Hannah Lofgren

Tuberculosis in Russia
From: Secretary of Health, Russia
To: Minister of Finance, Russia

Introduction:
Russia is on the brink of a serious TB epidemic. Since the collapse of the health
system after the breakup of the Soviet Union, we have been unable to sustain our TB
treatment programs, resulting in increased TB incidence rates, as well as drug-resistant
TB cases. We have the world’s third largest number of MDR-TB cases at 43,000i and one
of the highest rates of XDR-TB. HIV/AIDS is also on the rise and seriously exacerbates
existing TB treatment and detection problems. Socially vulnerable groups, including the
unemployed, substance abusers, and the prison population are high-risk TB groups.
Russia’s first priority is to arrest the increase of drug-resistant TB cases through improved
DOTS implementation and treatment oversight. HIV/AIDS awareness and information
campaigns are also crucial to tackling both disease epidemics.

Nature and Magnitude of the Problem:

TB is an increasingly severe public health problem in Russia. It ranks eleventh out
of twenty-two on the WHO’s list of high-burden TB countries.ii Among our
approximately 141 million people, the TB prevalence rate is 132 cases per 100,000, with
an incidence rate of 106 new cases per 100,000.iii In addition, an estimated 80 percent of
Russians have latent TB.iv Currently, about 16 percent of all new TB cases and 42 percent
of retreatment cases are MDR-TB.2 Even worse, 14 percent of all TB positive cases in
Russia are XDR-TB.v Although DOTS coverage has reached 100 percent, case detection
for new smear-positive cases remains low at 49 percent, as does treatment success at 58
percent,2 both of which are well below the WHO’s guidelines of 70 and 85 percent,
respectively.

Affected Populations:
In Russia, TB largely afflicts young males and poor, socially marginalized groups,
especially prisoners, migrants, substance abusers, the unemployed, and the homeless.6
Nearly 70 percent of new TB cases occur in individuals aged 25-54 years.vi The incidence
of TB in men is also 2.7 times higher than in women.5 Poor, socially vulnerable groups
have less access to continual treatment and are also more likely to engage in behaviors
that elevate the risk of contracting TB, including alcohol and drug use, smoking, unsafe
sex, and crime. Rates of TB incidence vary by region as well, with the highest rates
occurring in the poorest regions of Siberia and the Far East. The Republic of Tyva has an
incidence rate nearly twice the national average at 206.5 cases per 100,000. 5

Risk Factors:
The greatest risk factors for acquiring all strains of TB in Russia include
unemployment and/or homelessness, substance abuse, incarceration, inadequate treatment
and/or failure to complete it and being HIV positive. Among Russia’s unemployed
population, TB incidence is a startling 750 cases per 100,000, as opposed to only 45
among the working population.5 Unemployment is often connected to homelessness, and
 2

both factors have a strong correlation with substance abuse. Alcoholism and smoking,
both of which are rampant in our society, contribute to a weakened immune system,
making the individual more susceptible to contracting TB. These addictions may also
affect the patient’s adherence to treatment, increasing the spread of drug-resistant TB.
An estimated 12 percent of the total Russian prison population is TB positive,5
due to confined and overcrowded conditions where TB can spread rapidly. This is nearly
17 times higher than TB prevalence among the civilian population.5 Incarcerated
individuals are also much more likely to have been involved in other risk behaviors prior
to entering prison, which may in turn affect their ability to complete treatment. Russia’s
quickly growing HIV/AIDS incidence, largely driven by injection drug users, also has
serious implications for TB rates, as HIV raises TB susceptibility and complicates TB
treatment. Out of all current TB cases, 16 percent are HIV positive.2 Furthermore, TB has
recently become the leading cause of death for HIV positive people in Russia.5

Economic and Social Consequences:

Increasingly high rates of TB, often coexisting with or resulting from similarly
high rates of substance abuse and HIV/AIDS, will only further weaken our stagnant
economy and fragile society. The interconnectedness of TB, HIV/AIDS and substance
abuse in Russia creates a continuous cycle of disease and addiction. The alarmingly high
rates of drug-resistant TB are also of urgent and paramount importance. Russia’s low case
detection and treatment success rates are quickly breeding a sick population without any
hope of treatment. Not only does this create a new epidemic, it is costly. Six months of
first-line TB drugs cost $60-$100, whereas second-line drugs used to treat MDR-TB must
be taken for 18-24 months at a cost of up to $30,000.5

Priority Action Steps:

In order to combat the rising TB epidemic, Russia must prioritize halting the
spread of drug-resistant TB. This requires identifying drug-resistant cases and ensuring
that they receive quality drugs for the entire course of treatment. In addition, while better
case detection in general is necessary, we must first improve the poor treatment success
rate under our DOTS program to prevent new drug-resistant TB cases. Additional
healthcare personnel and an improved national database to track patients undergoing
treatment are therefore vital for the success of treating and preventing all strains of TB.
There is also a significant lack of coordination among the hospitals and the penal and
primary care health systems, which must be corrected to improve treatment outcomes and
reduce transmission. This collaboration is particularly salient in managing increasing
TB/HIV co-infections. Similarly, HIV/AIDS awareness and prevention is crucial,
especially since it remains quite a stigmatized and taboo subject in Russia.
i
“Tuberculosis: Russia.” USAID. 2009.
http://www.usaid.gov/our_work/global_health/id/tuberculosis/countries/eande/russia_profile.html
ii
“Tuberculosis: Russia.” USAID. 2009.
http://www.usaid.gov/our_work/global_health/id/tuberculosis/countries/eande/russia_profile.html
iii
“Russian Federation Tuberculosis Profile.” WHO. 2009. http://www.who.int/countries/rus/en/
iv

“Tuberculosis Policy Framework and Implementation in Russia.” Global Business Coalition on

HIV/AIDS, TB, and Malaria.
www.hivpolicy.ru/LeadersForum/en/.../TBRussiaPolicyFramework_eng.pdf
v

“Drug-Resistant TB in Russia.” Global Health Initiative and Woodrow Wilson Center. 2007.
http://www.wilsoncenter.org/index.cfm?
topic_id=116811&fuseaction=topics.event_summary&event_id=239772
vi

“Tuberculosis Policy Framework and Implementation in Russia.” Global Business Coalition on

HIV/AIDS, TB, and Malaria. www.gbcimpact.ru/files/upload/publications/3578.pdf.