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12 Top Certifications for Professional Resume Writers

Looking to hire (or become) a certified professional resume writer? Learn the details of the top resume certifications here.

Are you looking for a professional resume writer to help you craft the perfect resume?

Or maybe you are a resume writer hoping to obtain a resume writing certificate.

Either way, this article will provide the necessary information.

Does resume writer certification really make a difference?

A certified resume writer undergoes a testing process to ensure they have the skills to craft successful resumes.

There are several associations where a professional resume writer can seek certification.

In this article, you’ll find 12 resume writer certifications available from 5 different associations.

If the professional resume service you choose is connected with one of these associations, that can make all the difference in getting a job!

Find out more about the requirements for each certificate below.

Professional Association of Resume Writers & Career Coaches (PARWCC)

1. certified professional resume writer (cprw).

The  Certified Professional Resume Writer (CPRW) credential is offered by the Professional Association of Resume Writers & Career Coaches (PARWCC). This is one of the most recognized and prestigious certifications in the resume writing industry. The association also offers certifications for career coaches and interview professionals.

Year Founded: 1990

Resume writers will need to be active members of PARWCC to take the exam and use the certification.

Upon registration for the exam, writers will receive a study guide to prepare for the test. The test must be scheduled within a year of application.

Prospective resume writers will receive the test document by email on a scheduled date and they’ll have three days to complete the test and mail the documents back.

Tests are evaluated anonymously by the members of the Certification Committee, and results are available within 6-8 weeks.

Benefits: 

As a resume writer with PARWCC, you will get a personalized CPRW certification to display in your office.

You will also be able to:

• Use the CPRW logo on your website and other marketing material
• Use the CPRW credential after your name
• $150 for membership
• $250 for certification enrollment

National Resume Writers’ Association (NRWA)

2. nationally certified resume writer (ncrw).

The  Nationally Certified Resume Writer (NCRW) certification is issued by The National Resume Writers’ Association (NRWA). They have one of the most challenging certification processes. Certificate holders also need to offer proof of their continuing education efforts to maintain certification. The NRWA also offers another certification for online profile writers.

Year Founded: 1997

Process: 

The candidate needs to become a member of the NRWA to apply for the resume writer certification.

They also have to earn 10 Continuing Education Units (CEU) from the association. CEUs can be earned by participating in conferences and workshops, and also by writing book reviews.

The certification process consists of three steps:

• Earning CEUs
• Passing a quiz and sample submission based on the NCRW Study Guide
• Passing the NCRW examination

People can search for NRWA certified professional resume writers from the NRWA website.

The certificate holder will be able to use the NCRW designation after their name. They will also be able to display NCRW logos on their website and other marketing materials.

• $175 for NRWA membership
• $75 for writing sample review
• $250 for exam registration

Resume Writing Academy (RWA)

The Resume Writing Academy (RWA) is one of the most resourceful professional development organizations for professional resume writers and other career professionals.

The RWA offers three certifications for resume writers:

• Academy Certified Resume Writer (ACRW)
• Academy Certified Federal Resume Writer (ACRW-Federal)
• Academy Certified Career Storyteller (ACCS)

Year Founded: 2009

Unlike the Professional Association of Resume Writers and National Resume Writers’ Association, RWA certifications are achieved after undergoing training programs associated with each certification from the academy.

You will find a detailed description for each of the certifications below.

The RWA certification programs offer a great opportunity to learn plenty about professional resume writing, including info on the latest industry trends and other vital insights, along with getting the certificate.

You will also get a digital badge to display across your online portfolio.

All the resume writing certificates come with lifetime validity. As an added bonus, the writer will also get to attend an RWA E-Summit for free after completion of ACRW and ACRW-federal programs.

3. Academy Certified Resume Writer (ACRW)

Academy Certified Resume Writer (ACRW) credential is achieved after undergoing a 3-month resume training program from the academy. There’s also a self-paced version of the program available.

The training program consists of: 

• 5 web classes on grammar, formatting, writing, and homework assignments
• 3 independent industry-specific resume and cover letter writing projects
• Hands-on feedback on all assignments

Cost: $1895 or 3 payments of $650

4. Academy Certified Federal Resume Writer (ACRW-Federal)

Academy Certified Federal Resume Writer (ACRW – Federal) program is specifically designed to train and certify resume writers on the intricacies of resume writing and the job application process for federal jobs.

• Eight hours of instructor-led training
• Writing sample resumes and example applications
• Analyzing federal job postings and gathering content
• Quizzes to confirm understanding
• Projects to refine writing
• Receiving personalized feedback on quizzes and writing assignments

Cost: $2195 or 3 payments of $735

5. Academy Certified Career Storyteller (ACCS)

The Academy Certified Career Storyteller (ACCS) training and certification program helps career professionals master the art of career storytelling through resumes, cover letters, bios, and online profiles. This is an advanced-level certification from RWA. It requires writers to already have an industry-recognized certificate or complete a separate grammar assignment and evaluation of a sample resume.

The program consists of 4 sessions and homework assignments and a final project:

• Write a bio
• Write LinkedIn “About” and employment sections
• Write a “tell me about yourself” script and a letter
• Write a resume
• Write a portfolio of documents

Cost: $669 for members and $869 for non-members

Career Directors International (CDI)

Career Directors International (CDI) provides numerous professional development opportunities for career professionals, including resume writer certifications and courses.

The six CDI certificates focus on specific resume writing niches, including:

• Certified Advanced Resume Writer (CARW)
• Certified Master Resume Writer (CMRW)
• Certified Executive Resume Master (CERM)
• Certified Resume Specialist (CRS+X)
• Certified Graphic Resume Architect
• Certified Career Storyteller (CCST)

Year Founded: 2000

CDI adopts a tiered approach to resume writing certifications, based on the experience level of the candidates.

As there are a variety of resume writing certifications offered by CDI, you will find a description of each of them below.

Along with getting the CDI seal, the resume writers will get all the free tools and resources as a CDI member.

CDI also organizes the yearly Toast of the Resume Industry Awards (TORI) competition.

So, getting aligned with their best practices can give writers a headstart in achieving the TORI award.

Below is a brief overview of all the resume writing certifications offered by CDI.

6. Certified Advanced Resume Writer (CARW)

The Certified Advanced Resume Writer (CARW) certification program is for entry-level resume writers looking to get their first industry certification. It is also the most affordable resume certification offered by CDI.

The CARW certification process consists of four parts: 

• Resume sample submission
• Resume and cover letter writing
• Short-essay questions on client information gathering
• Final exam on spelling, grammar, resume writing, design, and related skills

Cost: $200 plus the $97 membership fee

7. Certified Master Resume Writer (CMRW)

Certified Master Resume Writer (CMRW) is a higher-level certification program offered by CDI to experienced resume writers. The candidate must already possess the CARW certification or any other recognized industry certification (such as the CPRW or ACRW).

The certification process involves submitting the following materials: 

• A 1000-word essay or article to demonstrate philosophy, skills, and expertise
• A portfolio of seven professional resumes
• One ATS-friendly resume
• Two cover letter samples

Cost: $297 plus the $97 membership fee

8. Certified Executive Resume Master (CERM)

The Certified Executive Resume Writer (CERM) certification is exclusively designed for executive resume writers. Consider it a high-level certification program for experienced professional resume writers. As of the date of this article’s publication, there are fewer than 25 CERMs worldwide.

