EECA INTERACT 2019

We are pleased to announce that, on the 18-19th November 2019, the first EECA INTERACT Workshop 2019 will take place in Almaty, Kazakhstan.

The EECA INTERACT 2019 Workshop builds scientific research capacity while simultaneously strengthening clinical, prevention, and research networks across the Eastern Europe and Central Asia (EECA) region. EECA INTERACT 2019 is an abstract-driven workshop focusing on factors unique to the region’s HIV, TB, and hepatitis epidemics. Bringing young and bright researchers together with top scientists, clinicians, and policymakers, EECA INTERACT 2019 aims to ignite a conversation that will build a stronger scientific base to serve the region and connect to the world.

EECA is the only region in the world where the HIV epidemic continues to rise rapidly. UNAIDS estimates point to a 57% increase in annual new HIV infections between 2010 and 2015.1 The World Health Organization has warned of a sharp rise in rate of HIV and tuberculosis coinfection, which poses a real threat to progress.2 Significant barriers to prevention and treatment services remain for people living with and affected by HIV, TB, and hepatitis across the region. For example, although the HIV epidemic in EECA is concentrated predominantly among key populations, particularly among people who inject drugs, coverage of harm-reduction and other prevention programs is insufficient to reduce new infections. The region urgently needs more effective strategies of prevention, treatment, and care and support that are tailored to the particular circumstances of individual countries.

The Amsterdam Institute of Global Health and Development (AIGHD) has over a decade of experience delivering in-country workshops and conferences that bring young researchers and established international experts together to share original research and state-of-the-art reviews on a wide range of topics. AIGHD has co-hosted the INTEREST Conference (the International Workshop on HIV Treatment, Pathogenesis, and Prevention Research in Resource-limited Settings) since its inception in 2007. The conference has grown from a small workshop to a full conference of more than 500 attendees each year.

Building on these proven results, AIGHD will collaborate closely with AFEW International and the AFEW network (AFEW) for EECA INTERACT 2019. AFEW’s deep roots and experience in the region offer a way to build sustainability into the new workshop, placing priority on local contributions. The EECA INTERACT 2019 will bring scientists, clinicians, members of civil society, and government officials together to tackle topics facing individual countries while building capacity and strengthening research and clinical networks. The two-day conference will focus on topics that are specifically relevant to EECA and dive deeply into particularities of the host country Kazakhstan, showcasing its successes, remaining challenges and responses.

The workshop objectives are:

  • To provide cutting-edge knowledge in the fields of epidemiology (modelling), treatment, pathogenesis, and prevention of HIV, TB, and viral hepatitis as well as chronic conditions;
  • To exchange ideas on providing and supporting HIV testing services and clinical care provision to adults, adolescents, and children living with HIV to achieve 90-90-90 goals;
  • To foster new research interactions among leading investigators and those who represent the potential future scientific leadership for health care and research in the region;
  • To build research and clinical capacity across EECA.

EECA INTERACT 2019 takes an innovative approach by bringing together experts in HIV, TB, and hepatitis to participate in the International Conference Committee developing the scientific program. The ultimate aim is a workshop that addresses the unique issues facing the region, finding paths forward to solutions for improvement. Challenges include slow implementation of harm reduction, insufficient access to treatment, and criminalisation and stigmatization of key populations. Sustainable change can be achieved if these challenges are faced head on, embracing scientific evidence and working with marginalized and stigmatized populations.

Introducing the EECA INTERACT concept in Kazakhstan for 2019 extends the sustainable goals laid out during the AIDS2018 conference in Amsterdam. AIDS2018 drew attention to the effectiveness of rights-based approaches to more effectively reach key populations, highlighting this work across the EECA region. By bringing people together, sharing knowledge, and building capacity, the EECA INTERACT 2019 will build further on this base to find tangible solutions.

IT’S TIME to End Tuberculosis in Eastern Europe and Central Asia

This year’s International TB Day’s theme is “IT’S TIME”

Authors: Helena Arntz, Olesya Kravchuk, AFEW International

24th of March marks World Tuberculosis day. The mortality rate of tuberculosis (TB) continues to decrease, but it is still one of the top 10 causes of death worldwide. According to the World Health Organization (WHO), TB caused 1.7 million deaths in 2017. Within the European region, most new TB cases and deaths are found in the Eastern European and Central Asian (EECA) countries. In this region, we face an increasing number of drug-resistant TB cases which becomes a real concern for patients and public health.

