Russia’s epidemic of drug-resistant tuberculosis is one of the worst in the world. Economic decline, the breakdown of social safety nets, alcoholism, and a high incarceration rate have led to a dramatic increase in the disease throughout Russia. The situation is particularly dire in Tomsk Oblast, Western Siberia. There, a dangerously high prevalence of drug-resistant strains in the incarcerated population has ultimately led to the spread of MDR-TB in the civilian community.

In 1998, DGHE physicians and Partners In Health (PIH) began working in collaboration with the Russian Ministry of Health to improve prevention, diagnosis and treatment of TB and MDR-TB in Tomsk’s prison and civilian sectors. The program has successfully reduced the prevalence of MDR-TB, improving diagnostics in order to detect cases earlier, implementing a comprehensive strategy to promote adherence among patients, improving infection control in hospitals and clinics and decreasing transmission of TB to HIV-positive patients.

In 2003, with support from the Eli Lilly Foundation, the project expanded to provide training for Russian healthcare professionals in the clinical management of MDR-TB. The training includes a seminar series encompassing clinical and epidemiologic curricula, followed by a clinically oriented field experience. Participants in the training have ongoing access to Boston-based DGHE faculty and Russia-based PIH staff for support in applying the clinical protocols, operational best practices, and research tools presented in the course. By 2008, the project will have trained over 300 physicians, representing every territory within the Russian Federation.

Throughout the project, DGHE clinicians have conducted research that has helped shape Russia's national MDR-TB treatment guidelines. Backed by the World Health Organization, the US Centers for Disease Control and Prevention and other leading agencies, the team’s research findings have also been incorporated into new global guidelines for treatment of MDR-TB.