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In that normative act the established measures to prevent the development of an epidemic of the disease are considered. It is written how specialized, medical, social and other prevention of the disease should be carried out. Basic advice is given on how to disinfect rooms, how to isolate a patient, etc. Tuberculosis prevention plays one of the most important roles in preventing an epidemic, therefore the importance of this Federal Law is very high.

Another general plan law from the health sector, which spells out general rules healthcare organizations, the procedure for providing services and their other features. The rules for providing care for tuberculosis are prescribed in the document in chapter 7, paragraph 4 of article 59.

Decree No. 892

This document is used in conjunction with Federal Law No. 77-FZ, explains its main provisions and suggests real ways to implement it.

Decree No. 1006

It is one of the main documents for private medical institutions providing services on a fee basis. Explains what features and differences this particular format of providing services has.

Decree No. 60

The law prescribes the basic sanitary rules that organizations must comply with to prevent the development of an epidemic of this disease.

Order No. 951

This document covers the following range of issues:

1. Basic rules for the diagnosis and treatment of this condition;
2. Rules for differential diagnosis of the state;
3. Chemotherapy and chemoprophylaxis regimens;
4. Features and expediency of surgical treatment of the disease.

Order No. 124n

The recommendations in this document are binding. It stipulates the frequency and, in part, the nature of the implementation of preventive examinations and samples (including Mantoux) to determine the presence of the disease in the early stages. Individual recommendations are given for patients of different age groups, as well as recommendations for various institutions on the systematization of diagnostic activities (for example, the implementation of the Mantoux test in secondary schools).

Decree of December 28, 2016 No. 2885-p

Strictly speaking, this order is not related specifically to tuberculosis - it is a complete list of medicines prescribed for health reasons for 2017. However, section J04a deals specifically with anti-tuberculosis drugs in this category.

Such materials are constantly updated, so it is necessary to monitor changes in the rules. Sometimes even several editions may come out in 12 months, and in each new edition the list is changed.

Decree No. 1403

The document discusses the guarantees of providing patients with free access to qualified medical advice, which meets the requirements that WHO puts forward regarding this. It also describes in detail the format of this assistance, the nature of access to assistance and the progress of its implementation, and in addition, the groups that have access to it (including priority ones) are listed. The resolution is valid for 2017 and until the release of its new edition.

Order of the Ministry of Health of Russia dated June 29, 2016 No. 425n

This order is mandatory. It is not directly related to tuberculosis, but is aimed solely at regulating the procedure for familiarizing the patient himself or his representative with the diagnosis, prognosis, planned treatment, etc. Naturally, these rules apply to all diseases, including the one discussed in this material. .

Decree No. 952

It also has no immediate and direct relation to TB or even public health. It only regulates the procedure for repealing old regulations and starting to apply new ones in all areas of legislation, including those related to healthcare. Why is this document considered in the article? New regulations come out quite often and in order to figure out which ones to follow at the moment, you need to know the rules described in this document.

Order of the Ministry of Health of the Russian Federation dated March 21, 2003 N 109

He lists recommendations and measures for centralized control over therapy and management of patients, listing the features of the classification of the disease. It also touches on the topics of correct registration of patients, the basics of Mantoux tests, the course and features of vaccinations and drug stabilization, etc.

Order of the Ministry of Health No. 932n

This is perhaps the main document used in this field of medicine. It describes the immediate procedure for providing medical care and includes not only the treatment regimen that the doctor must be guided by, but also the features of access to care. And also, the specifics of the course of the recovery period after treatment, diagnosis and removal, etc. Similar orders are issued by the Ministry of Health of Russia for almost any registered diseases included in the International Classification of Diseases (ICD-10).

Department of Organization of Medical Care and Sanatorium and Resort Affairs of the Ministry of Health of the Russian Federation in pursuance of paragraph 2 of Section I of the instruction of the Deputy Prime Minister of the Russian Federation O.Yu. Golodets dated 04.12.2014 No. OG-P12-325pr directs Guidelines on improving the diagnosis and treatment of respiratory tuberculosis of the Ministry of Health of the Russian Federation of December 29, 2014 No. 951.

The most specific for respiratory tuberculosis are the detection of Mycobacterium tuberculosis (MBT), their genetic markers, as well as a combination of morphological signs of tuberculous granuloma: caseous necrosis, epithelioid cells, Pirogov-Langhans giant cells.

If the medical organization does not have the capacity to perform the necessary diagnostic tests for tuberculosis, tests should be carried out in other medical organizations which have the capacity for high-quality diagnosis of tuberculosis.

Since 2000, a steady decline in the incidence of tuberculosis has been observed in the Russian Federation. In spite of results achieved, the tuberculosis situation in the country is assessed as very tense. According to the World Health Organization the Russian Federation is one of the 22 countries with a high burden of tuberculosis. One of the reasons for this is multidrug-resistant tuberculosis, which requires a special approach to treatment.

According to 2013 data, every fifth newly diagnosed TB patient and every third patient with a relapse of the disease had MDR in sputum, that is, there was multidrug-resistant TB (MDR-TB).
The spread of HIV infection in the country is already having a significant impact on the epidemic situation of tuberculosis. In 2013, every eighth TB patient diagnosed and registered for the first time was HIV-infected. Tuberculosis is the leading cause of death for people living with HIV (PLHIV). Today, a doctor of almost any specialty may be faced with a case of diagnosing pulmonary and extrapulmonary tuberculosis in a patient with HIV infection.

Successful treatment requires rapid and high-quality etiological diagnosis of tuberculosis. Usage automated systems cultural studies reduces the time for determining the drug sensitivity of the pathogen to 3-4 weeks instead of 3 months with classical methods, and molecular genetic methods make it possible to determine the genetic markers of MBT and the presence of mutations associated with MDR in sputum in a matter of hours.

Accelerated methods of laboratory diagnostics significantly increase the likelihood of effective treatment of patients with MDR-TB and reduce the time of chemotherapy. It is especially important to use these methods in patients with HIV infection, given their high likelihood of rapid progression of tuberculosis without adequate therapy.
Diagnosis of tuberculosis in patients with HIV infection on the background of immunosuppression presents significant difficulties. This is due to the variety of clinical and radiological manifestations that are uncharacteristic of the classical course of tuberculosis, as well as the expansion of the differential diagnostic range due to other HIV-associated diseases.

Properly organized diagnostic process and use modern methods diagnostics allows you to verify the diagnosis in the shortest possible time and give the clinician all the information necessary to select the optimal treatment tactics.