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.
With support of Alliance the Parliament Platform to Fight Tuberculosis Established at Ukraine
On October 3, 2017 in Verkhovna Rada of Ukraine, an interfactional platform of Parliamentarians was established to consolidate efforts to fight longstanding epidemic of tuberculosis (TB) in Ukraine. Members of Parliament representing different factions and committees willing to contribute to end the disease in our country joined the Parliament Platform to Fight Tuberculosis.
For over a year, the Alliance of Public Health, which is the focal point of the civil society organizations for working with the Global TB Caucus in our country, and the international movement of parliamentarians Global TB Caucus, contributed to the development of the deputy initiative in Ukraine and its setting in the interfractional parliamentary association to fight against TB. As a result of this activity, on October 3, 2017, the Speaker of the Verkhovna Rada announced the official creation of the Parliament Platform to Fight Tuberculosis.
“We united regardless of party affiliation or political views. Within the framework of the Parliament Platform to Fight Tuberculosis, beside legislative resolution of issues concerning elimination of TB, our goal is to effectively cooperate with all related authorities, listen to the needs of the patients, ensure sustainable budget to fight the disease, collaborate with the civil society and parliaments of other countries. That is, to be the center of partnership and joint efforts. A special task of the Parliament Platform is to promote the rights of people affected by TB and overcome discrimination and stigma toward the patients and their families”” —noted during the Round Table on Establishing the Parliament Platform Mr. Serhiy Kiral, Member of Parliament of Ukraine, PACE Reporter on antimicrobial resistance and tuberculosis in Europe.
Participation in the event was attended by peoples’ deputies of Ukraine,, delegates of key international organizations, leaders of respective authorities, representatives of civic society, patients, and people affected by TB. At the beginning of the Round Table Olha Klimenko, a former patient and author of the book “The World in Me. Confessions of Tuberculosis Patient”, told the participants of the event about importance of supporting patients during treatment and considering their needs, based on her own experience: “A patient with any diagnosis is, first of all, a human being in need of help and support. It is important for people receiving treatment to be able to count on all the human and professional support to complete it successfully. We have a goal: to introduce outpatient treatment models in our country. For patients, provided medical indications are positive, to be able to choose whether they get treatment in the TB dispensary or at home, with regular visits and support provided by a social worker”.
Acting Minister of Health of Ukraine stated: “We have the money, we have the medicines, we have new treatment protocols. Our task now is to change the system to serve to the needs of the patients, and not its own needs. We have to make quality diagnostics and effective treatment accessible to people.”
Andriy Klepikov, Executive Director of International Charitable Foundation “Alliance for Public Health” informed regarding the need to switch to comprehensive people-centered systems of outpatient TB care that arises out of the critical situation in Ukraine and throughout Eastern Europe and Central Asia (EECA) region especially with the burden of multi-drug resistant tuberculosis (MDR-TB). He noted that our country is among the countries with the greatest burden of MRTB and that this form of the disease is diagnosed in every second patient with recurrent case of the disease, and in one of every four new cases. “Civil society organizations have proven to be key players in provision of quality and people-oriented TB care. In particular, combining medical, social and psychological support allowed doubling the success rate of MDR-TB treatment! About 80% of patients with MDR-TB were cured! This is a really impressive result, considering that on average in Ukraine, the success rate for such patients is as low as 42%.” — stated Andriy Klepikov – “In view of future switching from donor support to domestic budget sources, it is important to ensure sustainability of funding of effective approaches to detecting and treating tuberculosis. Availability of budget funds and mechanisms for social contracting of services is the foundation of the sustainability of Ukraine’s response to epidemic of tuberculosis.”
Congratulations of the initiative to create a Parliamentary Platform on behalf of the Global TB Caucus announced Rosanna Flury, EECA Regional Director of Global TB Caucus. She noticed that today Caucus has already united more than 2,400 parliamentarians from 132 countries of the world. Due to the political will and support that can be provided by members of the Parliament Platform to Fight Tuberculosis as representatives of the main legislature of the state will enable achieving sustainable outcomes, approving respective budgets and rendering significant public influence required to overcome stigma and raise the awareness of Ukrainians about the disease. Rosanna Flury also stated that “Global political actions are crucial to draw the attention to the problem of tuberculosis, a disease that kills more people than any other infection. We are approaching an important moment in fighting TB — the 2018 UN High-Level Meeting on TB. Ukraine will play an important part in fighting TB in Eastern Europe and Central Asia, as well as on the global level. Global TB Caucus welcomes establishing the Ukrainian Parliamentary Platform.”
The Alliance is confident that the Parliamentary Platform is waited for the fruitful cooperation with the executive authorities, international organizations and civil society. It is very important today to combine all the efforts and key components of the response to the TB problem, in particular, within the framework of the regional TB-REP project, which Ukraine is a participate in.
Follow the official Facebook page at www.facebook.com/platformaborotbiTB for specific steps of the Parliament Platform to Fight Tuberculosis.
Video recording of the Round Table can be viewed at http://newsvideo.su/video/7664241
Video recording of the press briefing on the establishment of the Parliament Platform to Fight Tuberculosis can be found at http://newsvideo.su/video/7664241
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.