Countries in the Eastern part of the WHO European Region are most affected by the TB epidemic: 18 high-priority countries for TB control bear 85% of the TB burden, and 99% of the multidrug-resistant TB (MDR-TB) burden. These countries are Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, the Republic of Moldova, Romania, the Russian Federation, Tajikistan, Turkey, Turkmenistan, Ukraine and Uzbekistan. Despite much progress in Eastern Europe, critical challenges remain as regards access to appropriate treatment regimens, patient hospitalisation, scale-up of laboratory capacity, including the use of rapid diagnostics and second-line Drug Susceptibility Testing (DST), vulnerable populations human resources, and financing.

AFEW Network is helping to eliminate tuberculosis in EECA. AFEW Kazakhstan together with KNCV in the Improved TB/HIV prevention & care – building models for the future project is increasing access to TB treatment. A model for effective partnership between government and public sectors of health care and organisation of civil society that provide TB-HIV services in Almaty, Kazakhstan is being developed. Within the Fast-Track TB/HIV Responses for Key Populations in EECA Cities project, AFEW Kazakhstan is piloting the innovative model of increasing the participation of the city administration in programs for the prevention and treatment of HIV infection and tuberculosis in the city of Almaty with particular emphasis on key populations. Within this program, models of sustainable city responses to HIV and TB in key population in EECA that significantly contribute to achieving 90-90-90 HIV/TB targets for key populations are being developed. The program is working in Bulgaria (Sofia), Georgia (Tbilisi), Kazakhstan (Almaty), Moldova (Balti), Ukraine (Odesa).

This year’s International TB Day’s theme is “IT’S TIME”. This slogan is indicating that it is time to end tuberculosis. There is a number of events that will draw attention to this day in Eastern Europe and Central Asia. The youth community center “Compass” in Kharkiv, Ukraine will hold a training session on the prevention of TB in one of the schools they work in. Local NGOs in Kazakhstan have been providing tuberculosis screening in the shopping malls and markets before World TB Day and were raising awareness of the disease within the students and migrants.

UN High-Level Meeting on Tuberculosis: People should be the Centre of the Fight

New York, 26 September 2018

The challenge of tuberculosis (TB) is faced worldwide, including across all of Europe and Central Asia. 1.6 million people died of the disease in 2017, and Heads of State are meeting today to discuss the matter at the UN General Assembly. TB kills more people each year than HIV and malaria combined. As one of the top ten leading causes of death TB deserves the highest political attention.

“I call on leaders of the world to commit to ending TB in their countries by allocating the necessary resources in their health budget, and involve us, civil society and communities in helping to reach the unacceptable 36% of people with TB who are still missed by health systems every year,” says Yuliya Chorna, the Executive Director of the TB Europe Coalition (TBEC).

Traditionally, people in many countries of the European region have been treated in hospitals for long periods from six months to two years. Patients have to suffer not only the burden and toxicity of a long-term treatment with heavy antibiotics but also being apart from their families, jobs and social lives.

“TB patients are no longer infectious by at most two weeks after they start and receive effective treatment. It is ridiculous that many programmes still isolate people from society for many months. No wonder people are afraid to seek a diagnosis. TB care has to be designed for and with people,” says Ksenia Shchenina, a former TB patient from Russia and Board Member of TBEC.

While European Heads of States are noticeable by their absence at the meeting, the WHO Europe region continues to be a hotspot for the spread of the multi-drug resistant (MDR) form of TB. Conservatism in the way TB is being treated in Europe and the lack of involvement of civil society and communities in TB care, who play a vital role for treatment adherence, has led to terrible figures in Eastern Europe and Central Asia. Too many countries report rates of around 30% of new cases being multi-drug resistant. Furthermore, worldwide only 25% of people with drug-resistant TB are on treatment.

Yet we still don’t have the right tools to fight TB. Our leaders have not allocated the right amount of funds to develop new vaccines, diagnostics, and treatment. We continue to have an astonishing annual $1.3 billion gap in Research & Development for TB.

“While the European Union congratulates itself on allocating on average less than €30 million per year to TB research initiatives in the last four years, it should think of reorienting its priority setting in health research to a needs-driven approach. Our taxpayers’ money should go to funding priorities neglected by the private sector,” says Fanny Voitzwinkler, Chair of the TBEC Board.

The UN High-Level Meeting on TB held on 26 September 2018 is a time for action and unity. We need changes if we want to stop the millions of preventable deaths caused by TB. Civil society can contribute greatly to effective people-centred care, it wants to be involved and will be watching to make sure the commitments made by world leaders at the HLM will be put into practice.

