Poverty, under-funding of health services and technical inadequacies contributed to Russia having one of the highest rates of tuberculosis (TB) in the world. This was aggravated by the spread of multiple-drug resistant TB and HIV/AIDS.
The Russian Federation is one of the 18 high-priority countries for TB control in ECA as defined by the World Health Organization (WHO). It also has one of the fastest HIV/AIDS epidemics in the region. The national TB and HIV/AIDS programs supported by the World Bank - in partnership with the WHO, UNAIDS, Global Fund, and other international partners - are aiming at containing the growth of the twin epidemics of TB and HIV/AIDS in the short term and towards halting and reversing their courses in the medium term, both in the civilian sector and among prisoners. The project has contributed to expanding the access of the population, particularly low income groups and prisoners, to modern TB and HIV detection, diagnosis, treatment and monitoring methods.
New forms of TB recording and reporting have been produced and disseminated among all regions (both in the civilian sector and the penitentiary sectors) for the use of the cohort method analysis in TB detection and treatment control. Specialists from federal TB research institutes make monitoring visits to verify treatment effectiveness in every region of the project. Training workshops have been conducted on issues of TB monitoring and treatment at federal TB research institutes and in the regions. Three rounds of proficiency testing were organized between 2005 and 2007 in cooperation with the Swedish Institute for Infectious Disease Control, involving Russian labs from both the federal and regional levels. Project monitoring and evaluation is used not only to evaluate the status of implementation of project activities but also to inform policy makers for decision making purposes, particularly for assessing the evolution of the epidemic by region and the adoption of targeted measures to support low performing regions.
The project has also contributed to the strengthening of the national TB/AIDS programs by helping increase budgetary allocations since 2004 (for example, the AIDS budget increased from less than US$50 million in 2004 to more than US$400 million in 2008), develop treatment guidelines, strengthen laboratory capacity, and provide drugs. In addition, it has been successful in establishing a well coordinated mechanism facilitating complementarity of efforts between national and international organizations in TB and HIV Control in Russia - including the Ministry of Health and Social Development, Federal Corrections Center of the Ministry of Justice, Federal TB Institutes, Federal AIDS Centers, Oblast Governments who signed participation agreements, WHO, UNAIDS, USAID, Global Fund, and other partners.
"The best way to tell this story is by the results. During the last 5 years of its implementation the project helped reduce TB prevalence rate by 20% and TB mortality rate by 33% in the institutions of the Federal Correction Service. By the end of 2008 overall implementation of the TB/AIDS Control Project resulted in increasing coverage of TB patients by bacteriological tests up to 95%." — Svetlana G. Safonova, Chief Bacteriologist, Medical Administration of the Federal Correction Service of the Russian Federation, Doctor of biological sciences, Colonel of Interior Service
"At the beginning, we had some troubles, mostly because the role of high-tech methods for fighting TB in the World Bank project had been underestimated. However, gradually we overcame all difficulties, and the work went on very friendly terms. In our computer-intensive time, everybody knows what hardware and software is. I would say that the hardware part – meaning purchase of different equipment for the anti-TB institutions in Russia – played a key role in the project. However, the software part was even more important. The software part included learning and educational programs carried out in cooperation with the World Bank, and programs aimed at improving TB prevention and the organization of TB treatment. Thanks to cooperation with the World Bank, we have managed to improve the level of TB awareness and treatment." — Mikhail I. Perelman, Chief TB Specialist of Russia, Director of the Institute of Phthisiology and Pulmonology of the Moscow Medical Academy, Member of the Russian Academy of Medical Sciences
TB mortality in the total population decreased from 2006 to 2007 by 15.4%. Among prisoners - the most affected group - TB deaths dropped by 37.5%.
The rate of increase in HIV prevalence dropped by 7.7 % between 2006 and 2008. HIV-positive infants born to HIV-infected women decreased from 13.6% to 9.8% between 2004 and 2008.
Between 2003 and 2007, case detection among persons presenting TB symptoms using sputum smear microscopy increased by 32.8%. There was also a 72.7% increase in TB patients receiving the standardized treatment regimen, including direct observation of treatment.
New guidelines for HIV/AIDS prevention, diagnosis and treatment were developed by the Ministry of Health and Social Development from 2005 to 2007.
About 65% of HIV-infected persons received anti-retroviral treatment in 2008, a dramatic increase from 25% in 2006.
Mobilizing support from ‘national champions’ is key to secure ownership and to sustain activities and gains supported under a project. Federal TB Institutes covering the entire country were actively involved in project implementation.
A clear division of responsibilities among international partners helps harmonize and maximize the impact of international cooperation in support of national programs. Here, partners were WHO, UNAIDS, the Global Fund, and the World Bank.
It is important to strengthen national capacity to evaluate the program and its impact on an annual basis. This project supported improvements in the recording and reporting system, clear information from examinations on type of diseases and case category, and cohort analysis on treatment results.
Poverty, under-funding of health services and technical inadequacies contributed to Russia having one of the highest rates of tuberculosis (TB) in the world. This was aggravated by the spread of multiple-drug resistant TB and HIV/AIDS.
RSS