PIH Russia

 

-
Laboratory in Tomsk

-
Doctor with TB patient

Partners In Health'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 drug-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.

Partners in Health began working with local clinicians to improve treatment of MDR-TB in Tomsk in 1998. Our joint 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. 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.

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 215 physicians, representing three quarters of the territory of the Russian Federation. By 2008, PIH and DSMHI are on course to train 325 physicians and program managers, covering the entire territory of Russia, from the Baltic to the Pacific.

PIH has also organized an exchange program at the Harvard School of Public Health’s Program in Clinical Effectiveness that enrolls several promising Russian medical professionals every year. The first two students earned their Masters degrees in Public Health in 2006, and are now spreading their knowledge as lecturers at Moscow Medical Academy, where they hope to establish a permanent faculty for epidemiology and biostatistics.

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. One study showed that very high rates of treatment success could be achieved in Russia using the WHO's pilot DOTS-Plus strategy that adds treatment for MDR-TB to the standard Directly Observed Therapy Short-course (DOTS) regiment for non-resistant TB. Another demonstrated that providing DOTS-Plus treatment for MDR-TB patients did not undermine treatment of drug-susceptible TB, as some experts had feared. In fact, the results suggested that integrating DOTS-Plus treatment for MDR-TB may strengthen the standard DOTS program. A third study showed that the greatest risk factor by far for development of MDR-TB was hospitalization, not failure to adhere to treatment. These findings are likely to lead to a reevaluation of the role of hospitalization versus community-based TB treatment in Russia.

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 WHO 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.