The writer will need to: 

• Have or obtain any other recognized resume writing certificate
• Submit four examples of real-life executive resumes
• Take part in a 10-question Competency Review test

Cost: $297 for members and $564 for non-members

9. Certified Resume Specialist (CRS+X)

The Certified Resume Specialist (CRS+X) allows resume writers to get certification in their specific field of specialization or niche. For example, if you are a resume writer specializing in IT professions, you can get certified as a Certified IT Resume Specialist (CRS+IT). CDI offers this certification in 20 areas of specialization. The candidate must hold any other recognized industry certification for which testing was required.

Candidates will need to submit: 

• A portfolio of four industry-specific resume samples
• A one-page essay about their specialization

Cost: $197 for each specialization plus the $97 membership fee

10. Certified Graphic Resume Architect

As the name suggests, the Certified Graphic Resume Architect credential is for professional resume writers who also want to get recognized as graphic resume designers. Graphic resumes predominantly use visual elements, which contrasts the style of traditional “plain” resumes. Just like other advanced level certifications from CDI, this one requires that the candidates already possess any of the recognized certifications.

The writer will have to submit: 

• Five resume samples with visual elements
• An explanation of the project details for a selected resume

11. Certified Career Storyteller (CCST)

The Certified Career Storyteller (CCST) is a certification that accompanies a training program…similar to the ACRW certification from the RWA above. This course from CDI aims to train resume writers in the practices of how storytelling elements can be infused into resume writing and personal brand development. The course consists of 17 modules within a 6-part program. It’s a self-paced learning model requiring from 18 to 40 hours of total work.

The process includes:

• Each of the 6 parts involves lesson completion and a review process
• After all lessons are approved, the candidate will submit their final story-based portfolio
• The final portfolio is reviewed within 3-4 weeks

Cost: $2997 plus the $97 membership fee

Career Thought Leaders Consortium (CTL)

12. master resume writer (mrw).

The Master Resume Writer (MRW) credential is offered by Career Thought Leaders Consortium (CTL). CTL is owned by Marie Zimenoff, also the CEO of the Resume Writers Association above. CTL also provides certifications to career coaches, job search specialists, and digital branding specialists. Career professionals get many other tools and resources, like free guides, training, and webinars from CTL.

The candidate must have at least five years of experience to apply for the MRW credential. They also have to pass an English Language & Grammar Examination administered by CTL.

After that, the professional resume writer will need to submit five resume samples if they already have an industry-recognized certificate or 10 resume samples if they are not certified.

The certification has to be renewed every two years.

MRW is an advanced level certification that will project you as an expert in your field. There are only 27 MRWs out there.

You don’t have to become a member of CTL to get this certification. However, becoming an associate will get you a discount.

Key Takeaways

As a job seeker, you have every right to seek as many assurances as you can about your resume writer.

Getting your resume written by a certified resume writer is one of those assurances that should translate into a high-performing resume.

If the writer that you choose happens to be certified, that’s a great bonus. But more important than a writer’s certifications are the writer’s skills.

If you are looking for certified professional resume writers with a proven track record, Find My Profession is an excellent option.

We have some of the best certified professional resume writers on our team and they cover 85+ industries.

Check out our top-rated  resume writing services . We are confident that you will be satisfied with our work, and if you have any inquiries, please do not hesitate to contact us.

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This free resume course quickly teaches you how to organize, format, and write a resume that actually stands out

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• " How to Write a Resume " helps you strategically update, reformat, and improve your resume.
• The online course is led by a SUNY career counselor, with advice based on current job trends.
• It even includes a segment with an employer discussing how they approach a stack of resumes.

If you're looking to optimize your next career move, it'd be wise to start with a strong resume. This seemingly simple document is what markets you to prospective employers, and as something you'll submit over and over again, it's important that it's polished to the best version it can be.

"How to Write a Resume" is a free online Coursera course taught by Holly Justice , a SUNY career counselor and recruiter that walks you through creating the cornerstone of your job search. In roughly five hours total, you'll either revise a current resume or create one from scratch with the help of an insider's strategy. 

Broken down into shorter classes (which you can view at your own pace), the course covers everything from the foundations of a strong resume to the best formatting and buzzwords to make yours reach the top of the stack.  

While "How to Write a Resume" is mostly designed for college students or young professionals writing a resume for the first time, it provides a useful peek behind the curtain for anyone hoping to gain meaningful career guidance. And while resumes vary depending on the industry, Justice helps you to build a universal framework that's applicable to most, if not all, fields. She provides a top-to-bottom look at its typical sections, tips on extracting transferable skills from past experiences, and advice on crafting action statements, maximizing data, and organizing your work experience into a strong thesis statement to recruiters.

Students also hear from an employer about how they approach a stack of resumes, so they can understand how the application process works from a different perspective. By showing students the purpose of a great resume and what a gamechanger it can be, Justice makes this class feel as genuinely engaging as it is useful.

Enroll in How to Write a Resume for free here.

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10 Best Resume Builders to Create A Great Resume – 2024 Guide

A re you exhausted from investing endless hours into creating an impeccable CV? This article introduces the top resume builders that will revolutionize your job application approach. Bid farewell to monotonous formatting and greet a remarkable resume that distinguishes itself from the rivalry. Prepare yourself to secure your dream job with self-assurance effortlessly!

>> Unlock Your Career Potential With Super Star Resume

10 Best Resume Writing Services

• Super Star Resume - Best overall
• ZipJob - Best for guarantees
• Resumeble - Best with custom bundles
• Let’s Eat, Grandma - Best for range of career service
• ResumeSpice - Best for job seekers of any level
• TopResume - Best customer service
• Resume Writing Services - Best for affordability
• Craft Resumes - Best for quick turnaround
• Resume Companion - Best value resume writing service
• Resume.com - Best free service

When creating this compilation, we considered different elements such as affordability, ease of use, accessibility, the privacy policies of the companies involved, and more. The highest-rated services offer advice, templates, and tools and allow you to consult with experts who can help you craft an impressive resume highlighting your strengths to potential employers.

Our collection comprises free services and those that make use of professional writers’ skills. Some options require a subscription or one-time payment.

>> Secure Your Dream Job With Super Star Resume

Super Star Resume - Best Resume Builder Overall

Star Rating: 4.9/5

Super Star Resume is an innovative resume builder that completely transforms creating professional resumes. By offering a user-friendly interface and a range of powerful features, Super Star Resume enables individuals to produce exceptional resumes that effectively showcase their abilities, accomplishments, and work history.

• Skilled and seasoned writers
• Customized strategy aligned with unique career objectives
• Timely delivery of resumes
• More significant expense compared to certain other resume writing services
• Restricted selection of additional services
• Availability may be restricted depending on demand and geographic location
• Intuitive resume builder: An intuitive interface that simplifies the resume creation process, offering modern templates for a professional look.
• Customization choices: Users can personalize their resumes by selecting from various font styles, colors, layouts, and sections to align with their unique style.
• Comprehensive content suggestions: Access to a collection of expertly curated bullet points, action verbs, and industry-specific phrases to craft impactful resume content.
• Real-time previews and editing: Real-time previewing and editing capabilities ensure a visually appealing and error-free final resume.
• Integration with professional networking platforms: Integration with LinkedIn allows users to maintain consistency between their online presence and resume.
• Tailored resumes for different job applications: The duplication feature facilitates the creation of multiple resume versions, each customized for specific job applications or industries.
• Resume analytics and tracking: Users can monitor the views and downloads of their resumes, gaining valuable insights to optimize their job search strategies.
• Professional Resume : $169
• Resume With Cover Letter : $199
• All-Included : $199

>> Use Super Star Resume to Secure Your Dream Job

ZipJob - Best Resume Builder for Guarantees

Star Rating: 4.7/5

ZipJob is widely regarded as an excellent option for resume creation, especially for those who value guarantees. Their impressive 60-day assurance ensures that individuals searching for employment will experience a surge in interview invitations within this period.

