Feeling tired and sleepy all the time? Look like you've lost some pounds and developed a cough? There might me a change you got TB! Teresa Kasaeva, a Russian Health Ministry official, told us about the early symptoms of tuberculosis, risks of contracting it while travelling, and common patient’s reluctance.
According to a widespread opinion, the tuberculosis problem threatens only socially handicapped people, for example the homeless, the incarcerated, and addicts. Is this opinion correct?
Teresa Kasaeva: Yes, the incidence of tuberculosis reflects, in particular, the social and economic problems of a country. At first, tuberculosis was regarded as a disease of the poor, since adverse conditions of life facilitated the pathological process. But in course of time the disease went beyond the poor. In the age of modern globalization, with migration flows increasing, people who are not always healthy, are traveling more. This disease is airborne. That’s why almost everyone risks contracting it. However, in most cases the immune system prevents the disease from developing.
The factors which allow for the development of the disease are: a decrease in the immune system, weakness due to various conditions, malnutrition, and arduous working conditions. Unfortunately, the rush of the modern life, especially in cities results in even healthy and young people catching the disease, not just the lower class.
What symptoms should prompt one to go to the doctor?
Teresa Kasaeva: The main symptoms include coughing longer than a month, a subfebrile temperature (37 -37,5°C), ever increasing weakness, sweatiness, and weight loss. But there are cases when visible symptoms are absent. One may develop tuberculosis very rapidly whereas sometimes it can stay hidden for more than a year. It is all very individual. That’s why it is so important to undergo medical checks and photofluorography in timely manner and as doctors prescribe.
Will health workers ever succeed in stopping the spread of tuberculosis?
Teresa Kasaeva: Tuberculosis still poses a serious threat to the world and Russia is no exception. The World Health Organization (WHO) has set an ambitious aim - to have eradicated the disease by 2050. At the latest WHO Assembly, Russia joined on to the global strategy for stopping tuberculosis and that is a major step in attaining this objective. And we can even feel right to think we can beat the disease. We have made a significant breakthrough in the recent years. Russia in the late 1990s was plagued with social and economic problems, leading to a tuberculosis outbreak. The situation was threatening, but the state made a great effort and got the upper hand. The spread of tuberculosis in 2013 has decreased by 7,5 percent in comparison to that of 2012 and by more than 18 percent in contrast with that of 2007. The tuberculosis mortality rate in 2013 has dropped by 9,6 percent compared to 2012 and by 38,6 percent to 2007.
Does this mean the Russian tuberculosis prevention system is smoothly running, or are there still some difficulties left?
Teresa Kasaeva: Yes, the tuberculosis mortality rate and its spread have really seen some positive reductions. But there are yet some problems to be solved.
The global reach of Russia, its heterogeneous territory, and differences in its climate affect the epidemiological situation of tuberculosis. Whereas the central and southern regions have a situation similar to that in Europe, the Siberian and Far Eastern regions still suffer from high mortality and infection rates of tuberculosis, although the figures have fallen. The Ministry is paying special attention to such regions. Specialists from institutions have also been giving organizational and methodical assistance.
There is also a high concern about the growing number of HIV positive people contracting tuberculosis.
Another problem presenting itself to Russia and the world is the growing number of people with drug-resistant tuberculosis. Currently we concentrate all our efforts on providing such patients with corresponding treatment. Almost all regions use federal budget funds to supply their TB dispensaries with up-to-date lab equipment for measuring drug susceptibility, including accelerated measuring. Timely measured drug susceptibility allows doctors to institute optimum chemotherapy which is crucial in beating the disease.
An active campaign of modernizing tuberculosis dispensaries in the far regions has also been carried out since 2008. Federally and regionally allocated funds have allowed departments to purchase essential equipment including devices for in vitro diagnostics of tuberculosis.
What funds are allocated for regions from the federal budget?
Teresa Kasaeva: More than one billion rubles are annually directed to the far regions in the form of subsidies aimed at equipping tuberculosis dispensaries and medical facilities. More than 3,5 billion rubles are annually allocated from the federal budget to provide second line anti-TB drugs and diagnostics for patients with multi-drug resistant tuberculosis. On their own, the far regions spend a part of their budgets to meet the requirements for first line anti-TB drugs.
Some experts suppose that centralized purchasing directly from the manufacturer with precisely calculated regional needs could significantly save funds…
Teresa Kasaeva: Before 2008, anti-TB drugs were purchased in a centralized way in compliance with regional requests. Later, the Ministry of Health cancelled the routine procedure of collecting and carrying out those requests, because it hampered the timely delivery of medicines. Nowadays regions receive interbudgetary transfers, which helps them swiftly react to changes in the epidemiological situation and ensure continued treatment of patients with multi-drug resistant tuberculosis.
Continued treatment ranks among the most important factors in helping TB patients. There cannot be any breaks due to lack of medicines or because of a patient’s reluctance.
We understand this scheme may not solve all the problems we encounter. But nevertheless it enables us to render more targeted assistance to TB patients including ones with multi-drug resistant tuberculosis.
Some experts complain about Russia not receiving grants of the Global Fund to Fight HIV, tuberculosis, and malaria. What is the reason for that?
Teresa Kasaeva: Having settled the critical tuberculosis threat, the Russian Federation declared it is no longer a recipient of grants of the Global Fund to Fight HIV, tuberculosis, and malaria. This WHO-supported Fund provides medicines and diagnostic facilities for countries incapable of financially supporting their own anti-tuberculosis campaigns. Now, not only can we meet these needs, moreover, we are contributors to the Global Fund, providing funds for other countries. . This is why we cannot rely on such grants any more. If foreign funds are to be considered, we have active cooperation with them. For example, currently we are starting partnership with the Foundation for Innovative New Diagnostics (FIND). Hopefully, our fight against tuberculosis will benefit from these contacts.
