From a base in the region of Tomsk Oblast, Siberia, Partners In Health has collaborated since 1998 with the Russian Ministry of Health to combat one of the world’s worst epidemics of multidrug-resistant tuberculosis (MDR-TB). In partnership with the Division of Global Health Equity at Brigham and Women’s Hospital, PIH/Russia (PIH/R) focuses on improving clinical services for MDR-TB patients in Tomsk Oblast—a state slightly larger than the country of Poland—while undertaking training and research to catalyze change in treatment of MDR-TB across the entire Russian Federation.

Key components of our clinical efforts include improving diagnostics in order to detect cases earlier, increasing adherence rates, improving infection control in hospitals and clinics, and decreasing transmission of TB to HIV-positive patients.

In addition to its clinical work in Tomsk, PIH/R operates in seven regions, where it provides medical care to high-risk TB and MDR-TB patients and tests a novel approach to prevent the transmission of TB strains to new patients in TB hospitals through the introduction of GeneXpert machines. PIH/R also leads training sessions for hundreds of clinicians, nurses, and research staff every year—in this way spreading the lessons it has learned to every corner of Russia, from the Baltic to the Pacific.

Expanding lifesaving care

In the mid-1990s, only 40 percent of high-risk MDR-TB patients in Siberia completed treatment. In response, PIH/R introduced the Sputnik Program, which targets tuberculosis patients at risk for dropping out of care. To address factors such as poverty, homelessness, HIV, and substance abuse, the Sputnik Program hires and trains nurses to deliver treatment, food, and social support in patients’ homes throughout the two-year treatment. Unique to Russia, the program has improved patients’ adherence to treatment from 60 percent to more than 80 percent in five years.

PIH/R also recently launched the first MDR-TB Fellowship Training Program in Tomsk, Russia, which trains clinicians to effectively manage MDR-TB patient care.