Russian TB Called Epidemic

by Ramesh Jaura

Associated with poverty, TB is most prevalent in the least developed regions of Russia. In Western Siberia alone, according to independent estimates, the number of cases of TB has almost doubled in the last 10 years.

Precise figures are not available, though new cases of TB are required to be officially recorded.

However, "the Russian health system is struggling to maintain basic services," says Andrea Knigge, who is responsible at the GTZ for the TB program.

GTZ is a service enterprise that works primarily on behalf of the German Federal Ministry for Economic Cooperation and Development (BMZ). The organization, based in Eschborn near Frankfurt, has more than 10,000 employees in over 120 countries of Africa, Asia, Latin America and the transition countries of Eastern Europe and the former Soviet republics.

According to Knigge, the GTZ has been working with the World Health Organization (WHO) for a year now to set up a TB control system in Altai Region. The program treats 80 percent of all new infections.

The WHO estimates that tuberculosis kills two million people worldwide each year. "The global epidemic is growing and becoming more dangerous. The breakdown in health services, the spread of HIV/AIDS and the emergence of multi-drug-resistant TB are contributing to the worsening impact of this disease," says the WHO. The world body considers individuals living with HIV a new high-risk group. They are 30 times more likely to contract TB than other groups.

In 1993, the WHO took an unprecedented step and declared tuberculosis a global emergency, so great was the concern about the modern TB epidemic.

It is estimated that between 2000 and 2020, nearly one billion people will be newly infected, 200 million people will get sick, and 35 million will die from TB -- if control is not further strengthened.

In association with the WHO, GTZ runs seminars in Russia to familiarize specialists, general practitioners, medical nurses and laboratory staff with internationally recognized treatments in line with the DOTS principles (directly observed treatment, short course), reports Knigge.

"The X-ray diagnosis and long-term treatment in a sanatorium, which was the norm during the Soviet era, are no longer part of modern medical practice," adds Knigge.

DOTS was unknown in the Russian health system, and resistance was strong initially. DOTS, directly observed therapy with combined drugs treatment, strengthens the national health system, to accord priority to infectious diseases.

Standardization of patients' files, to allow staff to monitor success of treatment and the spread of the infectious disease, is also a part of the DOTS.

Patients' intakes of the drugs are consistently monitored for six to eight months. The idea is to ensure that patients complete the course of treatment.

"When patients fail to complete the treatment the pathogens become resistant and the costs of treatment can rocket from about $50 per patient to as much as $5,000 -- and the chances of success are then minimal," explains Knigge.

It is against this backdrop that Gro Harlem Brundtland, Director-General of the Geneva-based WHO, called for joint efforts to confront TB and HIV in the lead-up to World TB Day celebrated on March 24.

TB is a leading killer of people living with HIV and it is highest in countries with the highest rates of HIV.

"Not only is this a health imperative, it is fundamental to human rights. TB and HIV are both enhanced by poverty, homelessness, substance abuse, psychological stress, poor nutritional status and crowded living conditions," Brundtland added, referring to a new report on TB entitled "A human rights approach to tuberculosis."

The new report was released ahead of the World TB Day. Its theme, "DOTS: TB cure for all," calls for equitable and discrimination-free access to adequate treatment and services for anyone who has TB.

HIV and TB are closely linked, says the report. Testing in a number of developing countries shows that up to 70 percent of TB patients are infected with HIV. In addition, up to 50 percent of people living with HIV can expect to develop TB.

Worldwide, 36.1 million people are infected with HIV and 95 percent of them live in developing countries, where TB rates are highest. About 13 million people are infected with both HIV and the germ that causes TB.

"People with both diseases suffer double discrimination," says Peter Piot, executive director of the Joint United Nations Program on HIV/AIDS (UNAIDS).

"HIV severely weakens the immune system, and makes people highly vulnerable to diseases such as TB. According to our latest figures, nearly two-thirds of all people with HIV or AIDS were living in the countries with the highest TB burden in the world. The link between the two is inescapable, and TB is the first manifestation of AIDS in more than half of all developing country cases," he adds.