If this desired outcome cannot materialize, ZipJob proactively offers a complimentary review and revision of your resume. This guarantee highlights their commitment to client contentment and showcases their unwavering belief in the superior quality of their resume writing services.

• The starting package is cost-effective
• Complimentary ATS check included
• 60-day interview assurance with higher-tier packages
• The design and layout made it challenging to read the resume
• The summary section was overly lengthy and filled with clichés
• The formatting of the education and training sections was subpar
• Expert resume writers: ZipJob provides access to a team of expert resume writers with the skills and knowledge to review, evaluate, and optimize your resume for compatibility with Applicant Tracking Systems (ATS) and hiring managers.
• ATS optimization: Meaning they ensure your resume is structured and formatted to navigate and succeed in ATS filters effectively. Employers commonly use these filters to assess and rank resumes during the initial screening process.
• Keyword optimization: The resume builder online offered by ZipJob assists you in identifying and integrating pertinent keywords and industry-specific terminology. This practice heightens the visibility of your resume, making it more likely to capture the attention of hiring managers.
• Job-specific content suggestions: ZipJob provides valuable advice regarding the most relevant and influential content to include in your resume for different job titles and industries. This guidance is invaluable in customizing your resume for specific roles.
• Cover letter writing assistance: ZipJob supports the creation of impactful cover letters that complement your resume, strengthening your overall job application.
• Unlimited revisions: One noteworthy feature of ZipJob is the option for unlimited revisions and updates to your resume. This ensures that your resume not only meets but continues to meet your specific requirements and mirrors your professional growth.
• Collaboration with resume writers: the platform facilitates direct collaboration with the resume writers, enabling you to share additional information, discuss specific requirements, and seek clarifications at any stage of the resume creation process.
• Launch Package: $139 (or $48/mo)
• Fast Track Package: $189 (or $65/mo)
• Premium Package: $299 (or $27/mo)

>> Use ZipJob to Secure Your Dream Job

Resumeble - Best Resume Builder With Custom Bundles

Star Rating: 4.3/5

Resumeble is a highly efficient and user-friendly resume builder that empowers individuals to create professional and compelling resumes. With Resumeble, crafting a standout resume becomes a streamlined process thanks to its intuitive interface and extensive range of customizable templates.

Whether you’re a recent graduate, a seasoned professional, or someone looking to change careers, Resumeble caters to all needs and skill sets. It offers helpful suggestions and expert advice to ensure your resume showcases your unique qualifications and achievements in the best possible light.

• A 60-day interview guarantee is included
• Budget-friendly package deals are available
• It’s more established than some other websites
• Keyword optimization: This feature helps optimize your resume by suggesting relevant keywords aligned with your target industry or job, enhancing your visibility to Applicant Tracking Systems (ATS) and recruiters.
• Content import: Resumeble allows you to import your existing resume or LinkedIn profile, saving you the time and effort of manual data entry.
• Real-time editing: You have the convenience of editing and modifying your resume in real time, providing the flexibility to experiment with various formats, sections, and content.
• ATS compatibility: Resumeble ensures your resume is ATS-compatible, essential for better visibility and a higher chance of being shortlisted by employers using Applicant Tracking Systems.
• Download options: The platform offers various download formats, including PDF, Word, and plain text, ensuring compatibility with diverse application processes.
• Cover letter builder: Resumeble features an integrated cover letter builder, streamlining the creation of professional and personalized cover letters that complement your resume.
• Career Pro Package : $159.00
• Professional Package : $299.00
• Premium Package : $399.00

>> Use Resumeble to Secure Your Dream Job

Let’s Eat, Grandma - Best Resume Builder for Range of Career Service

Star Rating: 4/5

Let’s Eat, Grandma is an inventive and progressive tool for creating impressive resumes. The platform streamlines the resume-building process, making it easier for job seekers to craft exceptional resumes. With Let’s Eat, Grandma, individuals can create unique resumes that catch the eye of employers and set them apart from the competition.

This user-friendly platform offers a range of customizable templates that allow users to tailor their resumes to showcase their specific skills and experiences. Let’s Eat, Grandma also provides expert advice and recommendations to help ensure that your qualifications and achievements are effectively highlighted in your resume.

• Complimentary resume evaluation
• Choices available for individuals from entry-level to executive-level positions
• Extensive collaboration opportunities
• Not specialized in academic CVs or federal resumes
• Relatively higher pricing compared to some other services
• Potential for a longer turnaround time compared to competing services
• Expert choice: You can save your resume in multiple formats (PDF, Word, plain text) or easily share it with potential employers via email or a link, simplifying the distribution of your resume.
• Error highlighting: The builder can identify potential errors, inconsistencies, or missing information within your resume and provide suggestions or alerts for improvement.
• Section prompts: Pre-written prompts for various resume sections (e.g., work experience, education, skills) can help you structure your resume effectively and ensure you include essential details in each area.
• Customizable sections: You can add, remove, or rearrange sections to tailor your resume to emphasize your strengths and relevant experiences.
• Keyword optimization: The resume builder can recommend industry-specific keywords based on the job description, enhancing your resume’s chances of passing through Applicant Tracking Systems (ATS) and grabbing the attention of hiring managers.
• Starter Package : Priced at $439, but there is an anti-inflation sale price of $389.
• Accelerated Package : $549.
• The premium Package : $689, but the anti-inflation sale price is $614.
• Executive Concierge Service : $1,899 or as low as $119/month.

>> Use Let’s Eat, Grandma to Secure Your Dream Job

ResumeSpice - Best Resume Builder for Job Seekers of Any Level

Star Rating: 3.8/5

ResumeSpice , a renowned online resume builder, streamlines crafting professional resumes. This platform provides job seekers with a user-friendly interface and a wide selection of templates, enabling them to create impressive resumes that align with their career objectives.

With ResumeSpice’s seamless experience, users are guided through each resume section effortlessly while receiving valuable tips throughout the process. From personal details and work history to skills and accomplishments, this platform ensures that all crucial aspects of a resume are comprehensively addressed.

• Additional assistance
• Timely service
• ATS optimization
• Guaranteed interviews
• Restricted revisions
• Insufficient customization options
• Restricted refund policy
• User-friendly interface: ResumeSpice boasts an intuitive and user-friendly platform, simplifying the resume creation process and offering a seamless experience to users.
• Extensive template library: The platform offers a vast selection of professionally designed templates tailored to various industries and job positions. Users can explore different styles and layouts to find the perfect match for their needs.
• Import and export options: ResumeSpice enables users to import their existing resumes in formats like PDF or Word for easy editing and updates. Users can conveniently export their finalized resumes in multiple formats, facilitating sharing with employers or uploading to job portals.
• Mobile-friendly design: ResumeSpice is optimized for mobile devices, allowing users to create and modify their resumes using smartphones or tablets.
• Cloud storage: The platform provides secure cloud storage for users’ resumes, ensuring accessibility and updates from any device with an internet connection.
• Resume tracking: ResumeSpice includes tools for tracking the performance of submitted resumes, such as monitoring views, downloads, and application outcomes. These features empower users to evaluate their progress and make data-driven enhancements to their job search strategies.
• Entry Level Resume : $479
• Professional Resume : $589
• Executive Resume : $699

>> Use ResumeSpice to Secure Your Dream Job

TopResume - Best Resume Builder for Customer Service

Star Rating: 3.6/5

TopResume is an outstanding resume builder explicitly tailored for customer service professionals. It offers a seamless and user-friendly experience, enabling users to create exceptional resumes effortlessly. The platform goes beyond just providing a basic resume template, offering valuable suggestions and tips to optimize the content.

