Tuberculosis and Russia: Notes from Novosibirsk

In honor of this year’s World TB Day – March 24, 2011 – Modern Russia asked Dr. Rostislav Mitrofanov of Siberia’s Novosibirsk Tuberculosis Research Institute (NTRI) to write about tuberculosis and Russia.  Below, Dr. Mitrofanov discusses his unique perspective on battling the disease locally and globally.

When I first began studying tuberculosis at the Novosibirsk Medical Institute in 1986, I was under the impression that the epidemic was almost defeated in Russia. I was wrong.  Through my studies and research, I grew terrified by the desperation in my country at the end of the last century from this curable disease, this old enemy, and could not figure out why no significant progress had been made in treatment. So, for the past decade, I have dedicated my work to TB research and control in the Russian Federation.

Currently, I serve as the Head of the International Department of the Novosibirsk Tuberculosis Research Institute (NTRI) in Siberia under our director, Professor Vladimir Krasnov. Our institute is one of five specialized TB centers working throughout Russia to battle the epidemic and provide a new framework for control and treatment. We serve Siberia and Russia’s Far East, over two thirds of Russia’s sprawling landmass and 25 percent of our total population.  AT NTRI, we are devoted to our patients and dedicated to developing a new TB curriculum that can be implemented to more effectively treat patients with Multidrug-Resistant Tuberculosis (MDR-TB) and Extremely Drug Resistant Tuberculosis (XDR-TB).  I am also proud to work closely with Dr. Paul Farmer’s groundbreaking Boston-based nonprofit Partners in Health (PIH) and previously served as PIH’s Russia Training Coordinator.

In February 2010, Russia made another significant step in the fight against TB. NTRI partnered with PIH and the World Health Organization (WHO) to open a new WHO Collaborating Center for Training in Multidrug-Resistant Tuberculosis. Our new center has already begun to strengthen the standards of treating MDR-TB in the region and collaborates with TB experts locally and globally to organize trainings and conduct research on the most effective practices for treating and controlling TB.

On World TB Day

On March 24, 1882, Dr. Robert Koch announced the discovery of Mycrobacterium tuberculosis, the bacteria that causes TB.  Every March 24, TB professionals participate in outreach programs, awareness campaigns, press conferences and presentations around the world. Despite our efforts, we cannot garner the recognition that World TB Day deserves, especially in larger countries like Russia. In Russia, as well as globally, we need a fresh approach to eradicating the epidemic and educating the public about TB prevention and treatment. We want people to know what TB is, how to recognize and treat it, and what advancements we’ve made in the past year. And perhaps most importantly, we want people to know what’s next: what can we do differently in 2011 to make 2012 an even more successful year in the fight against TB?

Tuberculosis and Russia: What’s Next?

We need increased collaboration between Russia and other countries.
Russian medical professionals who treat and study TB are so overwhelmed with practical tasks—everyday treatment of patients—that we have little time and no financial support to analyze our findings and share them with the global community. As such, international collaboration is the lynchpin in the battle against TB. Instead of retracing our steps in different clinics around the world, collaboration allows us to pool our knowledge and resources in a mutually beneficial way. At NTRI, we are exploring a partnership with the CDC and the NIH, developing exchange programs with medical schools and teaching hospitals, and looking for key grants from pharmaceutical companies and benevolent funds.

We need more community involvement.
TB is a social disease with many interconnected factors hindering treatment (access to care, poverty, drug addiction, alcoholism, HIV/AIDS). People need to be familiar with early warning signs and educate themselves and each other on treatment options. People need to know TB is a curable disease. We need stronger community networks especially in the most remote and impoverished communities in order to stop the spread of the disease.

We need a fresh approach to patient care.
If we want to permanently alter the TB epidemic in Russia, we must change our perception of patient care. We must adopt a patient-centered approach, as advocated by PIH and seen most clearly through its Sputnik program that developed out of its Tomsk, Siberia pilot project. In short, Sputnik provided home-based care for MDR-TB patients who would otherwise have no access to treatment. Beyond regular visits to administer MDR-TB drugs, these specially trained nurses provided emotional support and companionship to patients. We learned from Sputnik’s tremendous success that we must personalize patient care, not implement a one-size-fits-all treatment regimen.

We need to develop new technologies and outreach tools.
Under my direction at NTRI, we plan to develop an incredible new patient device that would track the treatment process. The idea was born out of the success of the Sputnik program and an increased focus on home-based care and individual patient needs. Patients would wear a complex GPS bracelet with a number of features, including a panic button and a mechanism for keeping track of administered doses. This tool would be groundbreaking for developing countries where rugged terrain and limited infrastructure hinders patient outreach and access to care. Further, the device would revolutionize treatment by bringing TB management into the digital age.

Since the official opening of the WHO Collaborating Center on MDR-TB in September, NTRI has conducted six in-depth trainings and planned more than 20 educational events for 2011. Every positive result we achieve at NTRI will save so many lives, both in Russia and the world. It is my deep hope that NTRI will lead the fight against TB in Russia and dramatically change the landscape of the TB epidemic in Russia and globally.