On 24 March 2016, Ukraine and the world marked World and Ukrainian Tuberculosis Day. This day was accompanied by the slogan of Unite to End TB.
The issue of TB control is of great importance to Ukraine. The TB epidemic in Ukraine was declared in 1995. Since then, 20 years have passed, but the pre-epidemic incidence rate hasn't been achieved – on the contrary, all the epidemic indicators suggest that the situation has considerably worsened.
Ukraine ranks 2nd-last in the European region in TB epidemic prevalence.
Unfortunately, of great concern in Ukraine has been the spread of chemoresistant and HIV-associated TB.
Among patients who became ill with TB for the first time, some 70.0% are representatives of disadvantaged population groups. At the same time, every year the specific weight of well-situated people who became ill with TB grows, which indicates that the risk group includes many strata of Ukraine's population, not just those that are deemed to be disadvantaged ones.
The results of treatment of TB patients are the worst among the Eastern European countries.
With the socioeconomic crisis deepening due to the armed conflict in the East of the country, the situation with the TB epidemic is forecast to deteriorate further.
The existing state TB control policy can't be regarded as ensuring effective response to the epidemic, so it requires comprehensive review.
Today, the problem of tuberculosis has gone beyond the purely medical domain and become nationwide due to a steady growth in the rate of its spread among Ukraine's population.
In Ukraine, TB epidemic was declared in 1995, and the disease has been a considerable threat to the lives and health of Ukrainians. Although since 2007 a decrease in TB incidence has been recorded, according to the WHO, estimated TB incidence rate in 2014 was 94.0 per 100,000 people, but routine tuberculosis surveillance shows that TB incidence rate is 70.5 per 100,000 people. So, every year some 25.0% cases of TB go undetected in Ukraine, which contributes to its spread among the population. In particular, estimated TB prevalence rate was 114.0 per 100,000 people, but the current TB prevalence rate is 90.2 per 100,000 people, which is three times the target of the Stop TB Partnership.
Every hour, 4 people in the country become ill with TB and 1 person dies of it. Every year, about 30,000 Ukrainians become ill with TB and about 7,000 die of it, and as many get disabled because of the disease. In the time since the TB epidemic was declared in Ukraine, some 600,000 new TB cases have been detected and almost 200,000 people have died of the disease.
The issue of fighting TB is also very important for the city of Kyiv. In 2015 alone, 1,228 people with TB were detected in Kyiv and 336 people died of the disease. Overall in Kyiv, since 1995, more than 2,500 people have died of tuberculosis.
It should be noted that with many new TB cases going undetected every year, there's a huge reservoir of the infection which the public health authorities aren't aware of. This cannot but be alarming, given that Kyiv, as the country's capital, every day receives a significant number of people who may pose a threat in terms of uncontrolled TB spread – the homeless, internal and external migrants and refugees, Roma people, people released from penitentiary facilities etc.
Of special importance in this process is involvement of civil society organisations in dealing with TB, including in such activities as advocacy of transfer to the outpatient TB treatment model, increasing public awareness, dealing with the problem of negative attitude of the society to people with TB and HIV-infected people and their discrimination in the public health system. This important task should be carried out through development and implementation of advocacy, communication activities and social mobilisation.
Of great concern is the fact that today Kyiv, the capital of Ukraine, is the only city in Ukraine that doesn't have its city TB control programme. It's for this reason that public anti-TB organisations initiated the holding of the roundtable where the issue of effective TB control strategy in Kyiv, as the capital of Ukraine, and in Ukraine in general was discussed.
The roundtable on the topic "Kyiv needs an effective TB control strategy", on the occasion of World Tuberculosis Day and on the initiative of the Public Movement – Ukrainians Against Tuberculosis Foundation, was held on 22 March 2016 at the meeting room of Kyiv City Council (in this room, meetings of Kyiv's elected deputies took place there).
Invited to take part in the roundtable had been the country's and Kyiv's political figures who have a direct influence on decision-making on issues regarding TB control, namely: Olga Bogomolets – people's deputy of Ukraine of the 8th convocation, head of the Verkhovna Rada Committee on Public Health, Yuliya Loban – secretary of Kyiv City Council's Standing Commission on Public Health and Social Protection, representatives of the World Health Organisation, Kyiv City State Administration, Kyiv City Organisation of the Red Cross of Ukraine, National Council on TB and HIV/AIDS Control in Ukraine, State Institution "Ukrainian Centre for Control of Socially Dangerous Diseases", TB sufferers, Kyiv City Trade Union of Public Health Workers of Ukraine, F.G. Yanovsky National Phthisiology and Pulmonology Institute of the Academy of Medical Sciences of Ukraine and other interested organisations and persons.
The following issues were discussed at the roundtable:
1) Tuberculosis: present-day challenges, ways to overcome. Development of a new city TB control programme as a road map to strengthening Kyiv's public health system to ensure TB control with the following components:
– operational plan to implement a rational model for stable financing in the TB area in Kyiv;
– development of city criteria for hospitalisation of patients with drug-resistant and drug-sensitive TB forms;
– comprehensive approach with active involvement of non-medical departments and municipal services in TB prevention and control.
2) The need to strengthen the political commitment of the authorities (high-level advocacy efforts) to fighting TB in coordination with public advocacy efforts (bottom-up advocacy).
3) Ensuring protection of the rights and interests of Ukrainian people in transition to the outpatient TB treatment model.
4) New drug-resistant TB treatment schemes based on state-of-the-art drugs – a hope of recovery for tens of thousands of patients in Ukraine and millions worldwide.
In his speech, chairman of the board of the Public Movement – Ukrainians Against Tuberculosis Foundation Vitaly Rudenko gave analysis of the state policy in the area of TB control, the socioeconomic factors of the epidemic, political and legal aspects, international experience of organisation of government activities aimed at preventing development of socially dangerous diseases, the need to improve provision of information for people about the danger posed by TB.
Also, Vitaly Rudenko focused on the issue of urgent transfer to an outpatient TB treatment model and the issue of maximum integration of TB/HIV/hepatitis services so that high-quality medical services can be provided for the final consumer, full protection of the rights and interests of all Ukrainian citizens amid the TB epidemic and organisation of efficient infection control to ensure their safety.
Members of the Public Movement – Ukrainians Against Tuberculosis Foundation, "Stop TB Together" Coalition of Organisations, TB sufferers prepared Proposals for the resolution of the roundtable:
To recommend Kyiv City State Administration and Kyiv City Council, based on involvement of a wide range of stakeholders, prior comprehensive examination of the epidemic situation and existing barriers in TB control, to develop and implement a Kyiv city social TB control programme for 2017-2021 as a road map with the following components:
– operational plan to implement a rational model for stable financing in the TB area in Kyiv;
– development of city criteria for hospitalisation of patients with drug-resistant and drug-sensitive TB forms;
– comprehensive approach with active involvement of non-medical departments and municipal services in TB prevention and control.
At the roundtable, the decision was taken to set up a TB control group with Kyiv City Council's Standing Commission on Public Health and Social Protection.