zogierTi meore rigis preparatis mimarT tuberkulozis gamomwvevis rezistentobis gansazRvra saqarTveloSi kvlevis dagegmva, mimdinareoba, Sedegebi zogierTi meore rigis preparatis mimarT tuberkulozis gamomwvevis rezistentobis gansazRvra saqarTveloSi kvlevis dagegmva, mimdinareoba, Sedegebi samecniero-pedagogiuri samsaxuri II seminari

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 sawyis etapze sul mcire saWiroa:  kavSiri ucxoel kolaboratorebTan da maTi interesi kvleva Catardes Cvens qveyanaSi;  kvlevis ganmaxorcielebeli ZiriTadi organizaciebi saqarTveloSi da sazRvargareT;  doqtoris akademiuri xarisxis mqone ZiriTadi mkvlevari saqarTveloSi da sazRvargareT;  aqtualuri kvlevis dagegmva da proeqtis wardgena grantis gamcem organizaciaSi; adgilobrivi dafinansebis moZiebas Tavisi dadebiTi da uaryofiTi mxareebi aqvs

mocemuli kvlevis sawyisi etapebi:  2005-wels samoqalaqo kvlevis da ganviTarebis fondis ( CRDF ) da tfdec-is iniciativiT, b-ni sergo vaSakiZis ZalisxmeviT Catarda samuSao Sexvedra;  mklevarTa jgufma nata SublaZis teqnikuri asistenciiT waradgina proeqti ( proposal - N14577);  $ -iT dafinansda orwliani kvleva: CRDF, GEX TB-06 - “zogierTi meore rigis preparatis mimarT tuberkulozis gamomwvevis rezistentobis gansazRvra saqarTveloSi”;

kvlevis ganmxorcieleblebi saqarTvelos mxridan  ZiriTadi organizacia _ tuberkulozisa da filtvis daavadebaTa erovnuli centri;  ZiriTadi mkvlevari – F PI – lamara vaSakiZe;  mkvlevarebi - q. barbaqaZe, m. kikviZe, l. papitaSvili, m. nonikaSvili, n. SublaZe, n. beJaniSvili, i. xurcilava. aSS-s mxridan  ZiriTadi organizacia _ veteranTa hospitali, sirakuza, niu-iorki  ZiriTadi mkvlevari – US PI – maikl sinamoni;

grantis biujetidan gamoiyo Tanxa da SeZenil iqna kvlevisaTvis aucilebeli teqnikuri aRWurviloba: 3 kompiuteri; skaneri; qseroqsis aparati; proeqtori;fotoaparati; aucilebeli sakancelario nivTebi da aveji.

kvlevis aqtualoba: 2006 wlisTvis saqarTveloSi rezistentuli tuberkulozis marTva realur problemas warmoadgenda; 2005/VII-2006/V wlebSi DRS-is farglebSi qveynis masStabiT Catarebuli kvleviT dafiqsirda: “axal SemTxvevebSi” 54 (6,8%) DR-TB “warsulSi namkurnaleb SemTxvevaSi” 141 (27,4%) DR-TB saWiro iyo saqarTveloSi rezistentuli tuberkulozis gavrcelebis da formirebis Sesaxeb informaciis dagroveba

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

kvlevis masala da meTodebi: sakvlevi jgufi Seadgina tfdec-is stacionaris 605/972- ma pacientma, romlebmac xeli moaweres pacientis informirebul Tanxmobas; specialurad SemuSavebuli kiTxvaris daxmarebiT Segrovda maTi sruli socialuri, klinikuri da baqteriologiuri monacemebi; laboratoriuli kvleva tardeboda im droisTvis arsebuli SesaZleblobebis gaTvaliswinebiT; masala statistikurad damuSavda programa Epi Info-s versiiT.

