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The PHRI/Soros Russian TB Program ... Treating MDRTB
in Siberian Prisons

The tuberculosis epidemic in Russia, particularly in the Russian prisons, had reached alarming proportions by the mid 1990s. Virtually every prisoner in Russia was exposed to tuberculosis, many became sick, and many died, and tens of thousands of infected individuals were being released into the general population.

At the initiation of PHRI's Dr. Alexander Goldfarb, who became the Project Director, the Soros Foundation/Open Society Institute provided several grants, ultimately totaling $13 million, for PHRI to develop demonstration tuberculosis control projects which could become a model for replication throughout Russia.

Accomplishing this aim required the establishment of collaborative working relationships with a variety of partners in Russia, building a laboratory infrastructure virtually from scratch, training laboratory and medical personnel, implementation of TB control procedures, provision of appropriate first and second line drugs, advocacy to convince TB and governmental leaders to proceed with the program, and a myriad of additional tasks, all taking place in a highly charged political atmosphere.

Beginning in 1997, PHRI succeeded in establishing effective TB control systems in several Russian regions, in both civilian and prison populations, and successfully managed the treatment of thousands of patients with drug susceptible tuberculosis. In addition, PHRI established, in the oblast of Tomsk in western Siberia, the first, largest, and still (to our knowledge) the only large scale functioning program in Russia to treat multiple drug-resistant tuberculosis (MDRTB) in both prison and civilian settings.

Once the program was implemented, it required an ongoing medical presence, and PHRI invited the Partners-in-Health (PIH) organization, headed by Drs. Paul Farmer and Jim Kim of Harvard, into the project, first as consultants and then to assume medical management of the project. Ultimately, over the course of 2001-2002, PHRI transferred the entire Tomsk program to PIH.

The December 2000 report which PHRI submitted to the Soros Foundation/Open Society Institute, attached hereto, contains a complete overview and detailed description of the work PHRI did on this project.

PHRI did not work alone, however, and could never have succeeded without the significant contributions of its partners, including the UK based Medical Emergency Relief International (MERLIN), US Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), the Tomsk Oblast TB Services, the Tomsk Oblast Regional Health Administration, the Tomsk Regional Department of Corrections (UIN), the Federal Department of Corrections (GUIN) Medical Department, the Central TB Research Institute (CTRI), the Massachusetts State Laboratory Institute (MSLI), and of course, Partners-in-Health.

PHRI was also assisted in its work by an outstanding Advisory Committee chaired by Dr. Lee Reichman (New Jersey Medical School, UMDNJ), and including Malgosia Gzremska (WHO, Geneva), Dr. Kitty Lambregts (KNCV, The Netherlands), Dr. Max Salfinger (New York State Department of Health), Dr. Rick O'Brien (CDC), Dr. Naomi Bock (Emory University, Atlanta), Dr. Mike Iseman (National Jewish Medical and Research Center, Denver), and Dr. Paul Farmer (Harvard, partners-in-Health).

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