Objectives: Unlike most of the world’s nations, the Russian Federation has a growing incidence of people living with human immunodeficiency virus (HIV). Tuberculosis (TB) is the leading killer of people with HIV, and certain regions in Russia and countries of the former Soviet Union suffer endemic TB compounded by multidrug-resistant strains. In partnership with an academic university in the U.S. and regional academic and public health institutions in Irkutsk, Siberia in the Russian Federation, and supported by joint Russian Foundation for Basic Research and U.S. National Institutes of Health grants, we sought to understand the HIV/TB co-epidemic in Irkutsk, define the intersection of microbe, host and social factors that drive transmission and outcomes, and develop a person-centered mobile health-based programme to enhance integration of HIV and TB care in the region.

Results: We initially determined phenotypic and genotypic relationships within antibiotic resistance determining regions of regionally diverse circulating Mycobacterium tuberculosis strains including the identification of novel strains with enhanced intracellular survival. We then enrolled a prospective cohort of people with drug-resistant TB, the majority with HIV co-infection, and found distinct patterns of individual pharmacodynamic variability of key anti-TB drugs that determined treatment outcome when controlling for other co-variates. As injection drug use was treated with forms of incarceration and removal from larger society without access to opioid replacement therapy, injection drug use and other stigmatized behaviors were found to contribute to the social drivers of disease acquisition and treatment outcome. Thus, we next evaluated outcomes for a cohort of people with HIV, TB, and substance use in Irkutsk after participation in a multi-feature mHealth intervention called MOCT. Sixty patients were enrolled during hospitalization for TB. The majority linked to HIV care by 6 months (83%). Self-scoring of confidence in ability to communicate with HIV providers improved from baseline (median score 8, scale 1-10) to 6 months (10, p = 0.004). A higher proportion of the MOCT subset refilled antiretroviral therapy for HIV (69% vs. 43% in pre-intervention cohort, p = 0.01), with fewer deaths in the MOCT subset at 6 months (1 death vs. 10 deaths in pre-intervention cohort, p = 0.02) and a decreased likelihood of developing the composite outcome of death/failure to achieve viral suppression at 6 months (adjusted odds ratio = 0.33, p = 0.029). At the height of programmatic integration prior to Russia’s invasion of Ukraine, 4,640 people had attended mobile screening events for HIV testing in the Irkutsk region, 338 (7.5%) were HIV infected and linked to care; of those in care throughout the region, 2,005 were using the MOCT app. 

Conclusions: Our experience demonstrated that microbe, host and importantly sociobehavioral drivers of a considerable TB and HIV co-epidemic can served by using multimodal mobile health-based program to overcome stigma and social isolation, and enhance communication and streamline workflow between providers across multiple collaborating institutions. Social marginalization, such as policies of incarceration for addiction or exclusion of minority populations of sexual orientation or gender identity, were commonalities consistently shared in the HIV epidemic in Siberia/Russian Federation and the U.S. Gains toward inclusion and beneficial health outcomes that were observed prior to the abrupt end of the partnership following Russia’s invasion of Ukraine, are notably tenuous, and expected to erode as the war persists.