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Enhanced tuberculosis case detection among substitution treatment patients: a randomized controlled trial

Kristi Rüütel1*, Helle-Mai Loit2, Tiiu Sepp3, Kai Kliiman4, Louise-Anne McNutt5 and Anneli Uusküla6

Author Affiliations

1 Department of Infectious Diseases and Drug Abuse Prevention, National Institute for Health Development, Tallinn 11619, Estonia

2 Department of Chronic Diseases, National Institute for Health Development, Tallinn 11619, Estonia

3 LLC Corrigo, Jõhvi 41532, Estonia

4 Lung Clinic, Tartu University Hospital, Tartu 51014, Estonia

5 School of Public Health, University at Albany, State University of New York, Rensselaer, NY 12144, USA

6 Department of Public Health, University of Tartu, Tartu 50411, Estonia

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BMC Research Notes 2011, 4:192  doi:10.1186/1756-0500-4-192

Published: 15 June 2011



Historically, HIV, TB (tuberculosis) and illegal drug treatment services in Estonia have been developed as vertical structures. Related health care services are often provided by different health care institutions and in different locations. This may present obstacles for vulnerable groups, such as injecting drug users (IDU), to access the needed services. We conducted a small scale randomized controlled trial to evaluate a case management intervention aimed at increasing TB screening and treatment entry among IDUs referred from a methadone drug treatment program in Jõhvi, North-Eastern Estonia.


Of the 189 potential subjects, 112 (59%) participated. HIV prevalence was 86% (n = 96) and 7.4% (n = 8) of participants were interferon gamma release assay (IGRA) positive (6.5% were both HIV and IGRA-positive, n = 7). Overall, 44% of participants (n = 49) attended TB clinic, 17 (30%) from control group and 32 (57%) from case management group (p = 0.004). None of the participants were diagnosed with TB. In a multivariate model, those randomized to case management group were more likely to access TB screening services.


These findings demonstrate the urgent need for scaling up TB screening among IDUs and the value of more active approach in referring substitution treatment patients to TB services.

Trial registration NCT01290081