Source: TB Europe Coalition

Children with Tuberculosis and HIV Do Not Have Access to Education in Tajikistan

Children with HIV and TB do not have access to education in Tajik schools

Author: Nargis Hamrabaeva, Tajikistan

10-year-old Zarina (the name is changed) is from Dushanbe. The girl has a double diagnosis: HIV and tuberculosis. Zarina has never studied anywhere.

Her mother learned she was HIV-positive during the pregnancy. She received her HIV-positive status from her husband. The girl’s father died of AIDS several years ago, and her mother got married again. The stepfather did not accept Zarina, and that is why she lives with her grandmother.

When Zarina turned seven, the grandmother sent her to the first grade in one of the schools in Dushanbe, but the director said the school could not accept the girl, explaining that “she was sick and could infect other children with tuberculosis.”. Therefore, Zarina has not been studying anywhere for three years. The guardianship and trusteeship bodies never asked why the girl did not go to school.

The dialogue that never happened

Human rights activists found out about Zarina’s case and tried to help the family. The representatives of the Tajik network of women living with HIV and the public fund Your Choice approached the officials of the Ministry of Education to find out whether there was a mechanism for providing access to education for such children, but they faced a wall of misunderstanding.

“We were asked to leave the office. The Ministry representatives said that we lied, that there were no such cases, that all children were receiving education, and that we, representatives of non-governmental organizations, only traveled abroad and tarnished the country’s image before the international community. The dialogue never happened,” says Larisa Aleksandrova, representative of the public fund Your Choice.

According to her, children with a double diagnosis of HIV and tuberculosis do not have access to compulsory secondary education in Tajikistan.

“The revealed fact confirms that education officials improperly monitor and keep track of children who do not attend school due to tuberculosis, and they also do not provide these children with the opportunity to receive education at home, the so-called family form of education or homeschool. Although, according to the Health Code, the authorized body in the field of education is obliged to develop programs for getting education at home or in the hospital,” says Larisa Aleksandrova.

With discrimination and without statistics

Larisa Aleksandrova, representative of the public fund Your Choice

The human rights activists are sure that Zarina’s case makes the situation with discrimination of children living with HIV in an educational institution clear.

“The Law on education states that educators should keep track of children of preschool and school age, and monitor their education prior until they complete the compulsory education. In Tajikistan, a nine-year education is compulsory. However, the Law does not define the mechanism for identifying children not covered by compulsory education,” says Larisa Aleksandrova.

The number of children with tuberculosis and HIV who do not have access to education in the country is not known. The Ministry of Education of Tajikistan said that they do not keep such statistics.

Dutch Organisations Ask the Prime Minister of the Netherlands to Lead the UN High-Level Meeting

Prime Minister of the Netherlands Mark Rutte

AFEW International co-signed the letter to the Prime Minister of the Netherlands Mark Rutte. This letter is a request to lead Dutch delegation at the UN High-Level Meeting on Tuberculosis that will take place in New York on 26 September 2018.

“The Netherlands is an international leader in the fight against life-threatening epidemics, such as tuberculosis. Dutch companies, universities and social organizations make the difference with their knowledge and expertise in the field of health worldwide. 2018 is the year in which the Netherlands can present itself internationally as a member of the UN Security Council and as a participant in the G20, with global health as its theme. This year, the International AIDS Conference and the International Tuberculosis Conference will also take place in Amsterdam and The Hague.

We hope that he will strengthen this position of the Netherlands internationally by leading the Dutch delegation at the High-Level Meeting on Tuberculosis at the United Nations General Assembly in New York on 26 September. Tuberculosis is the deadliest infectious disease in the world with 1.7 million deaths per year. Multidrug-resistant forms of tuberculosis are responsible for a large part of the deaths due to antibiotic resistance. The disease is curable. Dutch expertise and research on antibiotic resistance, drug development and diagnostics are of great importance to stop this disease. International agreements and commitments at the High-Level Meeting on Tuberculosis will contribute to strengthening Dutch Research and Development for new diagnostics, vaccines and medicines. In addition, the work of Dutch NGOs will contribute significantly to the worldwide achievement of the outcomes of the summit,” written in the letter.

16 Dutch organisations are letting Mark Rutte know that to stop this disease, the political action is needed worldwide. They are asking Prime Minister of the Netherlands to represent the Dutch business community, universities and civil society during the High-Level Meeting on Tuberculosis and thus strengthen the leading Dutch role in international health.