This ensures that each resume created on TopResume is unique and attention-grabbing in the highly competitive job market.

Besides its user-friendly interface, TopResume provides expert review services. These services allow skilled professionals to provide personalized feedback on resumes, helping enhance their overall quality further. By leveraging this feedback and incorporating attention to detail, customer service professionals can create compelling resumes that effectively capture the attention of potential employers.

• Streamlined registration process
• Well-designed and formatted one-page resume
• The summary and Job Scope sections were overly extended
• The training section needed to have prominence
• Skill-based sections: The resume builder features dedicated sections highlighting essential customer service skills, including communication, problem-solving, conflict resolution, and relationship building.
• Expert review services: TopResume provides expert review services where experienced professionals offer personalized feedback and recommendations to enhance the overall quality of your resume.
• ATS compatibility: The platform ensures that the resumes created are compatible with Applicant Tracking Systems (ATS), which employers commonly use for scanning and filtering resumes.
• Download and sharing options: Users can download their resumes in various formats, such as PDF or Word, and easily share them with potential employers or upload them to job portals.
• Industry-Specific Tips: TopResume offers industry-specific tips and guidance to assist users in tailoring their resumes to the customer service field, helping them stand out among competitors.
• Cover letter builder: Besides resume building, TopResume provides a builder that empowers users to craft professional and compelling cover letters customized for customer service roles.
• Mobile accessibility: The platform is mobile-friendly, allowing users to create, edit, and update their resumes while on the go, using their smartphones or tablets.
• Entry level : Up to 200$.
• Professional level : Up to 200$-400$.
• Executive level : Up to $350-$700.

>> Use TopResume to Secure Your Dream Job

Resume Writing Services - Best Resume Builder for Affordability

Star Rating: 3.3/5

While Resumewritingservices.org may be a different size than its competitors, it stands out due to its team of talented and experienced resume writers. The website is user-friendly and provides exceptional service. However, this service’s true strength lies in its writers’ expertise.

Resumewritingservices.org sets itself apart by offering a comprehensive consultation process and goes beyond expectations by providing unlimited calls with its resume writers. This personalized approach distinguishes them from other companies and guarantees each client receives individual attention and support.

• Experienced resume writers of the highest caliber
• Unlimited phone consultations and revisions
• More expensive than rival services
• A limited range of products
• Skilled and experienced resume writers: Resumewritingservices.org takes pride in its team of highly trained and professional resume writers who possess a deep understanding of crafting effective resumes.
• Personalized service: Resumewritingservices.org offers a personal touch by providing unlimited calls with their resume writers. This unique feature allows clients to engage in direct communication and close collaboration with the writers throughout the resume creation process.
• Competitive job market expertise: The writers at Resumewritingservices.org have knowledge of current job market trends. This ensures that the resumes they create are optimized to excel in today’s fiercely competitive job market.
• Quality Assurance: The service maintains a rigorous quality assurance process to guarantee that the resumes delivered to clients meet the highest standards and align with their expectations.
• Timely delivery: Resumewritingservices.org is committed to delivering resumes within the agreed-upon timeframe, ensuring clients receive their documents promptly.
• Client satisfaction guarantee: Resumewritingservices.org offers a client satisfaction guarantee, assuring clients are fully content with the final resume. The service is ready to provide revisions if necessary.
• Affordable pricing: Resumewritingservices.org provides pricing options that are competitive and transparent, making professional resume writing accessible to a wide range of job seekers.

Resumewritingservices.org employs a pricing system that is clear and easy to understand for their resume-building services. The initial package begins at $270 , including a comprehensive consultation with a skilled resume writer and developing an individualized resume.

They offer extra options that enable customers to personalize their packages based on their unique preferences. This adaptable pricing strategy guarantees that clients can choose the services that align with their requirements and financial constraints.

>> Use Resume Writing Services to Secure Your Dream Job

Craft Resumes - Best Resume Builder for Quick-Turnaround

Star Rating: 3/5

Craft Resumes stand out as a well-established writing and editing service known for its ability to deliver effective outcomes. Our dedication to providing a 24-hour turnaround guarantees you’ll receive the initial version of your resume promptly.

Navigating our user-friendly website is effortless, making it easy to use our services. At Craft Resumes, we specialize in crafting customized resumes to match your skills, qualifications, and aspirations for your career.

• Speedy completion
• Customized CVs
• Intuitive site
• Insufficient details
• Absence of assurances
• Quick turnaround: Craft Resumes commits to delivering the initial draft of your resume within 24 hours, ensuring a speedy and efficient service.
• Expert Writers: Craft Resumes prides itself on its team of experienced writers who possess expertise across various industries and stay up-to-date with current hiring trends. They’re dedicated to making your resume stand out and catch the attention of potential employers.
• Unlimited revisions: We provide unlimited revisions to guarantee your complete satisfaction. If you have specific changes or additions in mind, our team will collaborate with you closely to implement the modifications.
• Confidentiality and Privacy: At Craft Resumes, we prioritize the confidentiality and privacy of your personal information. You can trust that your data will be handled securely and with the utmost discretion.
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Star Rating: 2.8/5

Resume Companion is a virtual platform and service that specializes in aiding individuals in creating resumes that are professional and impactful. It offers an array of resources and tools to assist job seekers in crafting interesting resumes that effectively showcase their skills, experiences, and qualifications.

A prominent feature of Resume Companion is its user-friendly resume builder. This tool allows users to select from various professionally designed templates and personalize them based on their specific requirements.

Users can effortlessly incorporate their personal information, employment history, educational background, skill set, and other pertinent details to produce a customized resume tailored to their needs.

• Intuitive user interface
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• Cost-effective choice
• Restricted editing features without subscription
• Absence of extensive customization options
• Limited availability of extra services
• Cover letter builder: Resume Companion goes beyond resumes and provides users with a tool for crafting customized cover letters tailored to specific job applications. This feature guides users through the process, helping them effectively present their qualifications and make a compelling case to prospective employers.
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Resume Companion provides a cost-effective solution for individuals seeking an all-inclusive service. It’s vital to remember subscription renewal is required to access future editing services. In summary, Resume Companion offers a wallet-friendly option for those who desire a user-friendly resume-building experience without needing advanced writing abilities.

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Our Ranking Methodology for Best Resume Writing Services

To comprehensively and objectively rank the top resume writing services, it is essential to have a thorough methodology. The first step in this process was conducting extensive research and analysis. This involved gathering a comprehensive list of reputable resume-writing services from multiple sources such as online searches, customer reviews, industry directories, and personal recommendations.

