PIH's project in Russia, long recognized as a global leader in the fight against multiple drug-resistant tuberculosis (MDR-TB), has recently received a number of visits and expressions of renewed support and funding from major organizations, including the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the Eli Lilly and Company Foundation, and Bill Gates of the Bill & Melinda Gates Foundation.

 Global Fund doctor during visit to Tomsk
Dr. Dumitru Laticevschi of the Global Fund (right) during his visit to Tomsk

At the end of February, the Global Fund sent its new representative to Tomsk, Siberia, to get a firsthand look at implementation of the $10.8 million grant to fight drug-resistant TB in Russia. PIH serves as principal recipient of this grant, which expires in December of 2009. During phase one of the grant (2005-2006), GFATM consistently gave the Tomsk project an “A” rating, and has subsequently approved the administration of the grant for phase two (2007-2009).

As of March 2007, the GFATM project in Tomsk is beginning its third year of implementation. During the first two years, 559 MDR-TB patients were enrolled in DOTS Plus treatment in both the civilian and prison sectors. [DOTS Plus is an enhancement of the standard Directly Observed Therapy Short Course (DOTS) treatment that PIH helped develop and establish as the model of treatment for MDR-TB.] All DOTS Plus patients receive daily nutritional support as a supplement and incentive for treatment.

For the first two years, 1863 TB and MDR-TB patients received this form of support. As a result, treatment adherence has improved dramatically. During the last quarter of 2006, the default rate was only 2.2 percent, far below the baseline of 10 percent before the start of the project.

In 2005, PIH initiated activities to prevent and treat HIV-TB co-infection under the GFATM grant. To date, 658 HIV-positive patients have received testing and counseling for TB. Almost 100 who had been infected with TB have received prophylactic medication to protect against developing active TB.

Dr. Dumitru Laticevschi, Global Fund Portfolio Manager for Eastern Europe/Central Asia, visited the TB prison, hospital, TB drug dispensary, and Tomsk Red Cross. Dr. Laticevschi was impressed by the level of program performance and treatment results. He expressed interest in sharing the Tomsk experience with other TB grants administered through the Global Fund.

Soon after Dr Laticevschi's visit, PIH received concrete confirmation of the Global Fund's continued support -- a $1 million installment that covers continuation of treatment and program improvement going forward for program quarters 10 and 11.

At around the same time, PIH received another $1 million pledge of continued support from the Eli Lilly and Company Foundation. Lilly has provided substantial funding for PIH to train TB doctors from the entire Russian Federation. To date, 263 physicians, representing 66 of 88 territories of the Russian Federation, have participated in PIH training sessions. PIH is on course to train 325 physicians by 2008, representing all territories.

 PIH Country Director Oksana Ponomarenko during meeting with Bill Gates
PIH Country Director Oksana Ponomarenko (third from left) during meeting with Bill Gates (left)

A few months earlier, in November 2006, PIH's country director for Russia, Oksana Ponomarenko, participated in a roundtable discussion about TB and HIV/AIDS issues with Bill Gates, the co-founder of the Bill & Melinda Gates Foundation. Ponomarenko was invited to participate in the discussion by the local Gates Foundation office, along with representatives of UNAIDS, the Open Health Institute's GLOBUS project (a consortium of Russian NGOs), the Russian parliament and Transatlantic Partners Against AIDS.

During the roundtable, Ms. Ponomarenko presented information about PIH's work combatting MDR-TB in Tomsk, funded in part by the Gates foundation and the Open Society Institute. She also highlighted PIH's initiative to train TB doctors from both the civilian and prison health systems funded by the Lilly foundation. Following the visit, Ponomarenko received a letter from Bill Gates thanking her for her participation and expressing his support for all of PIH's work in Russia.

[published March 2007]