A New Paradigm for TB/HIVControl in St. Petersburg

Summary

Principal Investigator: Andrei Kozlov
Abstract: The re-emergence of TB, complicated by the emergence of MDR- TB, is one of the greatest public health disasters for modern Russia if not for the entire world. Unlike the TB epidemics in most countries in the catchment ICOHRTA-AIDS/TB Program (=ICATB) areas, the Russian TB epidemic is unique because of: (1) a high prevalence of MDR- TB; (2) a TB epidemic that has not yet been escalated by HIV; (3) a historically effective Soviet-era TB control program that is now highly cost-ineffective and unsustainable in the current fiscal crisis in controlling the new Russian epidemic. This TB control program constitutes both a major part of the present TB problem and a potential part of the solution. The St. Petersburg ICATB Program builds on a strong pre-existing, largely NIH-supported research infrastructure. Following a Planning Grant-enabled period of ensuring political commitment, identification of priorities and suitable partners and creation of a training and research agenda, we will establish a multidisciplinary TB Research Unit at St. Petersburg State University (SPSU) modeled after, juxtaposed to and synergistic with our successful Fogarty AITRP-funded HIV Prevention Unit. Under this model, a multidisciplinary core of scholars from the SPSU Schools of Medicine, Biology, Psychology, Geography and Management and the St. Petersburg civil and prison TB Control Programs will receive long and intermediate term training in the USA and in Russian DOTS and DOTS-Plus pilot projects. Each US trained junior faculty will receive a Re-Entry Grant for TB/HIV-related research upon return to St. Petersburg. Once TB Research Unit staffing complete, we will pursue a research agenda to generate valid, timely evidence-based data to inform. Russian national TE3 decision makers and move towards a new paradigm for Russian TB control. The TB Research Unit in which a multidisciplinary team of well-trained Russian scientists conducts applied research in Russia is likely to influence national decision making in a way that the current "harping" by international agencies has not. The initial research agenda will focus on: (1) a RCT of DOTS vs. standard Russian TB treatment; (2) a DOTS-Plus pilot project following Green Light Committee guidelines; (3) a social network analysis of high TB transmission areas combining methods of molecular biology, epidemiology, medical geography; (4) molecular epidemiology of transmission of TB in prisons.
Funding Period: 2002-09-22 - 2004-04-15
more information: NIH RePORT