• Feature analysis: Evaluate the functionalities provided by each resume builder, considering elements like template variety and quality, customization flexibility, user-friendly editing and formatting options, import/export capabilities, spell check and grammar tools, and integration with job search platforms and professional networks.
• Template collection: Examine the assortment and quality of templates. Look for a wide range that suits various industries, job levels, and design preferences, considering these templates’ aesthetics, readability, and contemporary design.
• Editing and customization: Scrutinize the adaptability and user-friendliness of the editing and customization tools each resume builder provides. Assess the capacity to add or modify sections, reorganize content, and tailor resumes to specific job requirements.
• User interface and experience: Analyze the user interface and the overall user experience each resume builder offers. Evaluate the ease of navigation, instruction clarity, guidance or prompts, and the platform’s responsiveness.
• Integration with job search platforms: Determine whether resume builders offer seamless integration with popular job search platforms and professional networks like LinkedIn or ATS systems. Consider how well the resumes can be transferred and their compatibility with these platforms.
• Additional resources: Evaluate if the resume builders provide extra resources such as sample resumes, tools for creating cover letters, interview tips, or career advice. Consider the breadth and practicality of these supplementary resources.
• Mobile-friendliness: Gauge the mobile-friendliness and responsiveness of the resume builders, recognizing the growing trend of mobile job searching and application processes.
• Customer support: Reflect on the accessibility and quality of customer support services, encompassing options like live chat, email support, or knowledge bases. Assess the responsiveness and helpfulness of the support team.
• Pricing and value for money: Appraise the pricing plans presented by the resume builders in terms of the value they offer based on features, usability, and overall service quality.
• Industry reputation: Consider the standing and trustworthiness of the resume builders, considering factors such as awards, recognition, partnerships, and user feedback from reputable sources.

Buyer’s Guide: Why Use a Resume Builder?

Crafting a well-crafted CV comes naturally to particular job seekers. However, even the most seasoned experts may need help in resume writing. If you find yourself in need of help with creating a compelling resume, here are several ways in which the best online resume builder can be beneficial:

Resume builders provide users with pre-designed templates and helpful tips, streamlining the process of writing a resume and alleviating stress.

Offers Writing Tips

Promoting oneself requires considerable effort. Only some people possess writing skills, even if they enjoy self-promotion. To showcase one’s experience and knowledge effectively, a resume builder can help select the most appropriate words and phrases.

Improves Design

In every field, there are unique standards for an impressive resume. If you need to gain knowledge in design or the tools, resume builders can provide free templates to enhance your resume’s visual appeal and quality.

Applicant Tracking Systems (ATS)

Recruiters often use ATS systems to scan resumes. A good resume builder will help with formatting to ensure that your resume is easy for these systems to read.

What’s the Best Resume Builder?

The ideal resume builder for each individual may differ according to their specific requirements. If you prefer a tool that offers step-by-step guidance in creating your resume, we suggest using a builder that provides helpful tips and recommendations. If you prefer a resume builder that auto-generates a summary, we recommend using a tool that extracts information from your LinkedIn profile.

For those who enjoy having creative control over their resumes, we suggest using a platform with features. By selecting the resume builder that aligns with your needs and suits your industry and personal style, you’ll significantly increase your chances of capturing the attention of hiring managers.

Resume Builder vs. Resume Writing Service: What Matters for You

When it comes to crafting a resume, there are three options available. You can opt to create it independently, use a resume builder tool, or enlist the services of a professional resume writer. Your best choice will depend on your writing abilities, available time, and financial resources.

Do-It-Yourself

You have the choice to construct a resume entirely by yourself. The benefit of this option is that it costs nothing but requires a significant amount of effort. Along with composing all the information, you must possess graphic design skills.

This approach works well if you have these abilities, but with them, your options for creating a resume are unlimited. To overcome this limitation, you can use a resume builder or enlist the help of a resume writing service.

Resume Builder

A tool for creating resumes allows you to input your details into a template, resulting in an original appearance and layout with no design work. The top resume building tools also offer suggestions on enhancing your resume and tailoring it to match the specific job you are applying for.

While you are still responsible for writing the content, once it is written, you can quickly transfer that information into any other template with just a few simple clicks. Some of these services are free and many like to promote themselves as such, but most require a small payment to download your finished resume.

Professional Resume Writing Service

Professional resume writing services are expensive, but they offer the convenience of handling all the work for you. An experienced writer will gather relevant information about your background and transform it into a unique and engaging resume.

The process typically takes a few days, and the level of originality in the outcome largely relies on your choice of company and writer. However, we will not delve into these services further in this guide.

Are Resume Builders Worth It?

Definitely, without a doubt. An effective resume creator will guarantee that your CV is formatted correctly to navigate Applicant Tracking Systems and ultimately reach the hands of recruiters.

Is It Unprofessional to Use a Microsoft Word Resume Template?

Relying on a template will not set you apart, and there is a high likelihood that your application will be dismissed because your resume is identical to those of other job seekers.

Final Thoughts

Choosing the right resume builder is crucial in today’s competitive job market. Creating a professional and impactful resume that stands out from the crowd can significantly impact your job search. With the right tool, you can save time, improve your chances of landing an interview, and ultimately secure your dream job.

When selecting a resume builder, consider your specific needs and priorities. Look for features like customizable templates, industry-specific examples, and the ability to export your resume in different formats. Consider user reviews and ratings to ensure you choose a reputable and reliable platform.

Remember, an exceptional tool for crafting resumes should give you the power to present your skills, experience, and accomplishments effectively. It should simplify and expedite creating a resume without hassle. Investing in a reliable resume builder is investing in your professional future.

Therefore, explore the different options available for resume builders. Test out their free trials or demos and choose the best fit for your objectives. Our top recommendation is Super Star Resume . This meticulously designed resume can open doors to exciting career prospects and be a dependable companion on your journey toward success.

Ahad Waseem is a business, blockchain, and cybersecurity writer who often takes on art, politics, and economics too. As a linguistic engineer who writes to solve problems, he’s written for various tech and business publications. When he’s not writing, he’s probably on horseback, caring for his houseplants, or training Bonsai trees. He can be reached at [email protected] . McClatchy’s newsrooms were not involved in the creation of this content. We may earn a commission if you make a purchase through one of our links.

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The Directly Observed Therapy Short-Course (DOTS) strategy in Samara Oblast, Russian Federation

Y balabanova.

1 HPA Mycobacterium Reference Unit, Clinical TB and HIV Group, St Bartholomew and Queen Mary School of Medicine, 2 Newark street, London E1 2AT, UK

3 Samara City Tuberculosis Dispensary N1, Pionerskaya street, Samara, 443001, Russia

F Drobniewski

2 Samara Oblast Tuberculosis Dispensary, Samara, 154 Novo-Sadovaya Street, 443068, Russia

S Zakharova

V nikolayevskyy.

4 Center for Health Management, Tanaka Business School, Imperial College London, South Kensington campus, London SW7 2AZ, UK

5 Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The World Health Organisation (WHO) defines Russia as one of the 22 highest-burden countries for tuberculosis (TB). The WHO Directly Observed Treatment Short Course (DOTS) strategy employing a standardised treatment for 6 months produces the highest cure rates for drug sensitive TB. The Russian TB service traditionally employed individualised treatment.

The purpose of this study was to implement a DOTS programme in the civilian and prison sectors of Samara Region of Russia, describe the clinical features and outcomes of recruited patients, determine the proportion of individuals in the cohorts who were infected with drug resistant TB, the degree to which resistance was attributed to the Beijing TB strain family and establish risk factors for drug resistance.

prospective study

2,099 patients were recruited overall. Treatment outcomes were analysed for patients recruited up to the third quarter of 2003 (n = 920). 75.3% of patients were successfully treated. Unsuccessful outcomes occurred in 7.3% of cases; 3.6% of patients died during treatment, with a significantly higher proportion of smear-positive cases dying compared to smear-negative cases. 14.0% were lost and transferred out. A high proportion of new cases (948 sequential culture-proven TB cases) had tuberculosis that was resistant to first-line drugs; (24.9% isoniazid resistant; 20.3% rifampicin resistant; 17.3% multidrug resistant tuberculosis). Molecular epidemiological analysis demonstrated that half of all isolated strains (50.7%; 375/740) belonged to the Beijing family. Drug resistance including MDR TB was strongly associated with infection with the Beijing strain (for MDR TB, 35.2% in Beijing strains versus 9.5% in non-Beijing strains, OR-5.2. Risk factors for multidrug resistant tuberculosis were: being a prisoner (OR 4.4), having a relapse of tuberculosis (OR 3.5), being infected with a Beijing family TB strain (OR 6.5) and having an unsuccessful outcome from treatment (OR 5.0).

