Russia

Russia ranks 11th 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, the annual growth in the number of new cases has been smaller. According to the World Health Organization’s (WHO’s) Global Tuberculosis Control Report 2009, the TB incidence rate in 2007 was an estimated 110 new cases per 100,000 population, and an estimated one in five people have latent TB in Russia. Around 282,850 people died from TB between 1998 and 2007. Russia initiated DOTS (the internationally recommended strategy for TB control) in 1995, and population coverage has increased annually, reaching 45 percent by 2004 and 100 in 2007. Case detection remains low, particularly for sputum smear-positive (SS+) cases, though it increased from 15 percent in 2004 to 49 percent in 2007. Death, treatment failure, and default rates all continue to be high and contribute to low treatment success rate. Globally, Russia had the third largest number of multidrug-resistant (MDR) TB cases in 2007, with close to 43,000. 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 16.3 percent.

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 not able to sustain the previous TB infrastructure and this facilitated the spread of TB and MDR-TB. The country needed new approaches to TB control and 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. Yet 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 - 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

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. USAID funding for TB programming in Russia totaled $7.1 million in fiscal year (FY) 2008. 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; and establishing links between the civilian and prison health systems
• Increasing civil society involvement in TB control efforts
• Developing national- and provincial-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 on 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 and helped the Khakasia Republic TB laboratory 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 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 2005–2007
• Assisted five regions to obtain approval from WHO’s 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

Note: DOTS treatment success rate for 2007 will be reported in the WHO Report 2010. Source: Global Tuberculosis Control WHO Report 2009

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

May 2009

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Related Links

• USAID Overview of Russia