Directly Observed Therapy in TomskDirectly observed therapy in Tomsk

Partners In Health Russia marked a major milestone in November with the launch of "Sputnik," a new health promotion program to improve care for patients living with multidrug-resistant tuberculosis (MDR-TB) in Tomsk, Siberia. For the first time in Russia, the program is recruiting, training and paying local people to work as community health workers, who will visit patients in their homes every day to make sure they are taking their medications. The primary beneficiaries of the program are the most downtrodden and marginalized members of the Tomsk community—the elderly, jobless, homeless, and those suffering from addiction to alcohol and other drugs. 

With the launch of the new program, health workers are now providing directly observed therapy twice a day, along with intensive nutritional and social support in order to address patients’ urgent needs. Working with Tomsk Oblast TB services, health workers are empowered to provide financial and logistical assistance, including helping to clean patients’ homes, obtaining food, or making recommendations to governmental social services for additional help.  

 Directly Observed Therapy in Tomsk
An MDR-TB patient's home in Tomsk. Despite oil-fueled economic growth, many rural areas in Russia remain extremely poor.


Paid community health workers have long been an essential component of PIH's model of community-based care in Haiti, Peru, Boston and Rwanda. CHWs have often proven to be the key to maintaining adherence to treatment among the most vulnerable and marginalized patients. The decision to incorporate them into our work in Tomsk was taken after research showed a significant number of patients were not completing the long and difficult course of treatment for MDR-TB. Specifically, default from treatment has increased by 12 percent compared to the previous year among the most recent group of civilian patients in Tomsk.

PIH is eager to demonstrate the effectiveness of comprehensive social support coupled with MDR-TB treatment in the Russian setting. Dr. Salmaan Keshavjee, a PIH TB specialist who visited Tomsk in November to help launch the program, is optimistic:
“This new program of accompaniment is a critical tool to reach the poorest and most vulnerable segments of the population.  Like accompagnateurs at other PIH sites, it will provide essential linkages with the health care system as well as a program of social and economic supports that will create an enabling environment for economically, socially and medically vulnerable patients to complete treatment”.