The implementation of DOTS in Samara, Russia, was feasible and successful. Drug resistant tuberculosis rates in new cases were high and challenge successful outcomes from a conventional DOTS programme alone.

Since the 1990s the World Health Organization Directly Observed Therapy Short Course (DOTS) management strategy has become the internationally recommended approach for tuberculosis (TB) control programmes [ 1 - 3 ]. By the beginning of the new Millennium, 149 countries in the world had adopted the DOTS strategy to varying degrees and important measures of DOTS success (case detection and treatment success) were included in the Millennium Development Goals framework [ 4 ]. In the former Soviet Union (FSU) only a limited number of WHO DOTS implementation programmes exist and currently countries of the FSU report the lowest case detection rates (22%) with 9% of cases failing treatment and a death rate of 7% during treatment [ 4 ]. WHO has acknowledged that until TB is controlled in Africa and Eastern Europe, this disease will remain of major world-wide concern; current analysis indicates that it is unlikely that the Millennium Development Targets for TB will be met in these regions [ 4 ].

Russia is one of 22 TB high-burden countries as defined by the WHO [ 5 , 6 ]. Russia has a highly-specialised tuberculosis health care system with a large organisationally-vertical network of specialized institutes, dispensaries, hospitals, outpatient clinics, sanatoria and rural feldsher points. Case detection is based largely on the presence of radiological abnormalities on chest X-rays with or without bacteriological confirmation detected through a national policy of compulsory annual fluorographic population screening [ 7 - 9 ]. In contrast to the WHO recommended tuberculosis control DOTS strategy, which favour minimising hospital stays, clinical guidelines and health system financing incentives, TB patients in Russia experience frequent and lengthy hospitalisations, and historically have received individualised treatment regimens with doses of the main first line drugs and duration of chemotherapy varying from internationally accepted standard treatment regimens. The system also included prolonged periods of follow-up and repetitive courses of anti-relapse therapy [ 10 , 11 ].

The rationale for implementing the DOTS strategy in Russia is to establish cost-effective tuberculosis control by reducing unnecessary care costs due to lengthy hospitalisations, while improving cure rates and reducing the development of drug resistant TB [ 3 , 7 , 12 - 14 ].

In 2002, with assistance from the UK Department for International Development, a TB control programme that adhered to internationally accepted norms and standards was launched by the regional Ministry of Health. We have reported elsewhere on the considerable body of research undertaken in Samara that explores the epidemiological profile, the health care system structures and processes, and public health challenges being faced by the oblast [ 7 , 9 - 12 ], [ 15 - 23 ]

This paper describes the clinical features and outcomes of patients recruited to a DOTS programme which was implemented in civilian and prison sectors in Samara Oblast.

At the initial stage of implementation of DOTS a standard protocol was agreed with the Regional Ministry of Health. This was followed by extensive training of medical doctors and TB nurses with the involvement of WHO and experts from Russian Federal TB Institutes. Two project medical co-ordinators based in Samara were appointed to oversee implementation which was rolled out in three phases.

Under phase one, initiated in April 2002, patient recruitment commenced at two pilot TB dispensaries in Samara City and at two TB prison colonies (one, an inpatient prison facility used for initial therapy, the second an outpatient facility where continuation of therapy occurred) that looked after all prisoners with TB in the oblast. Recruitment was expanded in January 2003, under phase two, to all TB facilities in Samara city (five dispensaries and three TB hospitals) and to the neighbouring city Togliatti. Under phase three, a further rollout occurred in January 2004 to the rural district of Krasny Yar. We report results through all three phases and include patients recruited up to the third quarter of 2004.

Patients were recruited into standard WHO categories (Table ​ (Table1). 1 ). In 2002, initially only new cases were recruited (category I and III). From April 2003, recruitment was extended to include relapse cases (category II). Because of the prevalence of drug resistance and concerns that resistance profiles would be further amplified [ 23 - 25 ] chronic cases were ineligible for recruitment.

WHO treatment categories and outcome definitions [28]

* Treatment success is defined as the sum of patients cured and those who have completed treatment.

Given implementation of the internationally supported programme ceased in third quarter 2004, clinical outcomes presented are until the third quarter of 2003. Outcomes for patients recruited subsequently were registered within the newly adopted Russian national system which continued following this programme [ 26 , 27 ].

Standard TB control treatment outcomes were recorded (Table ​ (Table1). 1 ). Treatment success under the DOTS strategy was determined by cures and treatment completions and unsuccessful treatment included patients who failed and defaulted [ 28 ].

A modified feature of the programme was introduced where patients registered initially under the DOTS cohort could be transferred to an "individual treatment regimen", an approach that reflected the Russian legacy of individualised approaches to treatment. According to the prevailing views of Samara phthisiatrists not only patients who were diagnosed with MDRTB but also some severely ill patients or those with severe co-morbidities or perceived adverse reactions would be removed from the DOTS programme and managed within the regional TB programme using an individualised approach in line withy earlier Russian traditions. Cases, following recruitment, which were subsequently determined to have MDR TB, were transferred out to an individually-tailored MDRTB drug regimen. A further feature of the modification of the DOTS programme was the continuation of the intensive phase of treatment beyond two months (for one more month) despite patients becoming smear-negative in the end of the second month of therapy intensive phase. This was done, in accordance with Russian traditions, where extensive radiological changes were present.

Standard technical approaches to documentation and diagnostic/treatment protocols were employed[ 28 ]. Sputum collection was performed at recommended intervals. During the intensive phase of therapy ethambutol was administered instead of streptomycin because a previous drug resistance survey had documented very high rates of primary resistance to streptomycin [ 9 , 23 ].

For all patients smear microscopy and culture was performed at recommended intervals. Smear microscopy and culture were performed using standard Ziehl-Neilsen microscopy and culture on Lowenstein-Jensen media. All positive isolates were tested for drug susceptibility to isoniazid, rifampicin, ethambutol and streptomycin. Quality-assured drug susceptibility testing (DST) was performed at three civil and one prison site using an absolute concentration method on Lowenstein-Jensen media. DST was assured by a period of training by staff from the WHO Supranational Reference Laboratory (SRL) in London (Health Protection Agency MRU) and in Samara. A blinded analysis of a test panel of TB cultures was performed. A proportion (10%) were retested by the SRL in London.

DNA was extracted and Beijing family strains were analysed in London and Samara by detection of the IS6110 insertions in the dnaA-dnaN intergenic region on a proportion of sequential isolates (n = 740).

Direct supervision of treatment adherence was completed by TB nurses at TB hospitals and dispensaries with out-patients receiving treatment daily or three times weekly. Upon release, ex-prisoners completed their treatment upon transfer of their care to the civilian service.

Medical co-ordinators performed regular visits to all participating DOTS sites to support implementation, ensure recruitment was maintained, and review documentation and adherence to the protocol. Over-arching project management group meetings which included all clinical stakeholders and the project directors from each DOTS site occurred on a monthly basis.