USD 31 Million Saved by Stop TB Partnership’s Global Drug Facility Through Reduced Prices for Tuberculosis Medicines

Source: http://www.stoptb.org

On 14 June 2018 in Geneva, Switzerland, The Stop TB Partnership’s Global Drug Facility (GDF) announced agreements signed with 28 medicines manufacturers for 83 products that will substantially reduce the prices of medicines used in the treatment of tuberculosis (TB). As an outcome of GDF ’s recent competitive tender, savings of approximately USD 31 million are expected in the April 2018 to March 2019 period.

The USD 31 million in savings represent 14% of USD 217 million in TB medicines delivered by GDF in 2017. If the USD 31 million in savings were used to purchase additional medicines, the savings would be sufficient to provide 960,000 people with drug-sensitive TB medicines, 53,000 people with shorter regimens for drug-resistant TB, or up to 37,000 people with conventional regimens for drug-resistant TB.

Reduced medicine prices translate into lower TB treatment costs. GDF’s new prices for conventional, multidrug-resistant (MDR) TB treatment regimens are now as low as USD 812, leading to savings of up to 33% compared to 2017 prices of USD 1,214. Similar price reductions were realized for shorter MDR-TB treatment regimens which are now as low as USD 571, resulting in 27% savings from the 2017 price of USD 779.

To read the full publication, click here.

Source: http://www.stoptb.org

Civil Society of Kyrgyzstan in the Fight for Availability and Affordability of Medicines

Director of the Partner Network Association Aibar Sultangaziev

Author: Olga Ochneva, Kyrgyzstan

Kyrgyzstan is gradually switching to state drug provision system. Some of the tuberculosis medicine will be purchased out of the budgetary funds this year, and some of the antiretroviral (ARV) medicines – starting from the next year. Respective financial resources are planned to be allocated in the budget. At the same time, the question regarding the national legislation remains. A number of important documents is currently under the review. We discussed how these documents consider patients’ needs as well as the results of the analysis regarding the availability of medicines for HIV, hepatitis C and tuberculosis treatment with Aibar Sultangaziev, the representative of public council at the Ministry of Health and the Director of the Partner Network Association.

– Your organization and you personally are actively researching medicine availability and affordability. What are your successes so far?

– We started our work in 2009 with the issue of intellectual property. A respective study was conducted and, on the basis of the facts of high cost on brand medicines used for hepatitis C treatment, we advocated for the amendments to the Patent Law. In 2015, the Law was adopted; it also included the flexible provisions of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). Due to this, it became possible to bring more generic medicine into the country. To date, seven medicines have been registered. We keep the cost of hepatitis C treatment at the lowest level in the region: from 615 US dollars for a 12-week course.

Back then, the legislation lagged far behind the needs. We developed an intra-organizational strategy for ensuring the availability of medicines and started to work in several directions. In 2014, we approved the clinical guidelines for the treatment of hepatitis C that became a clinical protocol in 2016 that included a full range of medicine available within the country. Hepatitis C treatment was added to the State Program on HIV/AIDS, and from 2018 onwards, 150 people living with HIV (PLHIV) will receive it free of charge annually. We participated in the revision of protocols on HIV treatment, and now they include modern and inexpensive medicine, such as dolutegravir, darunavir, rilpivirine.

– The Essential Drugs List (EDL) is currently undergoing a revision. It is an important document related to the availability and affordability of medicines and holding public procurement. Did you participate in its elaboration?

“For the availability and affordability of hepatitis C treatment!” Campaign on amendments to the Patent Law

– In 2015, we conducted a study on five diseases: HIV, tuberculosis, hepatitis C, oncological diseases, conditions after transplantation, and found out what medicines for their treatment were registered in the country or included to the EDL and clinical protocols. We identified the differences between the WHO recommendations and the situation in the country, and then submitted a List of necessary medicines to the Ministry of Health (MoH). All of them were added to the EDL and will be approved soon after several amendments to the Law on Circulation of Medicines are introduced. By the way, the Law provides a List of medicines that can be imported and used in the country without registration. This List is used for socially significant diseases, and, as part of the working group of the MoH, we are currently working to determine the procedure for its formation.

– Will it allow the pharmacological companies not to register medicine in Kyrgyzstan?

