Russia
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Russia ranks 12th on the list of 22 high-burden tuberculosis (TB) countries in the world.
After years of gradual decline, TB incidence doubled during the 1990s but since 2000,
there has been much smaller annual growth in the number of new cases. According to
the World Health Organization’s (WHO’s) Global Tuberculosis Control Report 2008, the
TB incidence rate in 2006 was an estimated 107 new cases per 100,000 population, and
an estimated one in five people have latent TB in Russia. Around 288,250 people died
from TB in 1998�07.1 Russia initiated DOTS (directly observed treatment, short
course) in 1995, and population coverage has increased annually, reaching 45 percent
by 2004 and then almost doubling to 84 in 2006. Case detection remains low,
particularly for sputum smear-positive (SS+) cases, though it increased from 15 percent
in 2004 to 44 percent in 2006. Death, treatment failure, and default rates all continue
to be high and contribute to low treatment success rate. Globally, Russia has the third
largest number of multidrug-resistant (MDR) TB cases. Extensively drug-resistant
(XDR) TB is a serious problem, and may account for 6 percent of MDR-TB cases.1
The incidence of HIV, which complicates TB treatment, has also been growing again
in recent years. In 2007, HIV co-infection among new TB cases was 2.8 percent,
according to national data. ¹
Russia’s TB indicators reflect the slow progress following the collapse of the health
care system after the breakup of the Soviet Union in the early 1990s. Russia was
unable to sustain the previous TB infrastructure, which facilitated the spread of TB
and MDR-TB, and needed new approaches to TB control. Although TB specialists
and political officials (who favored the Soviet approach to TB control) initially resisted
the DOTS approach, their acceptance progressed and continues to grow as the
government looks for new solutions. However, problems still remain. The case
notification rate, which directly measures the capacity to detect cases of infectious TB,
has revealed a very high proportion of SS negative notifications among new cases.
Support for supervision at the regional level is needed in order to ensure accurate
implementation of the approved recommendations on TB control, particularly on
MDR-TB treatment.
The approach to TB in prisons is improving, but remains complicated. MDR-TB and
XDR-TB rates are high among prison inmates relative to other populations. The TB
notification rate in the penitentiary system is approximately 17 times higher than in the
civilian sector. DOTS is implemented in all prison health facilities, as most cases are
diagnosed when inmates arrive at pre-trial detention facilities, and TB incidence,
prevalence, and mortality in prisons are notably decreasing.
USAID Approach and Key Activities
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USAID assistance in Russia began in 1998 with the objective of helping the government
implement DOTS, reduce TB mortality, morbidity, and disease transmission. Through
its partners, USAID has expanded DOTS, helped the Ministry of Health and Social
Development (MOHSD) incorporate routine TB control into the health system, and
provided training on internationally recognized TB diagnostics. Between 2000 and
2007, USAID funding for TB programming in Russia averaged $3.5 million per year.
While this is a small percent of the total TB control program funding, it supports
important interventions in target areas. Technical assistance (TA) focuses on nine
target territories recommended by the MOHSD: Orel, Vladimir, Pskov, Belgorod, oblasts, Chuvashia Republic, Khakasia Republic, Republic of Adygeya (the North Caucasus region), Jewish Autonomous oblast and
Khabarovsk kray (the Russian Far East). Two other territories recently started to receive limited TA (Orenburg and Mariy El).
USAID activities have focused on the following:
- Developing regional models for DOTS activities for MDR-TB and TB-HIV/AIDS
- Increasing access to diagnosis and treatment for vulnerable populations
- Strengthening TB control and disease surveillance in the general population, with interventions extending into the prison
system; establishing links between the civilian and prison health systems
- Increasing civil society involvement in TB control efforts
- Developing national and province-level policies and training health care providers to understand DOTS
- Strengthening laboratories as well as capacity building for program monitoring and supervision
- Providing TA for improving infection control
- Developing social and psychological support schemes for patients to improve adherence to treatment
- Conducting operations research of TB control programs
USAID Program Achievements
USAID has played a major role in building political commitment in Russia for TB control and prevention based on the DOTS strategy. In partnership with WHO and others, USAID helped establish and support the High-Level Working Group on TB. At the program level, USAID support has expanded DOTS coverage to all of Russia’s territories. Achievements also include:
- Implemented modern TB control systems in nine provinces, resulting in improved treatment success rates of up to 75 to 80 percent
- Provided training in TB laboratory diagnostics, including smear microscopy, culture, and drug sensitivity testing (more
than 700 laboratory personnel, including prison staff)
- Supported the Khakasia Republic TB laboratory to become the highest ranked TB laboratory in proficiency testing
nationwide
- Improved infection control in six central province laboratories and provided equipment for 12 microbiological
laboratories
- Trained 2,297 health professionals in TB-related issues in fiscal year (FY) 2007
- Assisted the MOHSD in issuing new executive orders on TB diagnosis and treatment, recording and reporting systems,
and prevention and treatment of HIV/AIDS-associated TB
- Provided TA for the preparation of a proposal to the Global Fund to Fight AIDS, Tuberculosis and Malaria for TB
control that was approved for $88 million
- Provided treatment to 200 new MDR-TB patients in the Orel region in FY 2005�07
- Assisted five regions to obtain approval from the WHO Green Light Committee (GLC) for DOTS-Plus treatment for
MDR-TB for more than 5,400 patients in 2007
- Established a Center of Excellence for TB and MDR-TB in FY 2007
- Developed guidelines and training materials on the provision of TB care to people living with HIV/AIDS
- Supported HIV testing for more than 90 percent of TB patients in USAID-assisted regions in FY 2007
- Supported increased involvement of civil society in the fight against TB, including the more than 1,000 new Red Cross
volunteers involved in TB control efforts in FY 2007
Case Detection and Treatment Success Rates Under DOTS
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Note: DOTS treatment success rate for 2006 will be reported in the 2009 Global Report.
Source: Global Tuberculosis Control: Surveillance, planning, financing:WHO Report 2008. |
- Provided technical assistance to the Russian Health Care Foundation, enabling it to receive a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria to implement the first two years of a comprehensive five-year TB control program
- Collaborated on the design of the five-year TB control program, which is expected to reach $91 million of funding
- Provided more than $1 million in laboratory equipment for smear microscopy and bacteriology
- Strengthened practices of health care providers in DOTS strategy and other TB-related issues (more than 4,500 doctors, nurses, laboratory staff, prison health care staff, and general practitioners); MDR-TB diagnosis and treatment (more than 200 physicians); district-level TB management (more than 1,300 doctors and nurses); alcohol abuse management; and social support for TB patients (about 200 doctors, nurses, social workers, and Red Cross staff)
- Assisted in TB laboratory diagnostics, including smear microscopy, culture, and drug sensitivity testing (more than 700 laboratory personnel, including prison staff)
Partnerships
USAID’s partners include the MOHSD and the Ministry of Justice at the national and oblast levels, WHO, the International Federation of Red Cross and Red Crescent Societies, the Russian Red Cross, and the U.S. CDC. Russia received Round 3 funding from the Global Fund for $10.7 million and Round 4 funding for $88.2 million for TB activities. In 2007, the GLC approved purchase of second-line TB drugs for 5,478 patients.
1 Estimate from USAID
February 2009
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