The paper analyzes the data from the forms of Federal statistical observation No. 11 No. 37 for 2011-2020 and statistical materials of the Ministry of Health of Russia, characterizing the activities of medical organizations providing specialized alcohol and drug treatment and allowing monitoring of the drug situation.

Over the past 5 years, there has been a decrease in the number of patients seeking alcohol and drug treatment in Moscow, the decline rate in Russia was much lower. Among registered patients, alcohol users accounted for about 70%; drug addicts - two times less. In the Russia, the percentage of drug addicts is more than two times less than in Moscow.

The indicator of the general incidence of alcoholism and drug addiction tended to decrease. The rate of primary incidence of narcological disorders has more than halved over a five-year period in Moscow.

The efficiency and quality of alcohol and drug treatment services are determined by a number of indicators. This is most clearly characterized by remission rates, which in Moscow have shown a stable growth over the past 5 years. The percentage of alcohol and drug addicted patients included in inpatient rehabilitation programs out of the number of patients hospitalized due to addiction diseases in 2020, both in Moscow and in Russia, remained practically unchanged compared to 2016.

The proportion of alcohol and drug addicted patients included in outpatient rehabilitation programs out of the number of patients under dispensary observation in Moscow in 2020 increased compared to 2016. The rate of removal from dispensary observation registers of patients with alcoholism, as well as those with drug addiction, in connection with recovery has increased in Moscow over the past 5 years, and it has slightly decreased in Russia.

Evaluation of the activities of medical organizations allows us to detect trends, reveal individual shortcomings and develop proposals for management decisions.

Introduction

The purpose of this study was to assess the relationship between the value of tuberculosis notification rate in 2019-2022 with limiting measures associated with the COVID-19, a change in the legislative base of the stay of migrants in the country, and, as a result, a change in the channels of detecting the disease among certain groups of external and internal migrants.

Materials and methods

The study used data on 8771 of new tuberculosis (TB) cases from the Moscow city TB surveillance system for 2019-2021 and 9 months of 2022 without post-mortem TB detection. A comparison of groups of patients determined by the status of residence in the city: patients from the permanent population of the city, residents of other regions of the Russian Federation and residents of other states, which included only citizens of the Republic of Tajikistan, the Republic of Uzbekistan and the Kyrgyz Republic, because among former USSR countries, these countries currently have a decisive influence on the TB incidence rate in the city. A comparative assessment of changes in the monthly number of new TB cases, registered in these groups. Analyzed the socio-demographic composition of groups, data on the TB detection channels, as well as on the foci of tuberculosis infection in the city. According to the Ministry of Internal Affairs, data on changes in migration flows in Moscow and information obtained from the multifunctional migration center of Moscow (MMC) were made, including information on the flows of foreign citizens who applied to the MMC for a medical examination during the registration of a patent.

Results

In 2019 and 2020, a decrease in the mean of the monthly number of registration of new TB cases was noted: 41.2 ± 2.5 and 29.8 ± 2.6, respectively, among residents of other regions of the Russian Federation (p < 0.01), 20.6 ± 1.3 and 16, 1 ± 3.0 - the Republic of Tajikistan (p <0.01), 14.3 ± 1.1 and 12.7 ± 3.0 - the Republic of Uzbekistan (p = 0.139), and 17.3 ± 1.2 and 16,3 ± 2.3 - the Kyrgyz Republic (p > 0.05). In the 3rd quarter of 2021, a significant increase in the number of new TB cases among citizens of the republics of Tajikistan and Uzbekistan occurred. If in 2019, 2020 and in the first 9 months of 2021, on average, 20.9 ± 1.2, 16.0 ± 3.1 and 14.1 ± 3.2 cases of diseases of citizens of The Republic of Tajikistan were monthly registered, respectively, and 14.5 ± 1.0, 12.6 ± 3.0 and 10.1 ± 2.5 monthly registered new TB cases of citizens of the Republic of Uzbekistan, then in the last quarter of 2021 - 78.7 ± 7.3 and 60.0 ± 4.4 new TB cases were already monthly registered respectively from citizens of these two countries (p <0.01), respectively. For the first 9 months of 2022 the values of the mean monthly detection of the new TB cases among the citizens of the Republic of Uzbekistan and residents of other regions of the Russian Federation returned to the mean annual level of 2019-2020 - 13.7 ± 2.8 and 31.2 ± 4.2, respectively (p > 0.05 for both groups)/ New TB cases in citizens of the Republic of Tajikistan became significantly higher than the same indicator in 2020 and in the first 9 months of 2021 (p <0.01), and even slightly higher than in 2019 (p = 0.059). A significant increase in the number of new TB patients was registered since March 2022 among citizens of the Kyrgyz Republic - up to 27.6 ± 7.5 cases, which is two times higher than the previous values of this indicator (13.2 ± 1.5 - in 12 months 2021). Thus, from 2019 to October 2022, three significant changes in TB notification rate in Moscow were noted - a decrease in the indicator in 2020 compared to 2019, an increase in the indicator in 2021, starting from October and, finally, an increase the indicator in the first half of 2022, compared with 2021. These changes determined by the dynamics and channels of the detection of TB patients in Moscow among citizens of three countries - the Republic of Tajikistan, the Republic of Uzbekistan and the Kyrgyz Republic and amendments to regulatory documents governing migration flows in the Russian Federation.

