Russia site background

Russia’s epidemic of drug-resistant tuberculosis is one of the worst in the world. The country is considered one of the “hot spots” of drug-resistant 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 have combined to trigger dramatic increase in tuberculosis cases and the subsequent rise of drug-resistant 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 drug-sensitive TB 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 84 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 Partners In Health (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.

The epidemic of HIV in the Tomsk Oblast reflects the HIV epidemic in Russia itself. Isolated cases of HIV infection were first registered in Tomsk in 1993. By May 2003, there were already 660 registered cases in the Oblast. Although initially spread almost exclusively through intravenous drug use, by the beginning of 2002, sexual transmission accounted for 20 percent of newly detected HIV cases there. As in other countries with rapidly spreading epidemics, the greatest number of cases is found in cities and camps that have high numbers of temporary workers laboring in the gas and oil industry in the northern part of the oblast.

In order to combat the spread of HIV, MDR TB, and deadly HIV/TB co-infection, concerted effort and collaboration on the part of local Tomsk medical departments has been necessary. Since Tomsk was the first site in Russia to integrate TB services in the prison and civilian sectors in treating MDR-TB, a foundation for this work had already been built. The TB services work with the primary health care service to improve detection of TB in the general population. Adding HIV services to this successful collaboration is essential to curbing the rise of both infections. Local specialists have already initiated this crucial alliance, and Partners In Health has been working to encourage increased cooperation and communication.