PIH Russia

PIH’s Work in Russia

PIH’s work in Russia has a narrower medical focus over a vastly wider geographical area than any of our other projects. From a base in the region of Tomsk Oblast, Siberia, PIH has been working since 1998, in collaboration 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 Social Medicine and Health Inequalities (DSMHI) at the Brigham and Women’s Hospital, PIH has focused on improving clinical services for MDR-TB patients in Tomsk while undertaking training and research to catalyze change in treatment of MDR-TB across the entire Russian Federation.

Key components of our clinical effort include improving diagnostics in order to detect cases earlier, developing a comprehensive strategy to promote adherence among patients, improving infection control in hospitals and clinics and decreasing transmission of TB to HIV-positive patients. Our work in Tomsk also encompasses health education for the public and clinical and program management training for medical personnel in Tomsk. This effort got a major boost in 2004, when we assisted our partners in Tomsk in securing a five-year $10.8 million grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria for efforts to improve prevention, diagnosis and treatment of TB and MDR-TB.

Even before receiving the Global Fund grant, PIH had expanded its responsibilities to provide training for healthcare professionals and to advocate for institutional change at the federal level. Drawing on financial support from the Eli Lilly and Co. Foundation, PIH’s training program for MDR-TB program managers and physicians has played an integral role in catalyzing change within the Russian TB services. To date, PIH has led training sessions for hundreds of clinicians, nurses and research staff. In this way we’ve spread our lesson to every corner of Russia, from the Baltic to the Pacific.

Research carried out with data collected from the first two cohorts of MDR-TB patients treated in Tomsk has had a significant impact on discussions and decisions about MDR-TB treatment throughout Russia, other parts of the former Soviet Union and beyond.

The Tomsk research and the Russian-language edition of PIH's guide to treatment of MDR-TB treatment guide have had a significant influence on a High Level Working Group convened by World Health Organization and the Russian Ministry of Health that has helped shape the MDR-TB portion of Russia's national TB treatment guidelines.

And research findings from Tomsk also helped inform new global guidelines for treatment of MDR-TB that were released in May 2006, backed by the WHO, the US Centers for Disease Control and Prevention, PIH and other leading agencies in efforts to stop TB. The new guidelines were accompanied by a call to scale up treatment rapidly worldwide, from 16,000 patients in 2006 to more than 800,000 a decade later.

In 2010, PIH-Russia expanded services to five new regions in Russia. The expansion was funded by a USAID grant and allows the organization to deliver care to a greater number of people living with TB, MDR-TB and HIV.

The Situation in Russia

Russia’s is considered one of the “hot spots” of MDR-TB, rivaling Kazakhstan, several Chinese provinces and some countries in southern Africa. Economic decline, the breakdown of social safety nets, a growing AIDS epidemic, alcoholism, and a high incarceration rate has combined to trigger dramatic increase in tuberculosis cases and the subsequent rise of MDR-TB strains, especially in the prison sector.

Due to national shortages of medicine, doctors were forced until the end of the 1990s to treat patients with inadequate medication regimens, aware – but helpless to avert – the risk of increasing resistance among the population. By 1997 the MDR-TB problem in Russia had grown so daunting that public health experts realized the urgency of developing a plan of containment and treatment.

Nationwide, Russia reports 106 cases of TB for every 100,000 people, compared to only five per 100,000 in the United States. And ten percent of new cases of TB are drug-resistant. In Tomsk Oblast, Siberia—where PIH has been working since 1998 to expand our MDR-TB treatment model—15 percent of new TB infections are multidrug-resistant. The TB epidemic is especially complex in the prison system, where drug resistance is even more prevalent, with 18.6 percent of cases qualifying as primary MDR-TB.

Another growing threat to public health in Russia is HIV, spread predominantly through injection-drug use. One million Russians are estimated to be HIV positive and the country has one of the world’s fastest rising infection rates.