Impact of primary health care sector in the detection of tuberculosis on the model of Chisinau city

Abstract

Background: Tuberculosis detection represents the major challenge in actual health care system, recognised in the Republic of Moldova and worldwide. Material and methods: 101 pulmonary TB patients diagnosed in the period 1.1.2015-31.12.2015 in Chisinau were enrolled and distributed into two groups: the 1st group consisted of 73 patients with pulmonary TB detected in the frame of primary health care sector by general practitioners as symptomatic patients, and the 2nd group consisted of 28 patients with pulmonary TB detected by general practitioners by active way of screening. Results: Patients from both groups were enrolled in a similar proportion according to the demographic characteristics (urban/rural residency, civil and educational status). Two thirds of both groups were uninsured, but the economic state was lower in the group of patients detected as symptomatic cases. Chronic alcoholism, drug use, history of imprisonment, migration, comorbidities were established in a similar number of cases from both groups. Despite the fact that high risk groups (TB contacts and HIV infected individuals) must be screened actively, their rate is statistically higher in the group detected by passive way. Smear positive results, extensive pulmonary infiltrates and lung parenchyma destructions predominated in the group detected by passive way. The rate of patients that successfully finished the treatment was similar in both groups, but deaths were registered only in the group detected by passive way. Conclusions: The Republic of Moldova registers a continuous decrease of epidemiological TB indices due to the reduction of high risk groups designed to be investigated and the insufficient use of active screening.