At the turn of the millennium, there were more than 100 tuberculosis infected persons per 100,000 residents in Arkhangelsk County in Northwest Russia. In 2012, this number was reduced to 42.8 per 100,000. The corresponding figure for all of Russia was 68.1 in 2012. This shows that the cooperation between Arkhangelsk County and LHL International has had good results, but there is still a lot of work to do.
At the tuberculosis hospital in Arkhangelsk, medicines are administered to MDR-TB patients using the DOTS system. This means that health personnel shall always observe that tuberculosis patients take their tablets.
One of the greatest challenges in Russia is due to the development of multidrug-resistant tuberculosis, often called MDR-TB. The treatment of this type of tuberculosis is more expensive and takes up to four times longer to treat than standard tuberculosis. It is not unusual for an MDR-TB patient to be in treatment for up to two years. Of all the new cases of tuberculosis in Russia, 19 per cent are of the MDR type (source 1). In Arkhangelsk, it is closer to 30 per cent. The hidden statistics for this are probably also substantial.
Due to lack of knowledge, many people are afraid to associate with persons who have or have had tuberculosis, which leads to isolation and great social and economic challenges for those affected.
Partners in Russia
We also receive funds from various local organisations in LHL, in addition to some from our own foundation. From 2003 to 2012, we received support from the TV campaign of the Norwegian Broadcasting System (NRK) through the Atlas Alliance.
Our work in Arkhangelsk
Since 1997, we have cooperated with Arkhangelsk County on their tuberculosis programme. Cooperation shall ensure better control of tuberculosis by ensuring good information, qualitatively good treatment and better follow-up of patients. The programme consists of health system development, combined with measures to ensure better information about tuberculosis and better social support to those who are afflicted.
LHL International has a principal cooperation agreement with the Easy Breathing Charity Fund (EB Fund), a civil society actor specialised in tuberculosis work. Through the EB Fund, we also have agreements with the public health service and the prison health service.
We work with this in Russia
Health system development:
In cooperation with local actors in Arkhangelsk, LHL International works to fight tuberculosis and ensure that patients receive good treatment and follow-up. The cooperation programme in Arkhangelsk County emphasises both the medical side of the disease, as well as the psycho-social side.
On the medical side, we have recently focused most on the transfer of knowledge and technical guidance. Infection control measures are also an important element in this work. Medicines and laboratory equipment are secured through the Russian health authorities and the Global Fund to Fight Aids, Tuberculosis and Malaria.
Rasmus Malmborg and Berthe Stenberg of LHL International at a tour of the tuberculosis hospital in Arkhangelsk.
Health communication and patient-friendly information:
There is still a lot of shame and stigma associated with tuberculosis. It is a major challenge that there is a lack of knowledge and information in the society. We therefore also work with spreading information, campaigns, transfer of knowledge and health communication between health personnel and patients.
In order to prevent stigmatisation, we will continue to provide training to health personnel in how to communicate better with the patients
We also provide information on how they can take care of themselves in meetings with patients facing major challenges. Going forward, we will concentrate on training health personnel at other locations in the region, and we will work on developing information materials about tuberculosis and HIV that are adapted to the needs of the patients.
Large segments of the population lack information on symptoms, treatment and the risk of infection. The spread of information is thus an area that we emphasise in our work, and information campaigns are carried out in cooperation with volunteers in various districts.
The campaigns can contribute to persuading people with symptoms to visit a doctor sooner, reducing the stigma connected to the disease, and raising the consciousness of the public about the risk of infection. And the most important message in both health communication and campaigns is this: You will recover from tuberculosis!
Download the brochure “TB is curable – information booklet about tuberculosis for people living with HIV” in Russian and English here.
- TB is Curable - information booklet about tuberculosis for people living with HIV (PDF):
We support measures that make a stay in a hospital or sanatorium better for adults and children. Play equipment, clothing, sports equipment, hobby activities, excursions, arrangements, food preparation and training in the use of computers are examples of such measures.
It is challenging to undergo tuberculosis treatment, because the treatment takes a long time, and patients experience a loss of both their income and social network. Many patients must stay in a hospital or sanatorium for months, isolated from family and friends.
Little Sasha lives in a sanatorium in Arkhangelsk with 73 other children. They either have tuberculosis themselves, or have parents who are ill.
Tuberculosis measures in prisons:
In Arkhangelsk, there are more than 20 prison colonies that take in prisoners from other parts of Russia. Since many of those incarcerated have resistant tuberculosis, and many are in addition HIV positive, it is important to include the prison sector in tuberculosis work.
Among other things, LHL International works to ensure preventive tuberculosis treatment to impede the disease and further spread of infection. We have also contributed to upgrading several buildings in connection with the prison hospital.
Our goals and results
An important goal for the work in Arkhangelsk is to get tuberculosis contagion under control and establish cooperation between the health service in the civil sector and the prison health service. The two sectors have essentially autonomous systems, and they handle the disease differently. When it comes to the fight against tuberculosis, it is nonetheless important that the two different sectors cooperate and agree on the best type of treatment.
Arkhangelsk has now gained approval for the prison tuberculosis control to follow the same system and standard as the rest of the health service. This will yield better coordination and quality assurance of diagnostics, follow-up and treatment of the patients. One goal is to be able to guide other counties in corresponding amalgamation and coordination.
After more than 15 years of cooperation with Arkhangelsk, the programme can point to solid results.
Arkhangelsk County has for example achieved:
- dramatic reduction in tuberculosis sufferers
- earlier diagnosis of patients due to quick tests
- an electronic computer system that ensures good reporting and analysis opportunities for the registered numbers
- good distribution of information
- good health communication related to HIV and MDR
- coordination of tuberculosis control between the prison sector and the civil sector
Fewer people die of tuberculosis today than when the cooperation began, but a mortality rate of 15 per cent is still high. This is probably due to a combination of various factors, such as the development of resistant tuberculosis, lack of information on the course of treatment and risk of infection, and delayed diagnosis and treatment.
The overarching goal for cooperation in the next four years is to eliminate tuberculosis in Northwest Russia.
The incidence of tuberculosis is down by half since the year 2000. This is an indication that the programme has had a very positive effect. The main challenges ahead are related to the growth of MDR-TB and the increase in cases of co-infection of tuberculosis and HIV.