indoeTSi DOTS+ starategiis danergvis winapirobebi :

1. DOTS+ strategiiTmkurnalobis 7 wlianigamocdilebaindoeTSi: Sedegebi, SezRudvebidadaskvnebi tuberkulozisadafiltvisdaavadebaTasaerTaSorisogaerTianebis (The UNION) Jurnali 13(8): 976-981 “samSabaToba”, 06.10.09

2. indoeTSiDOTS+ starategiisdanergviswinapirobebi: • 1997 wlidantep-is farglebSiDOTS strategiiTmkurnalobiswarumatebeligamosavaliwarsulSinamkurnalebpacientTasaSualod 6%-Si fiqsirdeboda; • winaswarikvlevebiTMDR-TB dafiqsirda • “axalSemTxvevaTa” 3%-Si (6,8%); • “warsulSinamkurnalebSemTxvevaTa” 12-18%-Si (27,4%); • DOTSstrategiismuSaobaqveynismasStabiTSefasdadadebiTad; • 2002 wlisianvridanpiloturiprogramisfarglebSiDOTS+ strategiiTmkurnalobadaiwyoLRS institutSi (1997 wlidanDOTSstrategiiTnamkurnalebi 1,6 milionipacientiT).

3. CarTviskriteriumebi: • sawyisetapzepiloturprogramaSiCasarTavad II kategoriis “uSedego” gamosavlismqonepacientebiSeirCnen; • kvlevaSi DST-is SedegebiTdadasturebuliMDR-TB pacientebiCaerTvnen; • kvlevasmeTvalyureobdainstitutiseTikurikomiteti; gamoricxviskriteriumebi: • kvlevaSiarmoxvdnen II rigispreparatebiT 1 TvezemetixangrZlivobiTnamkurnalebi; • fexmZime; • HIV/AIDSpozitiuripacientebi. saboloodSeirCadaretrospeqtulianaliziCatarda 126 pacientismonacemebze (2002-2006 ww);

4. meTodebi: • LRS referens-laboratoriaSitardeboda: • 2 ulufanaxvelisbaqterioskopia; • DST ganisazRvrebodasaerTaSorisorekomendaciebisgaTvaliswinebiT(BACTEC, H – 0,4µg/ml (0.2); R – 128µg/ml (40); S – 16µg/ml (4); E – 8µg/ml (2)); • ZiriTadisamkurnaloreJimi: • intensiurfazaSi _ 6(max9) Km+Cs+Ofx+Eth+Z (Km – 750 mg (1000mg); Cs – 500-750 mg (1000mg); Ofx – 600-800 mg (1000mg); Eth – 500-570 mg (1000mg); ; Z – 1500 mg); • gagrZelebisfazaSi _ 12 Cs+Ofx+Eth; • PAS-iTCanacvlebaxdebodaZ-ismimarTrezistentobis, an romelimepreparatisautanlobisSemTxvevaSi; • yvelapacients minimum 1 TvisganmavlobaSiutardebodastacionalurimkurnaloba; • intensiurfazaSiyovelTveSi, xologagrZelebisfazaSiyovel II TveSitardeboda 1 kulturalurigamokvleva(ganmeorebiTiDST???); • statistikurianalizitardebodaEpi Info version 10.0 (CDC, Atlanta, USA). MDR-TB - Km(Cm)+Lfx+Pto+Cs+Pas+(E)+(Z) XDR-TB - Cm+Mfx+Pto+Cs+PAS+Cfz+Amx/Clv+Clr+(E)+(Z)

5. Sedegebi: • pacientTasaSualoasaki _ 26 w. iyo; • MDR-TB kontaqtidafiqsirdaSemTxvevaTa 4%-Si; • warsulSiCatarebulimkurnalobisxangrZlivobasaSualod 18,4 Tveiyo; • MDR-TB-is diagnostirebasaSualod 5 (4.2) TviTgviandeboda; • MDR-TB-is mkurnalobisdawyebasaSualod 3.3 (1.6) TviTgviandeboda; • rentgenologiurad • moculobiTi (infiltraciadakavitaciamoicavs 1-ze met wils) paTologiadafiqsirda 81%-Si; • bilateraluri 78%-Si; • mxolodkavitacia 43%-Si;

6. naxveliskulturalurikonversiamoxda • sul100 (79%) pacientTan _ mkurnalobispirvel 8 TveSi; • maTgan 82%-Si _ pirvel 3 TveSi; • 98%-Si _ pirvel 6 TveSi. • naxveliskulturalurikonversiaarmoxda • 26 (21%) pacientTan • maTgan 14 gardaicvala; • 8-m Sewyvitamkurnaloba; • mxolod 4-Tan (3,2%-Si) dafiqsirdauSedegomkurnaloba.