kvlevis Sedegebi: “axali SemTxveva” _ 222(36,7%); “warsulSi namkurnalebi” _ 383(63,3%); STB _ 114(18,8%) 73 (12,1%) “axali”, 73 (12,1%) “axali”, 41 (6,8%) “warsulSi namkurnalebi”; 41 (6,8%) “warsulSi namkurnalebi”; MDRTB - 261(43,1%) 51 (8,4%) pirveladi, 51 (8,4%) pirveladi, 210 (34,7%) meoradi rezistentoba; 210 (34,7%) meoradi rezistentoba; XDRTB - 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%) sul n=605 (100%) Mono DR-TB69 (11,4%)61 (10,1%)130 (21,5%) Poly DR-TB23 (3,8%)44 (7,3%)67 (11,1%) MDR-TB51 (8,4%)210 (34,7%)261 (43,1%) XDR-TB6 (0,99%)27 (4,5%)33 (5,5%) DR-TB149 (24,6%)342 (56,5%)491(81,2%) S-TB73 (12,1%)41 (6,8%)114 (18,8%)

S-is mimarT monorezistentobis maCvenebeli bevrad aRemateboda H, R da E-is mimarT rezistentobis maCveneblebs; S-is mimarT pirveladi rezistentobis monacemebi ufro maRali iyo, vidre meoradi rezistentobis; H+S PDR-TB-is da H+R+S, H+R+S+E kombinaciebiT MDR-TB-is SemTxvevaSi pirveladi rezistentobis monacemebi ufro maRali iyo, vidre meoradi rezistentobis; meore rigis preparatebidan Eth-is da Ofx-is mimarT dafiqsirda rogorc pirveladi (Eth-37(6,1%) da Ofx- 14(2,3%)) ise meoradi rezistentobis (Eth-104(17,2%), Ofx- 61(10,1%)) yvelaze maRali maCveneblebi;

Cveni monacemebiT, riskis miuxedavad, DR-TB- is ganviTarebis xelSemwyob faqtorebad ar dafiqsirda:  pacientis asaki, ojaxuri mdgomareoba, ganaTleba, dasaqmeba, yovelTviuri Semosavali, sacxovrebeli pirobebi;  Tambaqos moweva, alkoholizmi, narkomania, patimroba, an iZulebiT gadaadgileba;  Tanmxlebi daavadebebis: aiv/Sidsis, hepatitis, Saqriani diabetis, Tormetgoja nawlavis da kuWis wylulis arseboba.

uni da multivariabeluri analizis Sedegad miviReT, rom:  MDR-TB-is ganviTarebis gamoxatul risks warsulSi Catarebuli mkurnaloba warmoadgens;  MDR-TB-is ganviTarebis riskTan asocirebulia: mdedrobiTi sqesi; mdedrobiTi sqesi; mWidrod dasaxlebul qalaqSi cxovreba; mWidrod dasaxlebul qalaqSi cxovreba; ojaxuri TB kontaqti. ojaxuri TB kontaqti.

TermOdds Ratio95%C.I. Middle age0,97900,66111,4499 Female gender2,39831,44303,9859 Living in densely populated capital 1,52481,05322,2075 Secondary education 0,90680,43991,8696 Family TB contact1,36820,83732,2358 Previous TB treatment 5,11823,39337,7200

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

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

S-is, H-is, R-is da gansakuTrebiT Ofl-is mimarT gamovlenili rezistentobis maRali maCveneblebi jandacvis qselSi am preparatebis araadeqvaturi gamoyenebiT aixsneba da seriozul problemebs qmnis rogorc DOTS, ise DOTS+ strategiis Sesabamisi standartuli mkurnalobisas.

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

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

kvlevis Sedegad miRebuli masala damuSavda da  momzadda posteruli prezentacia UNION -is 39- e saerTaSoriso konferenciisTvis, 2008 weli, parizi;  daibeWda abstraqti - “Reasons for Development of Drug Resistant Tuberculosis in Georgia”, Vashakidze Lamara; Archil Salakaia; et All; The International Journal of Tuberculosis and Lung Diseases, Abstract book, 39th world conference on lung heath of the International Union Against Tuberculosis and Lung Diseases (The Union), 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 State University 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 US$ BTEP/ISTC project:,,rezistentuli tuberkulozis epidzedamxedveloba da erovnuli programis Sefaseba saqarTvelosa da somxeTSi” kvlevis Rirebuleba – US$

gmadlobT yurdRebisaTvis yurdRebisaTvis