I recently attended a roundtable discussion at the European Parliament in Brussels and woke up to the unpleasant fact that Ukraine is now not only faced with the double tragedy of MDR-TB and HIV, but it has an additional challenge of dealing with the fragmented care for people who use drugs, which in itself continues to catalyze the growth of both HIV and TB epidemics, in a rather complex interaction of factors.
Ukraine has the highest burden of tuberculosis in the European Region, second only to Russia, with a consistently high incidence of about 100 new cases per every 100,000 population per annum.
To make matters worse, and due to factors such as poor adherence to TB drugs, high rates of TB in prisons, poor infection control in prisons and health facilities, ad hoc supply and prescription of TB drugs, lack of adequate government support for opioid substitution therapy, one in every five new TB cases in Ukraine is drug resistant.
Among re-treatment cases, this incidence (of multidrug resistant TB) is as high as 44%, resulting in more than 8700 new MDR-TB patients who need treatment each year. These horrifying statistics are just the tip of the iceberg, whose base is inevitably comprised of an increasing number of untreatable extensively drug-resistant TB (XDR-TB), which due to poor laboratory capacity, are just not been diagnosed at the present time.
In addition, drug resistant TB is lethal to persons who live with HIV. There is a huge body of evidence which shows the deadly effects of the coexistence of MDR-TB and HIV infection among vulnerable groups in the population, and unless something is done to contain this situation, TB will continue to claim thousands of lives that it is already claiming in Ukraine today.
But how do we put a lid on this problem before it blows out of proportion?
Part of the solution lies in ensuring that the penal system is entirely overhauled through social reforms to ensure that prisons can provide essential healthcare, have inbuilt infection control infrastructure, are not acting as a reservoir of TB, are decongested, and are better linked with the civilian health care to ensure prisoners with TB enjoy continuity of TB care once they are released from prison.
In addition, better management of TB drugs, (including prescription practices and supply), drug adherence support, close cooperation between TB and HIV services, staff training on TB-HIV case management and integration, improved laboratory capacity and decriminalization of people who use drugs are key issues that require immediate attention if the growing burden of TB in Ukraine is to be controlled.
Finally, the bottlenecks associated with mandatory drug registration must be tackled with urgency to ensure that essential second line drugs are available to combat the threat that MDR has now become. Currently, only 3 of the 7 nationally recommended drugs are registered and available in Ukraine. As a result essential second line drugs are not available to treat MDR, further compounding the situation by making it difficult for clinicians to have alternative drugs when TB patients develop side effects. Side effects from TB drugs can potentially impair adherence and lead to further increases in MDR cases, creating a vicious cycle.
Ukraine, along with other countries in the European region must sign up to the upcoming and widely anticipated regional MDR-TB Action plan for Europe in order to curb the threat of MDR-TB and achieve the targets of the Global plan to Stop TB. The time to act is now.
Read Understanding and challenge TB stigma here.
Here you can find the Global Tuberculosis control Report 2010.
Download the Alliance standards for TB programming.
Learn more about the the Global Plan to Stop TB 2011-2015.