With COVID-19 emerging as a global pandemic, attention has centered on alleviating its effects. However, this has posed challenges to combating other respiratory illnesses, like tuberculosis, due to the lack of control efforts. Russia has been particularly hit by this, where it has a higher sensitivity to respiratory issues. To better understand this and the solutions that might be used to fight both COVID-19 and tuberculosis, here are eight facts about tuberculosis in Russia.
8 Facts About Tuberculosis in Russia
- Tuberculosis (TB) is endemic, or regularly found, in Russia. In fact, Russia has the world’s 11th highest burden of TB. Compounding its status as a major public health problem is a rising incidence of multidrug-resistant TB (MDR-TB). This means that TB does not respond to many of the antibiotics that are most commonly used to treat the disease. Russia has the third highest number of MDR-TB in the world.
- The severity of Russia’s TB epidemic stems from historical, social and economic factors. When the Soviet Union collapsed, health infrastructure and the economy declined dramatically. Poverty and crime rates increased, leading to higher incarceration rates. As TB is airborne, it spreads best in cramped and crowded conditions, just like those in prisons. These factors contributed to the rapid spread of both TB and MDR-TB. The Fall of the Iron Curtain also led to unstable living conditions, increased mass migration and exacerbated the TB epidemic with a 7.5 percent annual increase in new cases from 1991 to 1999.
- There is a close synergy between the TB and HIV/AIDS epidemics in Russia. The TB notification rate of individuals living with HIV infection is approximately 1,700 per 100,000 HIV-infected. Because HIV attacks the immune system, HIV infection leaves patients more vulnerable to infection with all sorts of pathogens, including TB.
- In the early to mid-2000s, the Russian government increased its budget allocation for tuberculosis control. Russia also received a $150 million World Bank loan, two thirds of which was designated for tuberculosis. Additionally, it received a $91 million grant from the Global Fund To Fight AIDS, Tuberculosis and Malaria.
- In recent years, there have been some improvements in TB infection rates in Russia. Cases of TB in Russia decreased by 9.4 percent to a rate of 48.3 per 100,000 people in 2017. In the same vein, Russia has recently experienced a steady decline in TB morbidity and mortality. Since 2012, morbidity or disability due to TB has decreased by more than 30 percent, and mortality has decreased by more than 48 percent.
- The COVID-19 pandemic is interfering with TB diagnosis, prevention, treatment and control efforts worldwide. It is grimly clear that Russia will not be exempt. A recent report based on analyses of several countries, including neighboring Ukraine, predicts an additional 6.3 million cases of tuberculosis by 2025 as a result of COVID-19’s disruption of TB control efforts. Progress in the fight against TB could be set back by five to eight years. Russia is facing its TB epidemic in a world where TB kills 1.5 million people a year, more than any other infectious disease. Five years ago, world leaders pledged to end the TB epidemic by 2030. In addition, in 2018, they pledged to double TB funding by 2022. However, the COVID-19 pandemic’s diversion of attention, funding, and resources makes the realization of these TB goals unlikely.
- Partners in Health, a nongovernmental organization, treats TB and uses a comprehensive model of ambulatory care. They treat every patient free of charge and provide care as it is most convenient to patients, bringing medication to each patient individually twice a day. Their close relationship with patients in this community based model gives their patients up to a 90 percent cure rate. Particularly, Partners in Health established The Sputnik Initiative, where it provided social and clinical support for poor MDR-TB patients in Tomsk, Russia. This initiative allowed Partners in Health to treat 70 percent of its total 129 participants who would otherwise not receive adequate medical care.
- Partners in Health has success in curbing TB by integrating TB treatment with the provision of other medical care. They have established TB clinics within HIV treatment centers, which is strategic as the HIV and TB co-infection rate among the patients they treat is five percent. Additionally, they have incorporated mental health and drug addiction services into their TB treatment program in Russia. A similar integrative model could conceivably be deployed for COVID-19 once a treatment becomes available.
Tuberculosis and COVID-19 pandemics present unique challenges both individually and as they co-occur. However, existing community based treatment models for tuberculosis in Russia may contain useful lessons as we learn to treat COVID-19.
– Isabelle Breier