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World Tuberculosis (TB) Day, observed worldwide on 24 March, provides an opportunity to underline an issue which has dramatic health, social and economic consequences – tuberculosis infection. According to WHO estimates, Ukraine has the 4th highest TB incidence rate among the 53 countries of the WHO European Region, with 17 593 new TB cases registered in 2020. To manage the TB burden in Ukraine, which remains significant in the country despite the overall downward epidemiological trends, Ukraine is stepping up to improve TB diagnosis and implement new people-centered treatment approaches, using WHO expertise and advice.

TB burden in Ukraine

Tuberculosis, a disease caused by the bacteria Mycobacterium tuberculosis, most often affects lungs and is spread from person to person through the air.

In Ukraine, TB re-emerged as a public health challenge in the 1990s. While the TB incidence rate in Ukraine has significantly decreased over the last 15 years – from over 127 cases per 100 000 people in 2004–2005 to 42.2 cases per 100 000 people in 2020 – TB prevalence as well as the mortality level remain high in the country.

While TB, which is one of the top 10 causes of death worldwide, is curable and preventable, its drug-resistant form has been a major obstacle to TB care and prevention.

Drug-resistant TB (DR-TB) remains a public health threat in the country. WHO estimates that, among bacteriologically confirmed TB cases in Ukraine in 2018, 6900 people had DR-TB representing 29% of new TB patients and 46% of previously treated patients. These rates are considered to be high in comparison with other countries in the Region. According to the WHO Global Tuberculosis Report 2020, treatment success of multidrug-resistant TB (MDR-TB) is suboptimal and was 51% for a cohort of patients enrolled in 2017, which is similar to most high-burden countries in the Region.

The treatment of TB and DR-TB is now completely oral with treatment regimens that are more effective and safer. In addition, digital health solutions for observing patients taking their medicines are making treatment more comfortable for patients and providers, allow treatment at ambulatory settings, and decrease the risks of infection transmission. All these innovations are greatly improving treatment outcomes for patients with TB and DR-TB.

To address the situation, reduce TB prevalence, scale up TB early detection and diagnosis, and ensure effective treatment, Ukraine adopted, in 2019, the 2020–2023 State Strategy for Development of Anti-Tuberculosis Care for the Population, aimed at establishing a new model for the prevention, early detection and provision of medical care for TB patients by 2023. Ukraine is also committed to achieve the targets set out in the WHO Global End TB Strategy by 2035.

Supporting Ukraine’s response to the TB epidemic

“WHO supports Ukraine in accelerating efforts to end the TB epidemic in the country,” says Dr Jarno Habicht, WHO Representative and Head of the WHO Country Office in Ukraine. “Working closely with the Ministry of Health of Ukraine and Ukrainian Public Health Centre, WHO provides technical assistance in applying patient-centered, integrated approaches to TB prevention programs, allowing increased access to treatment for the Ukrainian people.”

To reduce the TB burden in Ukraine, WHO provides strategic guidance on treatment optimization and adaptation, including recommendations for ambulatory care for TB patients in Ukraine with drug-susceptible or drug-resistant forms, in lieu of hospitalization, allowing patients to stay within their community and continue living a normal life while receiving TB care. WHO also supports Ukraine in strengthening TB surveillance, monitoring and evaluation along with the development and implementation of alternative models of TB care, and optimization of a TB laboratory network. Ukraine is the first country to have started implementing the multisectoral accountability framework for TB (MAF-TB). This is an important development and a practical tool to foster multisectoral collaboration and accountability in TB response.

In Ukraine, WHO works with the Ministry of Health of Ukraine; Public Health Center of the Ministry of Health of Ukraine; Global Fund to Fight AIDS, Tuberculosis and Malaria, Office of Health; USAID Regional Mission to Ukraine; and other international and national partners towards preventing and treating TB in the country.