The Magnitude of MDR-TB in Russia.

After much thought and research into several cities, I have decided to focus in on Tomsk, Russia.  Preliminary research didn’t reveal much data about MDR-TB in HIV patients in Tomsk, but more data was available for MDR-TB in new and re-treatment tuberculosis patients in Tomsk.  Therefore, I have revised my problem statement to: 

High Incidence of MDR-TB in New and Re-treatment Tuberculosis Patients in Tomsk, Russia from 1990 to Present Day. 

The role of surveillance of MDR-TB in Tomsk is given to the Tomsk City Tuberculosis Services (TCTS), which “oversees diagnosis, treatment and reporting of adult patients with TB,” following WHO guidelines [1].  Further research into the TCTS didn’t reveal much, other than the impression that there was a comprehensive network of tuberculosis facilities involved in surveillance [2], including tuberculosis laboratories that report all drug-susceptibility testing results accompanied by various other data (“new case” vs “previously treated case,” age, sex, HIV status, etc) [3]  

The WHO has a project called the Global Project (on Anti-Tuberculosis Drug Resistance Surveillance), which collects and analyzes drug-resistance, mortality and budget data from population surveys and national surveillance systems around the world.  It uses the data to help countries scale-up MDR-TB management, including standardized surveillance systems like patient surveys and drug susceptibility testing [3]. 

Interestingly, the WHO compiles country-specific data into country-specific “profiles.”  These profiles outline various surveillance parameters, some of which are indicators such as mortality, incidence and prevalence, finances.  Let’s just focus on a few of these indicators, and how they present the public health impact of the problem.  Rates such as morality, incidence and prevalence are direct indicators.   

In Russia, MDR-TB accounts for 13% of new TB cases and 49% of retreatment TB cases, as of 2007 [4].  In Tomsk, MDR-TB accounts for 11.2% of all new TB cases and 42.2% of all retreatment cases by 2003 estimates. [5] Together, the prevalence data show that Tomsk has a significant MDR-TB burden similar to Russia’s as a whole; strikingly, MDR-TB occurs a huge portion of previously-treated TB cases.  With TB incidence rates increasing by 2.1% in Russia [4], I would predict that these numbers would increase without good public health measures. 

Mortality data for MDR-TB is lacking; what I found was that in 2003, TB in general caused 17.6 deaths per 100,000 in Tomsk [5]; and since 2007, TB has caused 18 deaths per 100,000 per year in Russia as a whole [4].  Steady mortality rates may indicate that treatment protocols aren’t being largely beneficial across the board. 

TB budget expenditures of Russia [4] are an indirect indicator of the MDR-TB problem in Russia.  In 2009, the largest budget component (36%) was for staff dedicated to TB control, 28% for TB hospitals and 11% for MDR-TB, indicating that MDR-TB is recognized as a significant problem in Russia. 

A systematic weakness in most of these data from Russia is that this is reported data from facilities such as labs and hospitals.  For those in the rural areas or without access to such facilities, they may not be represented in these statistics.  For example, this could be reflected in the statistics taken from source 5, since the data is reported to be collected by the Tomsk Oblast Tuberculosis Services or TCTS. 

[1] http://www.who.int/bulletin/volumes/85/9/06-038331/en/
[2] http://eurpub.oxfordjournals.org/content/17/1/98.full
[3] “Guidelines for surveillance of drug resistance in tuberculosis” Fourth edition
[4] “Global Tuberculosis Control WHO Report 2009”
[5] “Treating Multidrug-Resistant Tuberculosis in Tomsk, Russia”