Tuberculosis is a chronic contagious disease which kills more youth and adults than any other infectious disease. Mostly spreading through the socially less favored populations, it is on the world’s agenda. Tuberculosis is considered a global emergency. The disease can be treated most favorably and less costly if cases are discovered early.

In many countries, including the Russian Federation, economic hardship and social distress have resulted in the re-emergence of TB as a major problem. Both in terms of rates and absolute numbers, new cases and mortality more than doubled between 1991 and 1997. Lack of anti-TB drugs and the application of non-standardized and sub-optimal therapy have resulted in rising numbers of multidrug resistant TB cases, which are cases difficult and costly to treat.

In recent years the search for new affordable approaches in the treatment of TB patients has lead to a revision of treatment strategies and the confirmation of the DOTS (directly observed treatment – short course) strategy which is recommended by World Health Organization. It is the most cost-effective strategy available for controlling the TB epidemic today, and gives hope that the trends can be reversed. It recognizes the necessity of a national commitment to solve the TB problem and clear definition of categories of patients, criteria of treatment effectiveness, and the standardized chemotherapy protocols for the different categories of patient. The core element is a fixed combination of drugs, which the patients will have to swallow under supervision for six months. The supervision is necessary to make sure the patients take tablets, experience has shown that it is hard for the individual patients to mobilize the nesessary motivation to go through with the cure. But the supervision does not mean hospitals; it can best take place in a primary health care setting close to where the patients live.

An experimental adaptation of WHO recommended methods of diagnosis and treatment of TB patients has been carried out in Ivanovo and Tomsk regions. WHO, together with the Ministry of Health, the Academy of Medical Science and other partner agencies in Russia will consider how to introduce these methods in health care facilities in other areas of Russia.

New legislation for TB control is under discussion in the State Duma and substantial loan from the World Bank is being negotiated for TB control and HIV prevention. WHO has agreed to act as a facilitator of a dialogue of tecnical experts from Russia and abroad on communicable diseases. The aim is to arrive at control strategies and health policies which are well suited for Russia and take into account the experiences from other countries with respect to communicable diseases, in particular TB.

WHO Concerned About STD Increase in Russia

Syphilis, gonorrhea and clamydia infections are treatable, curable infectious diseases, which are rare or almost extinct in many countries. But there has been a dramatic increase in the incidence of these sexually transmitted diseases (STD) in Russia over the last decade.

In 1997 alone, more than 400,000 new cases of syphilis, the marker of the trend in STDs were officially reported to the health care authorities of the Russian Federation. This is a major challenge in itself, but it is also seen as a part of the AIDS problem.

There is a clear evidence that the ulceration and inflammation that are characteristic of untreated STDs, represent an open gate for the contraction and further spread of HIV infection. Thus, effective STDs surveilance and treatment also represent primary prevention of HIV infection.

The National Health Care Authorities, in consultation with WHO, have adopted the WHO/UNAIDS strategy for controlling the STDs epidemic. The WHO guidelines on STD control consist of well defined STDs case management, guaranteed confidentiality and outpatient treatment with modern drugs. In addition they include the intervention in groups with high risk behavior as well as the integration of STDs management into primary health care services. This is important particularly in the remote areas with no immediate access to an STDs specialist. The implementation of all these strategic measures should help to curb the STD epidemic in the country, but the funds are lacking, and international assistance is requested.