Combatting the Rising Public Health Threat of Multidrug-Resistant Tuberculosis in Tomsk, Russia

Thesis Willemien van Bergen

Maastricht University student Willemien van Bergen completed her master thesis research on “Combatting the Rising Public Health Threat of Multidrug-Resistant Tuberculosis in Tomsk, Russia” (2017). She explored how MDR-TB control measures are being and can be attuned to the biosocial complexity of the disease. Here is an abstract of Willemien’s work.

Background

The rising threat of multidrug-resistant tuberculosis (MDR-TB) contributes to a high health and economic burden, as MDR-TB patients require prolonged and costly treatment with toxic second-line drugs, and rates of treatment failure and mortality are high. Extensive socioeconomic changes in Russia after the dissolution of the Soviet Union led to the predisposition of certain groups to get MDR-TB. There is an urgent need for adequate and tailored TB control in Russia to combat this rising health threat. Tomsk Oblast has served as a pilot area for various promising MDR-TB control initiatives.

Objectives

This study aims to explore the biosocial processes that predispose certain groups in Tomsk Oblast to get MDR-TB. Secondly, it aims to explore how MDR-TB control measures are attuned to this biosocial complexity through processes of standardization and adaptation.

Methods

An explorative, qualitative study has been conducted in Tomsk Oblast. Narrative interviews were conducted with MDR-TB patients and in-depth semi-structured interviews were conducted with TB care professionals. The interviews were audio-recorded, verbatim transcribed and analyzed according to a thematic model.

Results

In the absence of formal financial, health care and social support, people with a low SES are disproportionally prone to develop MDR-TB through processes of marginalization, isolation, increased poverty, alienation from formal support services, and an increased individual burden in taking care of family and oneself. It forces people into the “survival mode”, in which personal health is subordinate towards earning a living and taking care of the family.

The consequent delayed entrance to health care allows MDR-TB to spread around the patient and allows it to progress severely within the patient. As far as resources allow, MDR-TB care in Tomsk Oblast reaches out to the alienated communities from formal health care institutions via active source finding and screening practices. It separates patients from their harmful environment, provides centralized care for comorbidities and provides social support to adhere to treatment and to reintegrate in society after treatment.

Conclusion

Unless Russian health care rethinks its response to MDR-TB massively, this epidemic will not be controlled. Rethinking MDR-TB care would require acknowledging the day-to-day adaptations that many doctors in Tomsk Oblast already make in going beyond treatment guidelines. It would require making these adaptations explicit and extending them.

By extending the mandate of health care to fighting alienation, creating the necessary conditions for treatment adherence and supporting community resilience and reintegration, people can be lifted out of the biosocial processes that made them sick in the first place and their recovery will be sustainable.