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Aims To test the feasibility and effectiveness of Brief Counseling Intervention (BCI) and Naltrexone integrated into tuberculosis (TB) care in Tomsk, Russia. Design Using factorial randomized controlled trial design, patients were randomized into: Naltrexone, Brief Behavioral Compliance Enhancement Therapy (BBCET), treatment as usual (TAU); BCI, TAU; Naltrexone, BBCET, BCI, TAU; TAU. Setting and Participants In the Tomsk Oblast, hospitalized TB patients diagnosed with Alcohol Use Disorders (AUDs) by the DSM-IV were referred upon the start of TB treatment. Of the 196 cohort, the mean age was 41 years and 82% were male. Severe TB (84.7% had cavitary disease), and smoking (92.9%) were common. The majority had a diagnosis of an AUD (63.0%). 27.6% reported nearly daily drinking and consumed a median of 16 standard drinks per day. Measurements Primary outcomes were “favorable” TB outcome (cured, completed treatment) and change in mean number of abstinent days in the last month of study compared with baseline. Change in mean number of heavy drinking days, defined as 4 drinks per day and 5 drinks per day for women and men respectively, and TB adherence, measured as percent of doses taken as prescribed under direct observation, were secondary outcomes. Analysis based on “intention to treat” was performed for multivariable analysis. Findings Primary TB and alcohol endpoints between naltrexone and no-naltrexone or BCI and no-BCI groups did not differ significantly. TB treatment adherence and change in number of heavy drinking days also did not differ significantly among treatment arms. Among individuals with a prior quitting attempt (n=111), naltrexone use was associated with an increased likelihood of favorable TB outcomes (92.3% versus 75.9%, P=0.02). Conclusions In Tomsk Oblast, Russia, tuberculosis patients with severe Alcohol Use Disorders who were not seeking alcohol treatment did not respond to naltrexone or behavioral counselling integrated into tuberculosis care; however, those patients with past attempts to quit drinking had improved tuberculosis outcomes.

Russian Federation’s (RF) HIV epidemic is the fastest growing of any country. This study explores factors associated with high HIV risk behavior in tuberculosis (TB) patients with alcohol use disorders in Tomsk, RF. This analysis was nested within the Integrated Management of Physician-delivered Alcohol Care for TB Patients (IMPACT, trial number NCT00675961) randomized controlled study of integrating alcohol treatment into TB treatment in Tomsk. Demographics, HIV risk behavior (defined as participant report of high-risk intravenous drug use and/or multiple sexual partners with inconsistent condom use in the last six months), clinical data, alcohol use, depression and psychosocial factors were collected from 196 participants (161 male and 35 female) at baseline. Forty-six participants (23.5%) endorsed HIV risk behavior at baseline. Incarceration history(Odds Ratio (OR)3.93, 95% confidence interval (CI) 1.95, 7.95), age under 41 (OR:2.97, CI:1.46, 6.04), drug addiction(OR: 3.60 CI:1.10, 11.77), history of a sexually transmitted disease(STD)(OR 2.00 CI:1.02, 3.90), low social capital (OR:2.81 CI:0.99, 8.03) and heavier alcohol use (OR:2.56 CI: 1.02, 6.46) were significantly more likely to be associated with HIV risk behavior at baseline. In adjusted analysis, age under 41(OR: 4.93, CI: 2.10, 11.58), incarceration history(OR: 3.56 CI:1.55, 8.17) and STD history (OR: 3.48, CI: 1.5, 8.10) continued to be significantly associated with HIV risk behavior. Understanding HIV transmission dynamics in Russia remains an urgent priority to inform strategies to address the epidemic. Larger studies addressing sex differences in risks and barriers to protective behavior are needed.

Nosocomial transmission contributes to the spread of multidrug-resistant (MDR) tuberculosis to patients with drug-susceptible tuberculosis. Use of the FAST strategy in 2 Russian hospitals was associated with significantly less MDR tuberculosis after 12 months.