Today’s guest blog comes from Sergey Kornienko, M.D., Ph.D., Head of the Regional Clinical Tuberculosis Hospital in Voronezh, Russia, and Chief TB Specialist of the Central Federal District. Lilly congratulates Dr. Kornienko for being recognized as Best TB Health Care Manager by the Russian TB Society and the Foundation named after M.I. Perelman.
Talking about the need to improve the diagnosis and care of patients with multidrug-resistant tuberculosis, Paul Farmer, a world-famous anthropologist and physician, once said, “I can't think of a bigger challenge faced by medicine and public health.” As a physician who treats MDR-TB, I find it hard to find more precise words to define this problem. There are reasons to be optimistic, though, about overcoming this challenge, and one example comes from our work in Voronezh, Russia, where the rates of TB cases and deaths have more than halved.
Since 2005, we have established a systematic approach to prevent MDR-TB. It is based on eliminating a hidden reservoir of the infection by mass screening and introduction of innovative operational, diagnostic and treatment approaches both on initial and follow-up steps. Over the past seven years, we have seen important decreases in the rates of MDR-TB incidence and mortality.
How have we helped? Well, generally speaking, we simply took action. We focused on the goal of slowing the spread of MDR-TB, believed deeply that we could achieve it and encouraged colleagues by personal examples of how to take action as health care providers. If you work hard, so do others.
Fighting TB is a complex task; it requires everyone acting in harmony with a well-coordinated system. Unfortunately in this case, the system can fail when just a little part doesn’t work well. This is very true in our work. The best TB drugs and equipment will not generate any improvement unless our team takes ownership. So an important aspect of our work is inclusion: We reached out to everyone in the health center—including technical staff, nurses and physicians—so that everyone had a clear idea what to do and how to do it. Rather than hope for luck, through training we relied on increasing their knowledge and confidence in treatment.
In our region, we created policies to instill discipline and prevent treatment failures due to a human factor. Now everyone treats along standard lines. I’d like to see the same done in all regions of Russia, but it takes political commitment at all levels, including the governor’s office and municipal or rural heads.
We haven’t invented everything we do, of course. We learn from international experiences that might help us improve our system. Good examples are our joint projects with the Green Light Committee and Partners in Health. With Partners in Health, we are piloting the F.A.S.T. project to improve early MDR-TB diagnostics and treatment in hospitals and patient-oriented support services for hard-to-reach populations. These projects were implemented with the Lilly MDR-TB Partnership’s support and have become an innovative wave in providing TB care in Voronezh. That helped us make optimal choices in building up the regional model of TB care services and the regional health care system as well.
Today our region’s TB care system is well organized and yielding results! TB incidence per 100,000 residents fell from 70.1 in 2005 to 33.0 (59.5 in average in Russia). During the same period, TB mortality dropped from 14.8 to 5.2 persons (10.0 in average in Russia). We are proud but not satisfied. There is more work to be done. Stay tuned from more news from Russia!