7. mkurnalobis monitoringi wonis koreqciis mixedviT: • mkurnalobis dawyebisas pacientTa 30%-is wona ≤ 30 kg-ze; • kursis ganmavlobaSi 28%-ma moimata 6-10 kg; • 20%-ma 11-15 kg; • 11%-ma >15 kg-ze.

8. sul gardaicvala 24 pacienti • maTgan 7(29%) mkurnalobis I TveSi; • 13(54%) pirvel 4 TveSi; • mxolod 1 pacienti gardaicvala kulturis konversiis Semdeg; • 20(83%) warsulSi namkurnalebi SemTxveva iyo, rentgenologiurad yvelas aReniSneboda moculobiTi infiltracia, mravlobiTi kavernebiT. mkurnalobis Sewyvetis ZiriTadi mizezi migracia iyo

9. II rigis TB preparatebis toqsiurobiT gamowveuli gverdiTi movlenebi

10. MDR-TB mkurnalobis gamosavali 22 (17%) 76 (61%) 4 (3%)

11. SezRudvebi: • MDR-TB-isdiagnostikis dagvianeba 3-5 TviT (arasrulyofili laboratoriuli momsaxureba, teritoriuli problemebi, didi populacia); • regionaluri DOTS wertilebis kargi muSaobis miuxedavad maT Soris cudi kolaboracia, regionebSi aradamakmayo-filebeli laboratoriuli momsaxureba; • individualuri samkurnalo reJimebis gamoyenebis SeuZlebloba; • xSiri migracia;

12. daskvnebi: • gamoyenebuli samkurnalo reJimi 6(max9) KmCsOfxEthZ/12(max18)CsOfxEth efeqturia • 79%-Si naxvelis konversia; • 61%-is gankurneba; • 3%-is uSedego mkurnaloba; • 28%-Si wonis 6-10 kg-iT koreqcia, 20%-Si wonaSi <15 kg-iT mateba; • mkurnalobis pirvel TveebSi maRali sikvdilianobis mizezi dagvianebuli diagnostikaa

13. aucilebeliaregionebissrulyofililaboratoriulimomsaxurebiTuzrunvelyofa (regionSi min. erTilaboratoriakvlevisswrafimeTodebiT _ hainistestebisdanergva); • qveyanaSimeoradirezistentobismaRalidapirveladirezistentobisdabalimaCveneblisgaTvaliswinebiTrekomendebuliaDST-is SedegebamdeMDR-TB-is empiriulireJimiTmkurnalobisdawyeba; • retrospeqtulianalizissafuZvelzedasaerTaSorisostandartebisgaTvaliswinebiTcvlilebaSevida MDR-TB-is erovnulgaidlainSi _ standartulsamkurnaloreJims VI preparataddaemata E;

14. axali TB preparatebisSeqmnisaTvismimdinaresamecnierokvlevebivizualurimasala parafinismagvariorganulinivTierebebisadacilovaniSenaerTisagan(Acyl Lipids) SemdgariwyalgaumtariSre

15. gram-dadebiTi baqteria gram-uaryofiTi baqteria mikobaqteria acyl lipids lipid bilayer lipid + LPS peptidoglycan MYCOLATE LAM arabinogalactan porins

16. sensitiuri TB-is mkurnaloba I rigis preparatebiT

17. MDR-TB-is mkurnaloba II rigis preparatebiT

18. Semcirebuli arCevani XDR-TB-is mkurnalobisas

19. preparatebi, romlebzeac mimdinareobs kvlevebi

21. gmadlobT yuradRebisaTvis