The Russian Federation has not been eligible to apply for funding for TB several years. That does not mean that there is no TB problem in the Russian Federation. In fact, the TB risk is ranked as “severe” according to the Global Fund’s own index. The Federation was not eligible to apply for TB because of its income level. The Russian Federation is currently categorized as high-income. A couple of years ago it was classified as upper-middle-income. The Global Fund believes that the Russian Federation has sufficient resources to offer comprehensive TB services to its population without requiring outside assistance.
However, the reality has been that TB services were not being provided to some key affected populations (KAPs) because of the negative attitudes towards these populations in official circles.
So, The Global Fund took advantage of the fact that under the NGO rule, Russia was still receiving funding to provide HIV services. The Fund included a small TB/HIV component in the HIV grant aimed at early detection of TB among people who inject drugs (PWID) in the Tomsk oblast (i.e. region). This component of the grant also supports a training centre, which is providing educational seminars and training for KAPs in HIV, TB, and hepatitis C prevention; reproductive health; drug overdosing prevention; and other topics related to harm reduction and infection control. The component has two core objectives: (1) to prevent TB/HIV co-infection; and (2) to strengthen the TB-control capacity of NGOs providing HIV services.
The component is run by local NGO, Tomsk-AntiAIDS, founded in 2000 to support people living with HIV and PWID, and to prevent a rapidly growing HIV epidemic in the Tomsk oblast. Tomsk-AntiAIDS has been partnering with two PRs from The Global Fund rounds-based programs: Partners in Health, and the Open Health Institute (OHI). The latter is current PR for the HIV grant.
Tomsk Anti-AIDS has accumulated extensive experience and knowledge in providing low-threshold services, psycho-social support, peer education, outreach, training, and counselling. One of the achievements of the round-based programs is a replicable TB control and prevention model among KAPs.
The model, the capacity of the training centre, the existence of a counselling facility, and the technical knowledge and experience of the project staff and volunteers – all of these things argued in favour of the expansion of the TB/HIV component of the HIV grant.
According to Elena Zaitseva, The Global Fund Program Director at OHI, “Tomsk has a long and positive history working on HIV/TB co-infection among PWID. They were pioneers in providing TB treatment and social support at low-threshold settings and their experience is well known in Russia and beyond.”
Because the funding for the current grant was limited, initially only Tomsk was included in the project. However, the current budget of the HIV program may be large enough and flexible enough to accommodate expansion of the TB/HIV component to other oblasts. At the beginning of June, representatives of six cities in the Russian Federation, HIV project staff, volunteers, peer educators, and coordinators attended a training and learned about the basics of TB and TB-control, early diagnostics of TB among KAPs, methods of the treatment, and barriers to including PWID into the treatment services.
Some of the reasons why the TB/HIV project has been successful are that everything (including the budget) is built around a single strategy; all results are documented; and the results are presented to local government to obtain their buy-in. The initiative has been around a long time (since the early 2000s) and has been consistently producing results. As Elena Borzunova, program director of Tomsk Anti-AIDS explained, “We are not physicians, we see ourselves as mediators between the KAPs communities and medical services. Our mission is to identify, refer, accompany, and protect rights.”
Transforming the Tomsk project into a replicable model for TB/HIV prevention among KAPs and supporting the training centre’s capacity in module development would be a step towards sustainability of these services in the Russian Federation. However, the reality is that there are still legislative restrictions in the Federation to providing any prevention programs to certain KAPs. The road ahead is not without its challenges.