However, TB experts are increasingly worried about a type of TB which does not respond to the standard first-line drug treatments. This from of the disease is known as multidrug-resistant TB (MDR-TB) and according to the World Health Organisation (WHO) it is spreading at an “alarming rate” particularly in Eastern Europe. Over 80,000 cases of MDR-TB occur annually in Europe and Central Asia, almost a fifth of the world’s total. In this region, the Russian Federation has the largest number of cases, with around 40,000 infections each year.
The high incidence of the disease in Russia stems from the fall in living standards and partial collapse of the health system when the Soviet Union broke up. During 1991 to 1999, cases of tuberculosis rose alarmingly as money for health services dried up and control measures lapsed. The disease became particularly rampant among Russia’s prison population, where it is believed virtually every prisoner was exposed to TB. When released, thousands of ex-prisoners then infected the wider population. (If TB goes untreated, an active sufferer will infect an average of 10-15 people a year.)
In recent years, cases and deaths from TB have fallen in Russia, thanks to improved control and general health services and a programme to tackle TB within the prison system. A 2001 law also made tuberculosis detection, treatment and care free of charge. The WHO has been working in conjunction with the Russian government to improve detection rates, staff training and follow-up procedures.
However, the country still faces a major challenge in dealing with HIV/AIDS infections, which lower a sufferer’s resistance to TB, and from the rising number of MDR-TB cases. The costs for MDR-TB are much higher, since a course of second-line drugs is typically 5,000-6,000 dollars. Since treatment regimes for MDR-TB stretch for two years or more and with hospital costs and other medical care taken into consideration, the total bill per patient is usually between 200-300,000 dollars. And costs for treating TB in Russia are higher, since the country has a policy of lengthy hospitalisation stays within its network of around 100 TB hospitals and sanitaria.
Funding to tackle MDR-TB has therefore been increased by the Russian Government. Money has also been received from the World Bank and the Global Fund to Fight AIDS, Tuberculosis and Malaria. The extra money will be put to good use in the ongoing fight against TB and Russian medics have every intention of winning the battle eventually.