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Ann. N.Y. Acad. Sci., Annals PrePrint, published online ahead of print October 22, 2007 doi: 10.1196/annals.1425.009 Copyright © 2007 by the New York Academy of Sciences description
1 Social Medicine and Health Inequalities, Brigham and Women's Hospital, FXB Building, Boston, Massachusetts, 02115, United States; , 30 Essex Street, Cambidge, Massachusetts, 02139, United States 2 N/A, Partners in Health, 641 Huntington Ave, Boston, Massachusetts, 02115, United States 3 Tomsk Office, Partners in Health, Belinskogo St., 15a, Tomsk, Tomsk, 634029, Russian Federation 4 N/A, Tomsk Oblast Tuberculosis Services, R. Luxemburd St., 17, Tomsk, Tomsk, 634009, Russian Federation 5 Ministry of Justice, Penitentiary Services, Belinskogo St., 15a, Tomsk, Tomsk, 634029, Russian Federation 6 Social Medicine and Health Inequalities, Brigham and Women's Hospital, FXB Building, Boston, Massachusetts, 02115, United States 7 Department of Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, Massachusetts, 02115, United States
* To whom correspondence should be addressed. E-mail: salmaan{at}pih.org. PrePrint Abstract
Tuberculosis (TB) and multidrug-resistant TB (MDR-TB) are diseases of poverty. Since Mycobacteria. tuberculosis predominantly exists in a social space often defined by poverty and its comorbidities—overcrowded or congregate living conditions, substance dependence or abuse, lack of access to proper health services, to name a few—the biology of this organism and of TB drug resistance is intimately linked to the social world in which patients live. This association is demonstrated by the case of Russia, where political changes in the 1990s resulted in increased socioeconomic inequality and a breakdown in health services. The impact on TB and MDR-TB is reflected both in terms of a rise in TB and MDR-TB incidence and increased morbidity and mortality associated with the disease. We present the case example of Tomsk Oblast to delineate how poverty contributed to a growing MDR-TB epidemic and increasing socioeconomic barriers to successful care, even when available. The MDR-TB pilot project implemented in Tomsk addressed both programmatic and socioeconomic factors associated with unfavorable outcomes. The result has been a strengthening of the overall TB control program in the region and improved case-holding for the most vulnerable patients. The model of MDR-TB care in Tomsk is applicable for other resource-poor settings facing challenges to TB and MDR-TB control. Key Words:
drug-resistant tuberculosis, MDR-TB, DOTS-Plus, DOTS, Poverty, Inequality, Russia, Partners In Health, scale-up of MDR-TB treatment, community-based TB treatment
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