Die Kontrolle der Tuberkulose in den Nachfolgestaaten der Sowjetunion am Beispiel Russlands

Abstract

Tuberculosis (TB) remains a serious threat to public health in Russia and other former Soviet Union Countries. The purpose of this paper is to describe the current trends of TB and MDR-TB in Russia and identify the characteristics of the traditional Russian TB control model inherited from the Soviet Union. We discuss current challenges to TB control in the country. WHO tuberculosis notification data were analysed for Russia and 14 other former Soviet Union countries. To investigate the characteristics of TB control in Russia, we performed a systematic literature review using MEDLINE/EMBASE databases. 136 articles were initially identified of which 66 fulfilled the inclusion criteria. Full texts were reviewed. Additionally, we reviewed non-systematically Russian state reports, guidelines and legislations. In 2006, nearly 125 000 TB cases and 28 000 TB deaths were notified in the Russian Federation. The TB notification rate was 13 times higher than in Germany. The characteristics of the traditional Russian TB control model include: a centralised disease-specific inpatient network for diagnosis and treatment of TB, countrywide population screenings using fluorography, a strong focus on X-ray for diagnosis and disease classification, individualised and lengthy inpatient care, high rates of drug resistance, and inefficient financing systems. Current challenges to TB control in Russia are: the implementation of a quality-assured laboratory network for sputum-smear microscopy, culture and drug susceptibility testing, ensuring MDR-TB treatment and control, prevention and management of TB/HIV, and reform of health care financing systems. For TB control to be successful in the Russian Federation, the characteristics of the traditional TB control model need to be taken into account.