Socially disadvantaged patients were identified by a responsible physician at each dispensary and offered additional support to encourage treatment adherence with weekly food packages at a cost of 100 Russian Roubles (3 Euros) per person per week.

Data were entered and stored into a password protected database. The statistical analysis was performed using Excel and SPSS 12. Proportions with 95% confidence intervals (CI), relative risks (RR), odds ratios (OR), and χ 2 test are used for comparison of categorical variables.

The study was approved by the Samara Regional Ethics Committee.

2,099 patients were recruited from 1 st April 2002 to 30 th September 2004, including 1,971 individuals with pulmonary tuberculosis (93.9%) and 128 patients with extrapulmonary disease (6.1%); 1,684 of recruits were men (80.2%) and 415 (19.8%) women. 640 patients were recruited in the prison sector and 1459 were civilian TB patients.

One third (33.1%; 694/2,099) of recruited patients were WHO category I and 24.3% (162/694) of these were smear-negative cases with extensive parenchymal involvement; 58.8% (1,234/2,099) of cases were WHO category III patients. Recruitment into WHO category II was limited to relapse cases only and 171 patients (8.1%) were recruited.

The mean age of patients was 38.5 years (95%CI 37.9–39.1 years; range: 16–90 years) with prisoners being significantly younger than civilians (mean age 30.9 years; 95%CI 30.2–31.6 years versus mean age 41.9 years; 95%CI 41.1–42.7 years). Female patients were older than male patients (mean age of men was 38.0 (95%CI 37.4–38.6) years and mean age of women with TB was 40.4 (95%CI 38.8–42.0) years).

Details of bacteriologically (smear and/or culture) confirmed cases are shown in Table ​ Table2. 2 . Table ​ Table3 3 shows differences between the infectious status of civilian and prison populations with TB where civilians were more likely to have infectious disease whether determined by smear status or culture status. Overall the rate of laboratory diagnosed TB cases was slightly higher in civilian patients than prisoners.

Proportion of bacteriologically confirmed new and relapse pulmonary cases (II quarter 2002 – III quarter 2004)

*a proportion of patients could not expectorate a sputum sample of a quality that would be suitable for culturing

Difference in infectious status between civilians and prisoners

* statistically significant at p < 0.05

Cultures from 948 sequentially new and 94 relapse cases were isolated and tested for susceptibility to first-line drugs. Of the new cases, 24.9% (236/948) new cases had isolates resistant to isoniazid, 20.3% (192/948) new cases had isolates resistance to rifampicin, and 17.3% (164/948) had MDRTB (vs 34.0% (32/94) of relapse cases being MDR (OR-2.5; 95%CI 1.6–3.9). Table ​ Table3 3 and Figure ​ Figure1 1 show the differences between civilian and prison patients.

Rates of first-line drug resistance among civil and prison patients.

Molecular epidemiological analysis demonstrated that a half of all isolated strains (50.7%; 375/740) belonged to the Beijing family. Of note, seven isolates (0.9%) were mixed strains. The prevalence of the Beijing strain (60.9%; 117/192) among prisoners was significantly higher (OR-1.7; 95% CI 1.2–2.4) than in civilians (47.1%; 258/548) confirming earlier research findings in a drug resistance survey in the same region in the preceding year [ 19 ].

For 709 isolates data on both drug resistance and strain type were available (31 isolates were non-viable or were contaminated and DST could not be performed). Drug resistance including MDR TB was strongly associated with being infected with the Beijing strain (for MDR TB 35.2% in Beijing strains versus 9.5% in non-Beijing strains, OR-5.2 (3.4–7.9) (Table ​ (Table5) 5 ) confirming earlier research in a different population of patients treated under the Russian system in the same region[ 19 ].

Comparison of first-line resistance levels in Beijing compared to non-Beijing strains (n = 709^)

* statistically significant difference at p < 0.001

^ both epidemiological and drug resistance results were available for 709/1042 (68.0%) cultures; 31 cultures were non viable or contaminated; cultures were drawn from all dispensaries and prison facilities in Samara City.

Difference in resistance rates between civil and prison patients

*statistically significant at p < 0.05

Multivariate analysis suggests that being a prisoner (OR – 4.4; 95%CI 2.7–7.1), having a relapse of TB (OR-3.5; 95%CI 1.7–7.1), being infected with the Beijing family strains (OR-6.5; 95%CI 4.0–10.5) and having unsuccessful outcome of treatment (OR-5.0; 95%CI 1.1–22.7) were risk factors for MDR TB.

During the course of treatment the majority (97.7%; 284/290) of smear-positive new cases converted by the end of the intensive phase of treatment.

Treatment outcomes among new cases confirmed by culture are shown in Table ​ Table6. 6 . Because recruitment of relapses was initiated at a later stage, the number of these is small. Overall 85.4% (786/920) of newly diagnosed and recruited patients were treated according to the WHO protocol. Nearly fifteen percent (134/920) of patients were transferred out of the DOTS clinical protocol and this included patients transferred to individual regimens because MDRTB (17.3% of all new cases were MDR and 34.0% of all relapse cases) or extensive radiological abnormalities, adverse drug reactions, or co-morbidities). MDR TB patients were removed from the programme according to DOTS project criteria and further treated with tailored schemes using second-line drugs. More smear positive patients were transferred out than smear-negative cases (22.4% versus 11.6%; OR-2.2; 95%CI 1.5–3.2). In total 75.3% (592/786) of patients were successfully treated and in 7.3% (57/786) treatment failed or patients defaulted. The odds of failing treatment or defaulting were higher in smear positive patients (OR – 10.6; 95% CI 3.4–32.8).

Cohort outcomes for new cases confirmed by culture

*a proportion of patients were excluded from cohort (transferred to a different regimen due to MDR TB, extensive radiological abnormalities, drug adverse reactions, severe accompanying pathology)

** N of patients remained in the cohort (column "total") is taken as a denominator

There was no statistically significant difference in treatment outcomes between male and female patients.

The rates of unsuccessful treatment was higher among civilians compared to prisoners (OR-4.5; 95%CI 2.1–10.0)

Twenty-eight patients (3.6 %; 28/786) died during the course of treatment with a significantly higher proportion (11.3%) of smear-positive cases dying versus smear-negative (OR -12.5; 95%CI 5.0–31.3).

Discussion and conclusion

The WHO have argued that the introduction of DOTS cohort treatment strategies improves case detection and treatment and leads to a reduction in TB prevalence and death rates by cutting the duration of illness and case fatality.

Two examples from middle and high incidence countries (Peru and China) support this view. In Peru, the incidence rate of pulmonary TB has decreased annually by 6% after the nationwide implementation of DOTS[ 29 ]. In 13 provinces of China that implemented DOTS, the prevalence rate of culture-positive TB was cut by 30% between 1990 and 2000 [ 30 ]

The introduction of DOTS resulted in profound changes to the delivery of clinical care within the Samara TB Service. Although a direct observation component had, broadly. been present within the old system through lengthy hospitalisation periods, the strict adherence of physicians to standard regimens, the emphasis on laboratory diagnosis, and a robust system of recording and reporting of cohorts were new [ 7 ].

Similarly fewer than 70% of patients with TB were cured or completed treatment in Samara compared to 75.3% in the cohort groups. This is in keeping with the cure rates reported for DOTS programmes internationally (Table ​ (Table7) 7 ) and the global treatment success rate under DOTS has been high since the first observed cohort in 1994 (77%)[ 4 ].

