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Experts warn Russia's fight against TB is far from over
March 22, 2002
By ERIC ENGLEMAN, Associated Press Writer

MOSCOW - Despite signs of progress in the fight against tuberculosis in Russia, much more needs to be done to control the epidemic, a group of health officials and experts said Friday, two days ahead of World TB Day.

The Russian government announced last month that the number of new people infected with tuberculosis had dropped slightly — from 134,000 in 2000 to 133,000 in 2001 — the first positive sign in more than a decade of fighting the disease.

But health officials said it's too early to start celebrating and that Russia's battle with TB is far from over.

"Mortality from tuberculosis still remains at an unacceptable level, so the fight has to continue," said Mikhail Perelman, head of the TB department at Russia's Health Ministry.

Tuberculosis re-emerged with a vengeance after the breakup of the Soviet Union, including new strains resistant to traditional drug treatments.

The problem is most acute in Russian prisons, full of overcrowded, poorly ventilated cells. Among the nearly 1 million prison population, 100,000 inmates have TB, and almost 30 percent are infected with drug-resistant strains.

Every year, roughly 50,000 prisoners with active TB are released back into the community, many without adequate health care.

Experts said ex-prisoners infected with tuberculosis need counseling to ensure that they continue treatment after their release and that they understand how to keep from passing the disease on to others.

"To fight only the medical aspects of tuberculosis is to fight only half the battle," said Samantha Perkins of Merlin, a British health charity that runs one of Russia's most successful TB programs in the Siberian city of Tomsk.

The Soviet health care system kept tuberculosis, a major killer in the 19th and early 20th centuries, at bay by relying on mandatory inoculations and X-ray diagnosis and by isolating patients in sanatoriums for years.

That ended with the Soviet Union's 1991 collapse, when government funding collapsed and public health programs all but disappeared.

More recently, the Russian government has increased spending on anti-tuberculosis programs, but many regional hospitals and clinics don't have equipment to conduct even the most basic TB tests.

"Today our health institutions are not supplied adequately to screen the population, in particular the high-risk groups," Perelman said.

International health organizations are also funding anti-TB efforts. But some Russian officials are reluctant to accept outside help.

Russia last year rejected a dlrs 150 million loan from the World Bank for tuberculosis treatment. The loan stipulated that Russia use a heavily drug-dependent treatment — including mandatory home visits by health care workers, which many Russians considered intrusive.