On 24 March 2017, at the press conference to mark the World Tuberculosis Day, public health experts once more emphasized the need to change the outdated approach to treating patients with tuberculosis, which, as demonstrated by the best international practices, is the key obstacle in response to this dangerous disease.

Every year, over 30 thousand people in Ukraine are diagnosed with TB – 4 new cases are registered every hour. Every eighth patient dies. Transition to comprehensive, people-centered TB care can help to reverse the critical situation with the spread of tuberculosis (TB) in Ukraine and in Eastern Europe and Central Asia in general. This particularly applies to multidrug-resistant forms of tuberculosis (MDR-TB), which are not sensitive to most traditional TB drugs and are recently more and more spread both in Ukraine and in the world. As opposed to drug-sensitive tuberculosis, which needs to be treated for 6 months, treatment of MDR-TB is much more expensive and takes up to 2 years. In our country, MDR-TB is detected in each forth patient with newly diagnosed TB and in each second patient with TB relapses. Besides, Ukraine has the worst in Europe TB cure rates – only 71% newly TB cases and 39% MDR-TB cases are cured.

Today, Ukraine is one of the TOP 5 countries in the world with the highest burden of MDR-TB. Special threats are associated with patients seeking medical care at late stages, late detection of tuberculosis and HIV/TB co-infection, which leads to high mortality rates and is a result of failure to implement a comprehensive approach to combining prevention and treatment programs at the national and regional levels into a single effective response system,” – said Olha Bohomolets, MP, Head of the Verkhovna Rada Committee on Public Health in her speech at the press conference.

People-centered approaches, widely accepted all over the world, only start to be launched in Ukraine. They stipulate delivery of integrated medical and social support (e.g., food packages, transport vouchers, etc.) as well as psychological support of patients to enable them complete lengthy treatment courses. Provision of such services should be based on individual needs of each particular patient. In most cases, people-centered approaches stipulate ambulatory care – at home or in local polyclinics. Not all patients require in-patient treatment and, if there are no medical indications for hospitalization, the person does not have to be isolated in a hospital. From the point of view of public health, hospitalization does not prevent the spread of tuberculosis as most cases of transmission occur before a patient is diagnosed and admitted to a hospital. Several weeks after initiation of treatment, there is no more risk of the patient transmitting tuberculosis to other people.

“Without a robust people-centered care, we won’t see any meaningful impact on TB epidemiology,” – told Dr. Masoud Dara, Coordinator, Communicable Diseases and Programme Manager, TB, HIV/AIDS and Viral Hepatitis Division of Health Emergencies and Communicable Diseases, WHO Regional Office for Europe, – “It is high time to ensure services are adapted to people’s specific needs at all levels.”

Throughout the whole course of TB treatment, necessary support may be provided by a social worker or a nurse to help patients successfully complete their treatment.

To end the TB epidemic, Ukraine has only one recipe to implement quality people-centered TB care, – pointed out Andriy Klepikov, Executive Director of the Alliance for Public Health. – Within its pilot projects supported by the Global Fund, Alliance proved that combination of medical, social and psychological support allows increasing MDR-TB cure rate twofold! 80% of patients with MDR-TB were cured! This is a really impressive result, considering that the average treatment success rate for such patients in Ukraine is less than 40%.

Pain, fever, severe allergic reactions, etc. – when starting therapy, patients suffer from strong side effects. Not all of them have enough courage and willpower to spend two long years in a closed treatment facility, which leads to a threat of treatment interruption and further spread of the epidemic. That is where the new approach to TB care can help, ensuring that patients complete their treatment courses.

“For me personally, people-centered care has a number of advantages. First and foremost, it ensures uninterrupted supply of effective drugs,” – told Ihor Svachii, a patient who has been treated within social support program for almost a year. – “The second important thing is that I get treatment at home. In a hospital, you feel isolated anyway, and I surely wouldn’t be able to stand it for two years. Emotionally, it is very difficult. At home you are in familiar settings. You’ve got a computer, a TV set, music, books. You can go for a walk. You can feel support of your friends and family, while they would have limited access to hospitals.”

The importance of taking into account patients’ experience when implementing the reform may not be underestimated. People who were personally affected by the disease know about patients’ needs better than anyone else. Their opinion should be the basis of any decisions on what the quality TB care should be like.

“Patients should be the ones to make an impact on the national and regional TB response policies, control availability of the medicines, fight stigma and discrimination and choose the people-centered TB care model convenient for them,” – said Viktor Pylypenko, Chair of the Board of NGO “All-Ukrainian Association of People Who Recover from Tuberculosis “Stronger than TB”.

Currently Ukraine has all the chances to change the situation for the better, but to make it happen, tuberculosis should become a priority in the general trend of healthcare reforms in the country. There is an urgent need in accelerating efforts in response to the disease at all levels. Parliamentarians play one of the key roles in this regard, approving budgets, making policies and having great public impact. In Ukraine, international movement of parliamentarians against tuberculosis – the Global TB Caucus – is gradually gaining momentum. This unique network operates in the world since 2014 and unites over 1,500 parliamentarians committed to the fight against TB from 130 countries

As a member of the Eurasian Parliamentary Group on TB, which includes about 200 MPs from the countries of Europe and Central Asia, I support all the efforts aimed at implemented an integrated approach to unite prevention and treatment programs in order to end the epidemic of this disease in the country,” added Olha Bohomolets.

Now our country is a recipient of multilateral international aid to reform the approaches to ending the TB epidemic. But the future depends on us. We all – the government and the community – should unite our efforts for the reforms to benefit each person and the society in general.

Please see the press release.

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The press conference was organized by ICF “Alliance for Public Health” (www.aph.org.ua), a leading Ukrainian civil society organization, co-implementer of the National TB and HIV/AIDS Programs and one of the principal recipients of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GF). With the GF support, Alliance together with the Ukrainian Red Cross Society implements programs aimed at social support of patients. In 2016, with financial support of the GF, Alliance procured and provided to healthcare institutions medications and diagnostic equipment for over UAH 410 mln. On behalf of the TB Europe Coalition, Alliance is also partner of the PAS Center (Moldova) and WHO Regional Office for Europe in implementing the TB in Eastern Europe and Central Asia Project on Strengthening Health Systems for Effective TB and DR-TB Control (TB-REP) aimed at reformation of the TB care system to reduce the TB burden and stop the spread of drug-resistant forms of tuberculosis in 11 countries of Eastern Europe and Central Asia with support of the GF.


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