Karam is a 23-year-old from the Khatlon region of Tajikistan. He came to Moscow in 2015 to work in construction, and 2 years later fell ill with a high fever and headache. He felt as though he had no strength, but nevertheless tried to carry on. When his condition became so severe that he was barely conscious – a state described by his doctors as the edge of life and death – Karam’s uncle, with whom he lives, called an ambulance.
At the hospital, Karam was diagnosed with tuberculous meningitis. Up until that point, he knew nothing about tuberculosis (TB). He felt afraid and unsure, wondering how he would pay for the treatment he needed to get well. But then he learned that his treatment would be completely free, provided by the Moscow Research and Clinical Center for Tuberculosis Control. This was part of an initiative undertaken by the city of Moscow to ensure that all people, including migrants like Karam, have access to the TB services they need.
A new model of TB services
The city launched the initiative in 2012. Though at that time the TB rate among the resident population of Moscow was declining, increasing numbers of migrants, who are often more susceptible to the disease, made it necessary to change the traditional approach to TB control efforts.
The city created a new organizational model in the spirit of providing universal health coverage to everyone, without causing financial hardship. It based the model on key components that include:
- providing people-centred care;
- strengthening human resource capacity for TB; and
- monitoring the epidemiological situation.
The Chief TB Specialist of the Moscow City Department of Health oversees these activities.
In 5 years, the new model resulted in significant changes to TB care in Moscow. Most importantly, it allowed the city to provide quality services to all vulnerable populations, including migrants and homeless people.
Intensive work with latent TB infection and TB contacts has helped to reduce TB notification rates among permanent residents in Moscow by 11.7% (to 12.8 per 100 000 population) and among children by 23.8%. New approaches to treating multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) have also been applied, with positive outcomes.
In 2016, an increased focus on prevention among the migrant population in Moscow contributed to the detection of an additional 1605 TB cases. Since 2012, the number of TB deaths in the capital has decreased by 22%, and the number of registered patients with MDR-TB has decreased by 44% (to 3.4 per 100 000 population), making it the lowest in the country.
The benefits of Moscow’s new approach to TB services are perhaps felt most deeply on the individual level. For Karam, the news that his treatment would be provided free of charge came as a great relief. It took 2 months of intensive therapy before his condition stabilized and began to improve. He was treated and observed by several specialists over the course of 11 months.
Today, Karam has made a near-complete recovery. He appreciates the work of the doctors who have treated him, supported by the city of Moscow. “When I got here, I felt very bad. I had no strength at all,” he says. “After the treatment started, gradually I became better. I believe I will one day have enough strength to return to work.” When he is well, he hopes to return to his native Tajikistan and his large extended family still living there. He plans to work in his family’s lemon grove.
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