Tuberculosis (TB) remains one of the world’s top infectious killers, causing 1.4 million deaths each year and infecting millions more. TB patients need to undergo months or years of difficult treatment, which impacts hugely on their families and communities.
In partnership with Polish and Ukrainian health authorities, Polish health institutes, and Médecins Sans Frontières (MSF), WHO launched a comprehensive project focused on bringing innovative, people-centred approaches to care delivery for people with TB and drug-resistant TB (DR-TB).
Through this project, DR-TB patients – predominantly foreign nationals, including refugees from Ukraine – will be able to receive fully oral treatment, recommended by WHO, in their own homes, without the need for hospitalization.
Pilot project
As part of ongoing efforts to improve the quality and accessibility of TB diagnosis and treatment in Poland, representatives from WHO visited the southern town of Jaroszowiec. Lying 39 km north-west of the regional capital Kraków, it is where many refugees from Ukraine found shelter after the war began.
A hospital in Jaroszowiec specializing in lung diseases has been piloting a people-centred model of care for newly diagnosed patients and those continuing to require treatment and follow-up, including local patients, Ukrainians and nationals from other countries.
Ukrainian pulmonologist Dr Ivanna Mazur, a refugee from Ternopil who works for the Polish health system at the hospital, explains how this therapy works and why this new model of care is important. “Patients who can adhere to treatment without close supervision are eligible for home-based therapy and are provided with DR-TB medicines such as bedaquiline, delaminid and clofazimine. These medicines, which were previously not widely available in the Polish medical system, have been donated thanks to WHO.”
Dr Mazur continues, “To ensure adherence, patients are monitored remotely through daily video calls where a medical professional observes them taking their medication correctly. Being treated at home allows them to continue their work schedule, maintain social connections and live a regular life with minimal disruption. This is essential for the patients, especially refugees who are single mothers with nobody else to look after their children for months if they were to be hospitalized.”
Barriers to care
Poland diagnosed 3388 cases of TB in 2020, of which only 38 were multidrug-resistant TB (MDR-TB). WHO estimates that the number of Ukrainian refugees with DR-TB in Poland is around 230, but only 46 are currently receiving treatment.
One of the barriers to seeking medical help for Ukrainian refugees is the prospect of lengthy hospitalization, especially for single parents and single heads of households. Another is the stigma commonly associated with the disease. Dr Mazur emphasizes, “Patients with TB should never be stigmatized. TB is treatable and curable like many other diseases. In Poland, the treatment is free of charge, for both Polish and refugee patients.”
She recounts that her mother worked as a nurse at a lung disease hospital in Ukraine, and she often helped her in the ward during her medical studies. “Through this experience, I learned how to look after patients appropriately and combine different medicines to make their treatment more effective. I have seen people cured and able to continue with their everyday lives. An accurate and early TB diagnosis is crucial to effective patient management. It is paramount that those affected have continuous access to medication. Today, I am happy I can help people and share my knowledge and experience with my Polish colleagues in Jaroszowiec.”
Innovative solutions
The project was launched on 16 August 2022 with technical support from WHO, the Polish Institute of Tuberculosis and Lung Diseases, and MSF. The decentralized TB treatment and care model has already been implemented in 18 pilot treatment sites, where adequate capacity and technical guidance are provided.
Dr Paloma Cuchí, WHO Representative in Poland, says, “This pilot project was much needed to support Ukrainian refugees and will also benefit the Polish population by providing innovative solutions to patients needing complex medical treatment for TB.”
She adds, “The project also highlights the bold action and commitment of the Polish health authorities to taking new measures to treat this old disease. We expect the new model to result in better treatment outcomes, save more lives and reduce suffering.”
The project is a multiagency partnership coordinated by the Polish Institute of Tuberculosis and Lung Diseases with support from the Polish Respiratory Society, MSF, the Governmental Strategic Reserves Agency, and the Polish and Ukrainian ministries of health. WHO provides donations of medications and equipment as well as technical and methodological support.
This article was amended on 12 May 2023. An earlier version incorrectly noted that TB causes 4 million deaths each year when the figure should have been 1.4 million