Partners in Health Treats TB in Russia

What strategies have helped you reach this high-risk population?

One of the key challenges in treating MDR-TB in this population is finding and treating them every day, because they don’t always know where they are going to be from one day to the next. Some patients don’t have identification cards, and they may come from socially marginalized groups, so they are afraid of government institutions and are trying to hide.

One of the ways we’ve dealt with that is through a program called Sputnik that provides free home-based care for TB and MDR-TB patients. PIH hires and trains local nurses to follow up and locate patients and deliver medications as well as meals, psychological, emotional, and social support. The team works 12 hours every day. Each nurse works on a 6-hour rotation, and they aim to educate the patients and build trust, in order to bring them back into the medical system. Each day, they ask patients where they will be the next day, so they can contact them to maintain treatment. Patients in the program are thoroughly checked by the doctor for drug-related side effects, and they receive lab tests results once a month.

We are trying to promote treatment outside of the hospital to reduce the risk of hospital associated infections, so it is safer and much easier in many cases for patients to stay at home. Also, the weather is quite severe in Siberia, especially in the winter, when it is minus 22?Fahrenheit, and it is hard for patients to get out and get medications at a TB facility. In Tomsk, we provide daily food packages to about 80% of our TB patients, and to all our MDR-TB patients, to provide additional nutrition for them and their families. The Red Cross helps us provide food packages, and they support the medical staff, which provides home visits.

What are the outcomes of your program so far?

We have enrolled more than 1,700 MDR-TB patients from 2000 to 2010, and the cure rate on average is 75%, based on 2-year treatment results. For the prison sector, it is 85%-88%, mainly because it is much easier to manage patients in the prison environment. Unfortunately, some patients are very sick at the start of treatment and they die, especially if they have advanced disease or a high level of drug resistance known as XDR-TB, that is resistant to 5-9 different TB medications. The problem in treating TB is that no new medications have been available in 40 years, so we have to treat our patients with medications that were not created to combat MDR-TB. These medications cause a lot of side effects, and the treatment takes two years. We hope that with new medications, now in clinical trials, we can look forward to treatment regimens that are much stronger and take less time.

But our results have been good. We track the status of all major TB indicators, including TB mortality, and we are proud that Tomsk has the lowest TB mortality rate of all regions in Russia, and the lowest incidence rate among Siberian regions. Tomsk TB Services, in collaboration with PIH treats about 1,000 TB and 3,000 MDR-TB patients annually, and the results have led to the overall decrease of TB in the region.

When we started our Sputnik project, the adherence rate among high-risk patients was 40%, and now it is about 80%-85%.

What are the next steps for PIH in Russia?

Similar programs are under development in five additional regions. We will need to train the medical personnel there, because setting up the treatment plans and managing high-risk TB and MDR-TB patients is new to them. In addition, we would like to start screening people who are at high risk for TB, including the relatives and friends of our patients, in order to initiate an appropriate treatment for them as soon as possible.

For more information: Partners in Health MDR-TB program in Russia

Heidi Splete of Internal Medicine News Digital Network conducted this interview.

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