The Alliance for Public Health began work on tuberculosis in 2011 and is currently one of three principal recipients of a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria to implement the program “Investing for Impact against Tuberculosis and HIV”. Within this program, the Alliance is implementing a project aimed at early tuberculosis detection among most-at-risk populations: homeless, former prisoners, Roma population, and people who inject drugs. Those populations are most affected by the tuberculosis epidemic and have limited access to medical services. The goal is to find people with symptoms of tuberculosis and help them access medical examination and facilities. Thanks to the active involvement of social workers, since the beginning of 2015 405 patients with TB have been identified, and 350 of them have already started treatment.
The second important program component, in partnership with the Ukrainian Red Cross Society, is support of patients with multidrug-resistant tuberculosis (MDR-TB). Red Cross nurses visit patients at home on a daily basis, bring them TB drugs and providing social support in the form of food packages. Currently, 1,899 patients all over Ukraine are receiving this support.
Best Practices of Alliance TB Activities in WHO Publication
Best practices of Alliance activities in the various aspects of TB programs are presented in the publication of the World Health Organization (WHO) Regional Office for Europe “Good practices in strengthening health systems for the prevention and care of tuberculosis and drug-resistant tuberculosis”.
Alliance represents Ukraine with its unique experience in supporting patients with multidrug-resistant tuberculosis (MDR-TB) at the outpatient stage of treatment. Within Alliance cooperation with the Ukrainian Red Cross Society with support of the Ukrainian Center for Disease Control of the Ministry of Health of Ukraine, great progress was made in significantly reducing the rate of treatment interruption among the patients with MDR-TB. To promote treatment adherence among MDR-TB patients treated with second-line drugs in outpatient settings, daily follow-up care was delivered by nurses of the Ukrainian Red Cross Society. The package of services included the arrangement of high-quality DOT services brought close to patients aimed at preserving the customary way of life for patients to the maximum extent possible. Such services included delivery of medications and control over their administration at home or in another place convenient for patients and distribution of food packages among all patients who adhere to treatment twice a month. Besides, all patients received medical and psychosocial support during the whole period of treatment, which increased treatment success rate up to 85.6% as compared to 37% among those patients who did not receive such support.
Another best practice of Alliance included into the Health Service Delivery section is dedicated to early detection of TB among vulnerable groups. Taking into account that TB incidence in vulnerable populations is 10 times higher than the estimated incidence among general population, in 2013-2014 Alliance launched services of early TB detection in vulnerable populations. In cooperation with regional NGOs, questionnaires to screen for TB symptoms were introduced among clients at the high risk of this disease, and also a referral system was developed to guide patients in the healthcare system. One of the significant factors defining the success of early TB detection thorough screening among vulnerable populations is relatively low cost of this intervention.
WHO Regional Office for Europe also marked Alliance practice of TB treatment concomitantly with opioid substitution therapy (OST). Considering that over 40% of patients who receive OST are HIV-positive and almost one third of them also have TB, Alliance opened OST sites in TB treatment clinics. It allowed improving the access of people who inject drugs to health care, treatment of drug dependence, HIV and TB. People who inject drugs require a special approach to the treatment of TB, especially MDR-TB, but not all TB treatment facilities were ready to open their doors to such patients. An advantage of this approach is that it ensures effective cooperation between the TB and drug treatment services, which, in its turn, allows using an integrated approach to providing services to patients.
Read more about those and other good practices in prevention and care of tuberculosis.