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DTBE in Russia

map of Russia

Capital City: Moscow
Area*:17 million sq. km. (6.5 million sq. mi.)
Population (est.), 2011*: 142.9 million
Estimated TB Incidence, 2010**: 106/100,000
Estimated TB Prevalence, 2010**: 136/100,000
Adult HIV Prevalence Rate, 2009***: 1.0%
Number of people living with HIV (PLHIV), 2009***:980,000
Percent of tested TB patients who were HIV+, 2010**: 5%

*Source: www.state.gov
**Source: WHO Global TB Control Report 2011
***Source: UNAIDS, Report on the Global AIDS Epidemic, 2010

Background

Since 1999, the Centers for Disease Control and Prevention’s Division of Tuberculosis Elimination (CDC/DTBE) and World Health Organization (WHO) have collaborated on implementing directly observed therapy (DOT) and multidrug-resistant TB (MDR TB) treatment pilot projects in four Russian territories: Orel, Ivanovo, Vladimir, and Chuvashia. CDC/DTBE expanded its technical assistance to provide support to the International Federation of the Red Cross (IFRC), Russian Red Cross, and four additional territories in 2004.  Technical support also focused on addressing TB prevention and control in people infected with HIV and HIV infection among TB patients.  CDC/DTBE technical assistance to Russian national partners has included revising current TB control policies, conducting programmatic and clinical research to determine optimal strategies for MDR TB control, strengthening laboratory capacity and staff technical skills, and developing infection control (IC) plans and renovation recommendations.  The overall goal of CDC/DTBE’s work in Russia is to develop sustainable capacity, prioritizing TB treatment and care, laboratory diagnosis of TB and MDR TB, implementation of IC measures, and conducting sound, relevant epidemiologic research. 

Recent Accomplishments & Ongoing Collaborations

Program Strengthening and Epidemiology

Ongoing IC Training and the Center of Excellence in TB Infection Control: Since 2001, CDC/DTBE has conducted IC trainings in multiple Russian territories, including Orel, Ivanovo, Vladimir, Chuvashia, Tomsk, Khakassia, Kaliningrad, and Murmansk.  The trainings cover administrative and environmental controls, safe sputum collection, retrofitting ventilation systems and ultraviolet lights, and the use of personal respirators.  The trainees engage in practical exercises at local TB dispensaries and health clinics.  In October 2008, the Vladimir TB Dispensary established the Center of Excellence in TB Infection Control in partnership with the US Agency for International Development (USAID), CDC/DTBE, the Central Tuberculosis Research Institute (CTRI–Moscow), WHO, and the Vladimir Oblast Administration.  The Center is involved in monitoring and implementing infection control measures and serves as a training hub for Russia and other Russian-speaking countries. 

Laboratory Strengthening:  CDC/DTBE has strengthened the laboratories in Vladimir and Orel by purchasing equipment and information systems, updating biosafety procedures, training laboratory scientists, and assessing quality control measures. With CDC/DTBE support, Orel’s laboratory is functioning as a Center of Expertise in laboratory diagnosis of drug-resistant TB (DR TB).   

GeneXpert MTB/RIF:  One of the main priorities in the next few years will be to support implementation, evaluation, and assessment of strategies to optimize case detection and diagnosis of drug resistance based on rapid, molecular diagnostic technologies (GeneXpert MTB/RIF).  A study currently underway in Russia will implement and validate GeneXpert™ MTB/RIF for MDR detection, and  confirm the performance of this test against routine conventional methods in three laboratories in Russia.

Capacity building: CDC/DTBE is helping develop additional centers of excellence for microbiology training and clinical and programmatic management of MDR-TB in Orel and Vladimir.  These platforms will provide the human resources, skills, and information technology capacity required to conduct randomized controlled trials of new TB drugs and treatment regimens.

 

Multidrug-Resistant TB (MDR TB), TB/HIV, and Other At-Risk Populations

Preserving Effective TB Treatment Study (PETTS):  In collaboration with the Ministry of Health (MOH) and local partners in nine countries (including the Russian Federation), CDC/DTBE spearheaded the Preserving Effective TB Treatment Study (PETTS). PETTS, a large multi-year, multi-country study compared programs approved by the Green Light Committee (GLC) to programs that were not GLC approved; this was done to determine the incidence and consequences of acquired resistance to second-line drugs (SLD) among MDR TB patients. Preliminary results suggest that acquired resistance to these drugs was lower in GLC approved programs. GLC approved projects also demonstrated higher cure rates, lower mortality, and lower treatment failure rates when compared with non-GLC approved projects. PETTS has informed the new framework for WHO and international partners that support countries in achieving universal access to the diagnosis, treatment, and care of MDR TB.

Supporting Management of MDR TB:  CDC/DTBE has supported a number of activities designed to strengthen ability to diagnose and manage MDR TB and to guard against service disruption.  A few of these activities have been to support access to second-line drugs through the WHO Green Light Committee, conduct programmatic evaluations of new diagnostics to determine performance and cost, and developed and evaluated models for MDR TB management for use nation-wide. CDC/DTBE is also supporting an evaluation of the treatment outcomes of the first group of patients in Russia to complete therapy on the internationally recommended strategy for treating MDR TB patients, Directly Observed Therapy Short-course (DOTS) Plus (second-line treatment).

Additional Information

 
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