24 MARCH IS A WORLD TB DAY
Today, every fourth person with tuberculosis (TB) remains unnoticed by our national healthcare system! Due to the lack of minimum conditions required for early TB detection in the context of the military conflict in the East of Ukraine, the development of TB epidemic is now uncontrolled like a “black hole”, which is a real threat for other regions of the country, especially considering high level of migration and big number of internally displaced persons. This is a catastrophe which should be in the focus of attention of policy-makers, government officials and national media!
Recently, a tendency is observed in Ukraine and in the world of further transmission of the forms of tuberculosis not sensitive (resistant) to most traditional drugs. Ukraine ranks fifth in the worldaccording to the prevalence of multidrug resistant tuberculosis (MDR-TB)! According to the results of the first national epidemiological study, the level of MDR-TB among newly diagnosed patients is 22.0%, and among people with recurrent cases of TB – 55.6%.
Ukraine still has the worst in Europe TB cure rates – only 71% of newly diagnosed TB cases and 34% of MDR-TB cases are cured.
The main activities of International Charitable Foundation “Alliance for Public Health” (hereinafter – Alliance) as a co-recipient of the Global Fund to Fight AIDS, Tuberculosis and Malaria (hereinafter – Global Fund) in countering the TB epidemic are aimed at its early detection among members of key populations and providing effective treatment to patients with MDR-TB.
In 2015, almost five thousand patients with MDR-TB received drugs and social support withsupport of Alliance; in total, it is planned to provide treatment courses to 9,300 patients.
Alliance implementing partner in support of patients with MDR-TB who receive outpatient treatment is the Ukrainian Red Cross Society (hereinafter – Red Cross). Cure rates of the patients who receive medical and social support of the Red Cross with the help of Alliance are encouraging: cure rates went up to 89.6% as compared to 32% among the patients who did not receive such support. Thus, social support of patients and forming adherence to treatment are as important for eliminating the epidemic as financing of TB treatment.
If the cost of a treatment course for drug-sensitive tuberculosis is $35, the cost of MDR-TB treatment is about $2,200, which is 62 times higher! Providing access to high-cost TB treatment for members of key populations is one of the key tasks of Alliance. Since 2012, we have been procuring drugs for treatment of patients with MDR-TB, and the scope of our procurement has been increasing every year. Thus, in 2015 drugs were procured in the total amount of USD 11.7 million, which will allow providing treatment to 5,250 patients or half of all MDR-TB patients in Ukraine.
Nine percent of MDR-TB patients develop side effects, which often result in treatment termination. To minimize the number of patients who drop out of treatment and to prevent development of drug-resistant TB forms, last year Alliance for the first time procured medications to eliminateside effects for all MDR-TB patients who needed them, which is very important to improve their quality of life.
The situation with tuberculosis treatment in Ukraine is aggravating due to the outdated approach to patients’ hospitalization. The average period of hospital stay is 90 days, while according to WHO data most patients are no longer dangerous to people around them three weeks after they start their therapy, and they can switch to outpatient treatment. So their isolation in inpatient units is not justified. Alliance also promotes modern approaches to TB treatment that should be first ofall patient-oriented, which stipulates expansion of outpatient service delivery models, case management practices, and multidisciplinary approaches to meet social and psychological needs of the patients.
Despite considerable restrictions of the activities of humanitarian organizations in the temporarily occupied territories in the East of Ukraine, in 2015 Alliance conducted six successful deliveries of humanitarian consignments, including 23 thousand packs of TB treatment drugs. Aggravation of the epidemic situation in the East of Ukraine is more and more critical. For example, the numberof cases of active TB forms even in Ukraine-controlled areas of Luhansk oblast grew by almost30%, in particular among children and adolescents – 2.3 times! As for the incidence of TB/HIV co-infection, its level increased almost 30% among the general population of Ukraine-controlledareas of Luhansk oblast. There are no official data related to the areas not controlled by Ukraine. The war in Eastern Ukraine led to the creation of some kind of a “black epidemic hole”, which may become a source of transmission of socially dangerous diseases in Ukraine. Alliance plans to provide further support to 14 partner civil society organizations in Donetsk and Luhansk oblasts, which work to provide early TB detection among the key vulnerable populations.
Alliance implements TB programs not only in Ukraine, but also in other countries of WHO European region. Thus, January 2016 was a starting point of the first three-year regional project “Strengthening health systems to effectively control TB and MDR-TB in Eastern Europe and Central Asia”. Alliance together with TB Europe Coalition is one of the leading partners involved into implementation of the project, focusing on its vital component – coordinating and uniting efforts of partners and stakeholders. In particular, this component is aimed at uniting the efforts of CSOs to advocate for the development of outpatient care systems with high-level efforts aimed at reforming healthcare systems to increase the effectiveness of TB control in target countries.
On the occasion of the World TB Day, the Alliance for Public Heals calls to policy-makers andresponsible government officials of all levels not to delay reforms of healthcare systemsnecessary to implement patient-oriented approaches in the delivery of timely and high-qualitymedical and social support to TB patients!