The article outlines the principles and contradictions inherent in the activities of medical tuberculosis control organizations within the system of mandatory medical insurance.
The objective of the study: to investigate the efficacy and cost-effectiveness of the introduction of mandatory health insurance into tuberculosis control.
Subjects and methods. The following indicators were compared and analyzed: rate of reduction of tuberculosis incidence and mortality, abacillation, the number of hospital admissions per patient, the number of visits per patient, the coverage of population with TB doctors, wages and salary per doctor, the cost of abacillation of one patient with multiple drug resistant tuberculosis.
Results. The hypothesis about the influence of mandatory medical insurance system on the analyzed indicators was not confirmed. It was proved that it was not expedient to transfer funding of tuberculosis control activities into the mandatory health insurance system.

The objective of the study: to assess the changes in the level of disability due to respiratory diseases in Omsk Region for the period from 2013 to 2017.
Subject and methods: a retrospective study. Based on the reports for clinical expert work of Omsk Regional Head Bureau of Medical and Social Assessment no. 8 by the Russian Ministry of Labor, primary and recurrent disability was analyzed.
Results. In 2013, totally 382 people were recognized as disabled for the first time due to respiratory diseases and tuberculosis, in 2014 –545, in 2015 –435, in 2016 – 512, and in 2017 – 455. The share of tuberculosis of all localizations made 51.8% in 2013, 34.1% in 2014, 48.7% in 2015, 47.1% in 2016, and 40.6% in 2017, respiratory tuberculosis was the cause of disability in 49.2% in2013, in 32.3% in2014, in 42.3% in2015, in 31.2% in 2016, and in 30.1% in 2017. 1,069 people were recognized as disable due to respiratory diseases and tuberculosis in the Omsk Region in 2013,1,322 in 2014,969 in 2015,922 in 2016, and 1,056 patients in 2017; due to tuberculosis in 2013 – 50.6%, in 2014 – 43.9%, in 2015 – 54.4%, in 2016 – 44.3%, and in 2017 – 40.1%, respiratory tuberculosis was the cause of persistent disability by years, respectively: in 2013 – in 48.2%, in 2014 – in 41.1%, in 2015 – in 50.8%, in 2016 – in 27.4%, and in 2017 – in 24.1% of cases. From 2013 to2017 in Omsk Region, tuberculosis incidence, prevalence, and mortality went down. At the same time, the index of disability due to tuberculosis decreased slightly, and the proportion of persons recognized as disabled due to tuberculosis still varies significantly.

The objective of the study: to evaluate the effectiveness of the introduction of screening for tuberculosis using the skin test with tuberculous recombinant allergen (TRA) in children and adolescents in Stavropol Region.
Subjects and methods. The method of continuous sampling was used for retrospective analysis of files of 1,112 patients with respiratory tuberculosis in Stavropol Region. There were two time periods distinguished: 2009-2011 and 2016-2018.
In 2009-2011, Mantoux test with 2 TU PPD-L was used for screening for tuberculosis in children and adolescents, and in those 15 years old and older, fluorography could be used. Among those of 18-24 years old, fluorography was the only method used.
In 2016-2018, a skin test with TRA was used for screening for tuberculosis in children of 8-17 years old.
Results. In the clinical structure of tuberculosis in children of 0-14 years old in both periods, the primary forms prevailed. During Period II, the primary tuberculosis complex was detected statistically significantly more often compared to Period I: 31/113 (27.4%) and 11/113 (9.7%) (p < 0.01; χ2), which was associated with the additional examination of individuals selected based on results of the test with TRA, using spiral computed tomography of the chest, which provided good visualization of this form of tuberculosis. When tuberculosis was detected in adolescents (15-17 years old), the test with TRA demonstrated statistically significant higher efficacy – 46.9% (15/32 of all detected) compared to Mantoux test with 2 TU – 1.5% (1 / 65 of all detected), p < 0.01; χ2. In Period II, the structure of clinical forms of tuberculosis among adolescents improved due to increased incidence of focal tuberculosis from 16.7% (Period I) to 32.5% (p < 0.05) and decrease in the frequency of lung destruction from 33/84 (39.2%) (Period I) to 3/40 (7.5%), p < 0.05; χ2. Bacillary excretion was registered in 21/84 (25.0%) of the adolescents (Period I) and in 3/40 (7.5%) of them (Period II), p < 0.05; χ2. Dispensary follow-up over preventive treatment in children with a positive and hyperergic reaction to the test with TRA provided a positive effect on the frequency of respiratory tuberculosis development in young people (18-24 years). In the period from 2009 to 2018, the incidence (per 100,000 population) decreased by 69.8%.