Conclusions

New TB patients in citizens of the Republics of Tajikistan and Uzbekistan and the Kyrgyz Republic had a decisive influence on changes in the indicator of TB notification rate in Moscow in the period 2019-2022. The coverage of foreign citizens with a medical examination, being the most important tool for early detection of tuberculosis, it significantly affects the increase or decrease in the indicator of TB notification rate in the city.

We analyzed bacterial suspensions (mixtures) containing various proportions of resistant and susceptible strains to assess the effectiveness of molecular genetic tests and bacteriological methods for determination of the heteroresistant population of M. tuberculosis (MTB) to rifampicin (RIF). We established that the efficiency of determining the RIF-resistant MTB population in mixtures depends on the method of mutation detection used in the test system. The Genotype MTBDRplus, TB-TEST, and TB-BIOCHIP-1 tests showed the same results in detecting a resistant population with the Ser531Leu mutation. Genotype MTBDRplus more effectively detected His526Tyr, His526Asp, Asp516Val substitutions and less efficiently detected mutations determined by the absence of wild-type probes compared to TB-TEST and TB-BIOCHIP-1 tests.

The efficiency of bacteriological detection of the resistant MTB population depends on the terms of cultivation. The method of serial microdilutions in the Middlebrook 7H9 liquid medium is the most effective in detecting RIF-resistance in the heteroresistant MTB population with the MTB cultivation for 21 days in comparison with the automated system Bactec MGIT 960 and the method of absolute concentrations on the L-J solid medium with the MTB cultivation for 28 days. It was noted that the proportion of resistant MTB strains detectection by Bactec MGIT 960, the method of absolute concentrations on a solid L-J medium for 28 days and by the method of serial microdilutions for 14 days did not differ significantly and amounted to 45.1; 44.1 and 38.9 respectively

Introduction. Mycobacteria chelonae – abscessus complex (primarily М. abscessus) are the most common causative agents of mycobacteriosis among fast-growing non-tuberculosis mycobacteria (NTM).

Materials and methods. The drug sensitivity to bedaquiline of the М. chelonae – abscessus complex has been studied (43 – М. chelonae and 64 – М. abscessus). The study was carried out by the method of serial microdilutions in a liquid medium Muller-Hinton using a 96-well plate.

Results. The MIC spectrum of bedaquiline against М. chelonae and М. abscessus was determined in the range of 0.0015–2.0 µg/ml and 0.0015–1.0 µg/ml, respectively. MIC50 for М. chelonae and М. abscessus was 0.015 and 0.007 µg/ml, MIC90 was 0.12 and 0.06 µg/ml, respectively. Established preliminary epidemiological cut-off values (ECOFF) for clinical isolates of М. chelonae and М. abscessus were 0.25 and 0.12 µg/mL, respectively. Bedaquiline resistance was found in 1 strain of М. chelonae and 2 strains of М. abscessus.

Conclusion. The indicators of drug sensitivity to bedaquiline of М. chelonae and М. abscessus differ in different studies, which is a reflection of the interaction of the pathogen and the macroorganism in different environmental conditions. However, the development of such studies is necessary to create, as a result, real criteria for assessing drug sensitivity to bedaquiline.