Earlier this summer Partners In Health released a comprehensive report on The Sputnik Initiative, a program that provides daily social and clinical support to poor and marginalized multidrug-resistant tuberculosis patients in Tomsk, Russia.
Russia has the third-highest burden of MDR-TB in the world, trailing only China and India, and the Sputnik Initiative is designed for patients at the greatest risk of defaulting from treatment, including those who struggle with alcohol and drug addiction. Since it launched in 2006, Sputnik has made significant progress in expanding access to care for vulnerable patients facing social and behavioral challenges.
The following four charts demonstrate how a spectrum of patient-centered interventions, including Sputnik, have driven down the TB incidence and mortality rates in Tomsk. To learn more, download the entire report.
We start with a simple look at the referral process for Sputnik. Through December 2012, the most recent date for which data are available, Sputnik enrolled 129 patients, most of who struggled with previous TB treatment efforts. In fact, more than 10 percent of the original Sputnik cohort had stopped their tuberculosis treatment and the rest were on the verge of stopping. While 129 may not seem like an extraordinary number of patients, keep in mind that Sputnik enrolls only patients at the greatest risk of defaulting from treatment, including those who had been discharged from hospitals for alleged behavioral issues.
Each Sputnik patient is visited daily by a specially trained nurse and driver, and the program provides various forms of social assistance—from delivering food packages to helping patients obtain state-issued IDs so they can access other services. Ensuring that these at-risk patients have access to treatment and social support is critical to stemming the transmission of TB in Tomsk.
Here we have the outcomes of the 129 patients who passed through Sputnik. Globally, the cure rate for MDR-TB is 48 percent. That 70 percent of Sputnik patients have been successfully treated is testament to the team’s dedication and their ability to forge meaningful relationships with patients. It also suggests that daily social and psychological support is a critical component to improving outcomes among vulnerable patients. And though there’s room to improve the default rate—10.8 percent of patients defaulted—it should be noted that globally between 10 and 48 percent of MDR-TB patients do not complete their treatment.
In this chart, the incidence rate is a measure of all new diagnosed TB cases each year per 100,000 people. As you can see, Tomsk experienced a significant drop in the incidence rate of TB when compared with the wider Siberian region and the entire Russian Federation. It’s important to note that this chart isn’t specific to Sputnik; rather it reflects how a spectrum of patient-centered interventions delivered by PIH and the Tomsk Oblast Tuberculosis Services—with the support of numerous partners, including the Eli Lilly Foundation and the Global Fund to Fight AIDS, Tuberculosis and Malaria—resulted in a sustained reduction of TB incidence in Tomsk.
Lastly we look at the mortality rate, or the number of deaths caused by TB per 100,000 people in Tomsk, Siberia, and Russia. Again, we see a steep decline—far steeper than at the national and regional levels. As with the previous chart, these data aren’t Sputnik-specific, but represent numerous patient-centered interventions—at inpatient facilities, including prisons, and in the community—that have been carried out in partnership with many stakeholders. Results from Tomsk have helped change the national approach to combating drug-resistant TB in Russia and neighboring countries.