The objective of the study: to determine the efficacy and safety of chemotherapy regimens with bedaquiline in patients with respiratory tuberculosis in the context of everyday clinical practice with minimal non-inclusion criteria.
Subjects and methods. In a prospective, open-label, non-randomized, single-center trial which included 315 patients, the efficacy and safety of chemotherapy regimens were evaluated, when prescribing a regimen the priority was given to bedaquiline, linezolid, levofloxacin/moxifloxacin, and cycloserine/terizidone. Patients were followed up for at least 24 months, 52.4% suffered from extensive drug resistance of M. tuberculosis (MTB), the majority of patients (50.8%) had a failure of the previous course of treatment, and serious co-morbidities were found in 89.5% of patients.
Results. In 104 patients, the duration of treatment with bedaquiline was limited to standard 24 weeks, in 42 patients, it lasted for 36 weeks, in 56 patients – 48 weeks, and 94 patients received bedaquiline for more than 48 weeks. The increased duration of treatment with bedaquiline for more than 24 weeks provided a significant increase of treatment efficacy (regardless of drug resistance profile) from 66.2% (95% CI 54.4-77.9%) to 84.3% (95% CI 80.0-89.7%). The used regimens were well tolerated: serious adverse events (AE) were observed only in 27.6% of patients, and bedaquiline contribution to their development was not significant (bedaquiline had to be discontinued due to AE in 2.2% of cases). The range of AE practically did not differ from that when using only traditional anti-tuberculosis drugs.

The objective of the study: to establish criteria for the integration of epidemic processes of HIV infection and tuberculosis.
Subjects and methods. The article presents the retrospective analysis of the long-term changes in the main epidemiological rates of HIV-infection and tuberculosis in two regions within the Siberian Federal District, and these rates were compared with data for the whole of Russia.
Results. The following criteria for the integration of epidemic processes of HIV infection and tuberculosis were established: simultaneous development of epidemic processes; high activity of epidemic processes with involvement of the general population (HIV prevalence of more than 6500/0000, tuberculosis incidence of more than 1200/0000); positive statistically significant correlations at least in pairs of indicators, which were HIV prevalence – incidence of tuberculosis and HIV prevalence - incidence of tuberculosis in the HIV positive population. The conclusion about the integrative effect of HIV infection on the spread of tuberculosis should be made using all three criteria.

An HIV reservoir is a collection of HIV DNA in target cells in an HIV-infected person. HIV reservoir in patients with HIV infection prevents eradication of the pathogen and cure of the disease. The review presents published data on the structure of HIV reservoir, its formation and change of its size at different stages of the disease, depending on the time of treatment initiation. The article demonstrates the results of studies that investigated the effect of antiretroviral therapy on the size of the reservoir and the ability to use the size of HIV reservoir as a clinically significant indicator of the course of the disease. The current strategies for influencing on HIV reservoir are considered, the ultimate goal of which is recovery from HIV infection.

The introduction of a new generation of immunological tests based on in vitro or in vivo reactions using specific ЕSAT-6 and CFP-10 peptides allowed changing the understanding of the diagnosis of latent tuberculosis infection, as well as improving the diagnosis of tuberculosis in pediatric and adult practice. The article presents the analysis of the Russian studies conducted over the past ten years aimed to investigate the informativeness of a skin test with tuberculosis recombinant allergen. High diagnostic significance of the skin test, comparable to the internationally recognized IGRA-tests has been proved. Today, the test with TRA in the form of locally manufactured Diaskintest has been introduced inRussianot only to the practice of TB units, but also in the practice of pediatricians, pulmonologists and infectious disease specialists.