Comparison of Samara DOTS cohort with overall treatment success and outcome for global DOTS cohorts in 2002

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The relatively high failure rates noted elsewhere in Eastern Europe, (9% of cases failed treatment and 7% died during treatment) are believed to be associated with high rates of multidrug resistance (which in itself is an indicator of a programme with low cure rates previously). In Samara, prior to the introduction of the DOTS cohort strategy we established that drug resistance was high in both new (approx 20%) and chronic cases in Samara [ 9 , 17 , 23 ].

Dye et al [ 4 ] further established that the prevalence will decrease sooner if case detection by DOTS programs (and hence the quality of treatment) can be improved more quickly, thus reducing the burden of illness during this period in future years. The DOTS programmes emphasise the importance of bacteriological confirmation. [ 7 ]Prior to the establishment of the cohort, there were more than 1.5 million flurographic examinations of the general population for early diagnosis of TB reflecting the national policy of fluorography screening of the population for TB for early diagnosis. We have reported on the subjective nature of radiological examination elsewhere [ 31 ] and emphasised the need for bacteriological confirmation of the diagnosis in line with international standards.

Previously, less than one-third (30.1%) of cases were bacteriologically confirmed (Coker et al, 2003 IUATLD) compared to the DOTS cohort where 49.6% of all cases (and 57.6% in civilian cases) were bacteriologically confirmed. [ 10 , 11 ]Overall the proportion of cases which had a bacteriological confirmation of the diagnosis was similar to rates reported from other regions of Russia [ 4 ];.

[ 31 ]Although the laboratory component of the TB service in Samara Oblast has been extensively upgraded and improved with prison and civil laboratory services working to these improved standards, maintenance and further quality improvement remains a priority. Without appropriate laboratory support, over-diagnosis of tuberculosis remains a possibility, resulting in unnecessary treatment and side-effects without benefit, and compounding service inefficiencies [ 13 ].

Relatively low default rates occurred with implementation of DOTS in Samara. This may be, in part, attributable to a programme of externally financed social support. This component was discontinued after external funding ceased, and it remains to be seen whether adherence rates will suffer. Of note, substance abuse, alcoholism, poverty and unemployment are common amongst patients with TB in Samara Oblast, co-factors likely to influence treatment adherence [ 22 ]. The sustainable success of DOTS in Russia is likely to be dependent on how care and support for these social and behavioural factors are integrated into TB care systems.

Effective responses in support of TB control demand political commitment and investment from local and federal budgets into non-medical support to patients and their families. However, few integrated social support systems for tuberculosis patients currently exist, and current laws and regulations have the potential to ensure that health and social care budgets remain disconnected from each other and from need [ 32 , 33 ]. Consequently, to compensate for inadequate social support systems for tuberculosis patients, providers use sophisticated practices to ensure lengthy admissions in the winter months – a response to social rather than medical need [ 32 , 33 ]. Whilst the two recent decrees on TB control issued in 2003 (#109 and #50) [ 26 , 27 ] support convergence of Russian TB control practices with WHO's DOTS strategy (with some specific differences reflecting Russia's clinical legacy), the sustainability of reforms needed to ensure cost-effective implementation such that DOTS implementation is allied to structural reform remains uncertain.

The rate of successful treatment (75.3% overall and 79.0% in civil sector) though below the 85% WHO target, was higher than reported from other several DOTS pilot regions in the former Soviet Union (68.1% according to the meta-analysis performed by Faustini et al, 2005 [ 25 ]). The zero mortality among prisoners may be misleading: several patients died after data censoring. Furthermore, policy that very severely ill patients are released from prison for treatment in the civilian sector means that deaths of these ex-prisoners are recorded as civilian deaths.

The high prevalence of drug resistance and the frequency of the Beijing strain family (previously shown to be associated with drug resistance) [ 19 ] remains a major clinical and public health challenge. Extremely high rates of drug resistance among prisoners despite significantly lower default rates in prison likely reflects on-going transmission of resistant strains. Rapid isolation of MDR TB cases, good co-ordination between the prison and civilian TB services and enhancement of infection control and treatment are needed to prevent further nosocomial and institutional spread of MDR TB and would increase the success of the current TB programme. This issue is likely to become considerably more of a problem as the emergent epidemic of HIV in Samara matures

Although the DOTS strategy does not include specific therapy for multi-drug resistant cases its effective implementation reduces the occurrence and further transmission of resistant strains [34]. However, in regions such as Samara with very high rates of MDR TB it is essential to ensure the availability of appropriate and timely diagnosis and treatment of existing cases as well as preventing the development of new ones. Rapid drug susceptibility techniques, with appropriate treatment to be tailored to circumstance may be necessary. Cost-effectiveness analysis of rapid methods in the post-Soviet context is required to inform investment and policy changes.

Abbreviations

CI – Confidence Interval

DOTS – Directly Observed Therapy Short-Course

MDR TB – multi-drug resistant tuberculosis

OR – Odds ratio

RR – Risk ratio

SRL – Supranational Reference Laboratory

TB – tuberculosis

WHO – World Health Organization

Competing interests

The author(s) declare that they have no competing interests

Authors' contributions

YB participated in the design of the study, its coordination, acquisition of data, statistical analysis and drafted the manuscript; RC participated in acquisition of funding, design of the study, its supervision and drafted the manuscript; IF participated in administration of the study, its design and revision of the manuscript; SZ participated in design and coordination of the study, data acquisition and manuscript revision; VN carried out laboratory work and revised the manuscript, RA participated in acquisition of funding, design of the study, its supervision and revision of the manuscript, FD participated in acquisition of funding, design of the study, its supervision and gave final approval of the version to be published. All authors read and approved the final manuscript.

Acknowledgements

The UK Department for International Development (DFID) funded this study, but the views and opinions expressed are those of the authors alone.

We would like to thank all doctors and nurses who took part in this study.

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Trains Disrupted in Russia's Samara Region After Blast Rocks Rail Bridge

Trains Disrupted in Russia's Samara Region After Blast Rocks Rail Bridge

MOSCOW (Reuters) -Russia's state railway company said on Monday it had been forced to cancel and re-route some trains in the Samara region after an explosion at a rail bridge, which Ukrainian military intelligence claimed was used by trains carrying ammunition.

An explosion rocked the bridge, which spans the River Chapayevka near the Russian city of Samara, around 530 miles (850 km) southeast of Moscow, early on Monday morning, Russian news agencies reported, citing emergency services.

Located on the Volga river, the Samara region is one of Russia's heavy industry hubs.

Ukrainian military intelligence issued a statement in which it "confirmed" but did not take responsibility for the blast. It said the rail line was used by Russia to transport military cargo, including ammunition made at a factory nearby.

It forecast the bridge would be out of use for some time.

Reuters could not confirm the Ukrainian assertion. Russia regards the location of its military factories as a state secret. Russia and Ukraine have targeted each other's infrastructure in the course of the two-year war that Moscow calls a "special military operation".

Traffic over the bridge was suspended due to what local rail authorities called "illegal interference." One image posted on social media and verified by Reuters showed some damage to the metal structure of the bridge on one side but the concrete support appeared intact.

Local media in Samara said sappers and Russia's National Guard were on the scene. Unverified images posted on social media showed what looked like at least one homemade bomb on the scene which had not gone off.

Nobody was reported to have been hurt in the incident.

(Reporting by Reuters Moscow buroAdditional reporting by Dan Peleschuk in Kyiv, Writing by Andrew Osborn; Editing by Sharon Singleton)

Copyright 2024 Thomson Reuters .

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