeneba;mgb(+) pirebisagan janmrTeli adamianebis mgb(+) pirebisagan janmrTeli adamianebis drouli drouli izolireba, infeqciis kontrolis zomebis izolireba, infeqciis kontrolis zomebis dacva dacva (gansakuTrebiT kompaqturad dasaxlebul (gansakuTrebiT kompaqturad dasaxlebul qalaqebSi);qalaqebSi);tuberkulozis Sesaxeb pacientis, misi ojaxis tuberkulozis Sesaxeb pacientis, misi ojaxis wevrebis, zogadad sazogadoebis srulyofilad wevrebis, zogadad sazogadoebis srulyofilad informireba;informireba;DOTS+DOTS+ strategiis Sesabamisad strategiis Sesabamisad rezistentuli rezistentuli tuberkulozis mkurnalobis dauyovnebliv tuberkulozis mkurnalobis dauyovnebliv dawyeba.dawyeba.

kvlevis Sedegad miRebuli masala kvlevis Sedegad miRebuli masala damuSavda dadamuSavda da

momzadda posteruli prezentaciamomzadda posteruli prezentacia UNIONUNION-is -is 39-e saerTaSoriso konferenciisTvis, 2008 39-e saerTaSoriso konferenciisTvis, 2008 weli, parizi; weli, parizi;

daibeWda abstraqti daibeWda abstraqti - - “Reasons for “Reasons for Development of Drug Resistant Tuberculosis in Development of Drug Resistant Tuberculosis in Georgia”, Vashakidze Lamara; Archil Salakaia; et Georgia”, Vashakidze Lamara; Archil Salakaia; et All; The International Journal of Tuberculosis and All; The International Journal of Tuberculosis and Lung Diseases, Lung Diseases, Abstract book,Abstract book, 39th world 39th world conference on lung heath of the International Union conference on lung heath of the International Union Against Tuberculosis and Lung Diseases (The Against Tuberculosis and Lung Diseases (The Union), ParisUnion), Paris

UNION-is saerTaSoriso Jurnalis 2009 wlis seqtembris nomerSi (INT J TUBERC LUNG DIS 13(9):1–6 © 2009 The Union) gamoqveyndeba statia:

“Prevalence and risk factors for drug resistance among hospitalized tuberculosis patients in Georgia” - L Vashakidze,* A. Salakaia,* N. Shubladze,* M. Cynamon,† K. Barbakadze,* M. Kikvidze,*L. Papitashvili,* M. Nonikashvili,* N. Solomonia,* N. Bejanishvili,* I. Khurtsilava

*National Centre for Tuberculosis and Lung Diseases, Tbilisi, Georgia;

† Veterans’ Affaires Medical Center and StateUniversity of New York Upstate Medical University,

Syracuse, New York, USA

kvlevis safuZvelze momzadda sadoqtoro kvlevis programa

• Temis dasaxeleba: rezistentuli, maT Soris multi (MDR-TB) _ da eqstensiuri rezistentobis (XDR-TB), Dtuberkulozis samedicino - epidemiologiuri aspeqtebi da marTva saqarTveloSi

• Temis samecniero xelmZRvaneli: lamara vaSakiZe

• doqtoranti: arCil salayaia• • kvlevis dafinansebis wyaroebi: 1. CRDF proposal, project # 14577: “zogierTi meore rigis

preparatis mimarT tuberkulozis gamomwvevis rezistentobis gansazRvra saqarTveloSi”; kvlevis Rirebuleba - 47 000 US$

2. 2004-2007 BTEP/ISTC project: ,,rezistentuli tuberkulozis epidzedamxedveloba da erovnuli programis Sefaseba saqarTvelosa da somxeTSi” kvlevis Rirebuleba – 43 768 US$

gmadlobTgmadlobT

yurdRebisaTvisyurdRebisaTvis