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Russia: Confronting the Dual Epidemics of Tuberculosis and AIDS

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Russia
Health
Russia: Confronting the Dual Epidemics of
Tuberculosis and AIDS

Overview

Supported by International Bank for Reconstruction and Development (IBRD) funding in partnership with other international agencies, the Russian government implemented a comprehensive nationwide strategy to strengthen health care organization and service delivery for the diagnosis, care and treatment of tuberculosis (TB) and HIV/AIDS among civilians and prisoners residing in most of Russia’s 83 regions (from the Baltic Sea to the Pacific Ocean). This strategy contributed to a trend of stabilizing and decreasing annual notification of new TB cases, reduced TB-related mortality by 25 % during 2003–2009, and scaled up diagnosis and treatment for HIV-infected people.

Challenge

Poverty, poor nutrition, low levels of immunity, and underfunding of health services contributed to Russia having one of the highest rates of TB in the world. This situation was aggravated by the spread of multiple-drug resistant TB and HIV/AIDS. Russia is one of the 18 high-priority countries for TB control in the Europe and Central Asia region, as defined by the World Health Organization (WHO). The country also has a growing HIV/AIDS epidemic. Approach: IBRD provided assistance under the project to improve access to quality services, including development of guidelines for prevention and treatment of patients; strengthened laboratory capacity; provision of drugs; training of personnel; and improved surveillance systems, including recording and reporting system and cohort analysis on treatment results.


Approach

IBRD provided assistance under the project to improve access to quality services, including development of guidelines for prevention and treatment of patients; strengthened laboratory capacityto improve early detection and diagnosis; provided drugs for treatment; supported training of personnel; and improved surveillance systems, including recording and reporting system and cohort analysis on treatment results.ngthening of health systems and management capacity.


Results

  • Since 2003, improved efforts by the Russian government at the federal and regional levels supported by the World Bank project contributed to a trend of stabilization and decreasing annual TB notifications. The notification of new TB cases was 82.6 per 100,000 population in 2009, down from 90.7 per 100,000 at the beginning of the decade. In 2009, the estimated prevalence rate of TB was 185.1 per 100,000, significantly down from 218 per 100,000 in 2004.
  • Project helped to stabilize the spread of the TB epidemic in both the civilian and penitentiary sectors.
  • Between 2003 and 2008, case detection among persons presenting TB symptoms using sputum smear microscopy increased by more than 24%, reaching at 73% level in 2008. By 2008, 75% of new TB patients received the standardized treatment regimen, up from 44% in 2004.
  • TB mortality in the general population decreased from by 25% over 2003-2009. In prisons, TB deaths dropped by 35% over this period.
  • 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.

Voices


At the beginning, we had some troubles, mostly because the role of high-tech methods for fighting TB in the 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 means. 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


Partners


In Russia, a strong partnership was developed with the Federal Ministry of Health and Social Development, the Federal Corrections Department of the Ministry of Justice, Federal TB Institutes, Federal HIV/AIDS Center, Regional Governments, and the Russian Health Care Foundation. International partners included WHO’s Stop TB Team in Russia, Joint United Nations Programme on HIV/AIDS (UNAIDS), the Global Fund to Fight AIDS, TB and Malaria, United Nations Office on Drugs and Crime (UNODC), U.S. Agency for International Development (USAID), and the Clinton Foundation.


Toward the Future


The Russian government is committed to sustaining the achieved gains. Support for the implementation of TB HIV/AIDS control activities is continuing with financing from federal and regional budgets. Under the TB program, the timely availability of first-line drugs and compliance with WHO-recommended standard treatment regimens are critical to prevent the spread of multiple-drug resistance cases. Under the HIV/AIDS program, additional efforts are needed to support prevention activities among vulnerable groups, particularly among injecting drug users


For more information, please visit the Projects website.

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