– Registration is needed. However, in cases when the government urgently needs medicines that are not available on the market, it will be possible to legalize them by the decision of the commission without registration. Of course, there are criteria: medicine must be of high quality, prequalified by the WHO, etc. This list already exists. Last year in November, together with UNDP, (the organization manages grants of the Global Fund in the country – author’s remark), we submitted a list of 12 essential tuberculosis and antiretroviral medicines for the Ministry of Health to consider the possibility of importing them. This is a matter of political will and one commission’s meeting, but there has been no progress with the documents yet. That is why we are preparing a new regulation so that another commission could formalize it via a new procedure.

– Does it mean that practically all conditions for public procurement are in place?

Activists’ campaign to support the amendments to the Patent Law allowing the import of generic medicines to the country

– A lot has been done but the risks still remain. We have to make every effort to regulate the process by autumn. The point is that this year the state’s responsibility is to purchase 10% of second-line tuberculosis medicines, none of which has yet been registered in the country. In 2019, the state should purchase 20% of the required amount of ARV medicines, and in 2020 the share will increase up to 30%. Not all pharmacological companies enter the national small market, and those that do, inflate prices. We are determined to promote the possibility of medicine purchase through international mechanisms. For example, if Kyrgyzstan purchases medicines through UNICEF, one can expect a 5-7-fold decrease of the cost since UNICEF places a single long-term order that covers several countries with the medicine producers.

– What other plans do you have and what is the ultimate goal of your work?

– We carry out constant monitoring of procurement. Price regulation remains one of the priority tasks. We want people to have unhindered access to inexpensive and effective treatment, and the state to provide medicines for socially significant diseases.

A Survey on Collaborative TB/HIV Activities in Countries of the WHO European Region

Tuberculosis (TB) and HIV cause significant suffering in Europe. It is estimated that 27,000 patients have both diseases. The distribution of co-infected patients is heterogeneous in Europe. Collaborative activities are needed to take the best care of those with TB/HIV co-infection. This is the background information of the survey on collaborative TB/HIV activities in countries of the WHO European Region created by the Wolfheze working group on collaborative TB/HIV activities.

The Wolfheze group documents and promotes the best models and identifies research priorities of integrated TB/HIV care in the European region. Members of the group also identify barriers in TB/HIV services and collaboration. AFEW’s executive director Anke van Dam is the chair of Wolfheze Working Group on TB/HIV collaborative activities.

What this survey adds:

• All countries have guidelines for management of TB/HIV co-infection.

• Models of care for TB/HIV co-infection differ between countries.

• Collaborative TB/HIV activities as recommended by WHO are not universally implemented.

The full version of the survey is available here.

 

 

Artificial Respiration: will Russia End Tuberculosis by 2030

In 2016, 1.3 million people worldwide died of tuberculosis. Over the same year, 10.4 million people fell ill with tuberculosis

Author: Anastasia Petrova, Russia

March 24 is World Tuberculosis Day. Tuberculosis (TB) is the ninth leading cause of death worldwide. Russia is one of the top three countries with the highest burden of drug-resistant TB. At the first World Health Organisation Global Ministerial Conference on Ending TB held at the end of the last year in Moscow, the Russian Minister of Health Veronika Skvortsova proclaimed that Russia, supporting the global community goal, aims to end TB by 2030. Experts comment on how feasible this goal is.

Treatment is not cost efficient

Tuberculosis is called a biosocial disease as people from the most socially disadvantaged populations face the highest risk of being infected. People from low- and middle-income countries – India, Indonesia, China, Nigeria, Pakistan, Philippines and South Africa – are affected the most. Such countries cannot procure the required drugs at high prices and, as the treatment access experts point out, it is not cost effective for the pharmaceutical companies to invest in the production of drugs, which will not bring them enough income. It complicates the development and launch of new drugs, while the lack of innovative drugs leads to the development of drug-resistant forms of tuberculosis, aggravating the situation.

In 2016, 1.3 million people worldwide died of tuberculosis. Over the same year, 10.4 million people fell ill with tuberculosis.

Sustainable threat

TB morbidity rate in Russia is 58.44 cases per 100,000 people. On one hand, there has been a steady declining trend in TB mortality in the country since 2005 (except for the vulnerable populations). According to the WHO, in 2016 the mortality rate was 8.2 cases per 100,000 people a year (as compared to 16 cases in 2011). On the other hand, WHO experts observe two crucial problems in the Russian Federation: growth in TB morbidity among people living with HIV and widespread of the drug-resistant forms of TB – extensively drug-resistant tuberculosis (XDR-TB), multidrug-resistant tuberculosis (MDR-TB), and rifampicin-resistant tuberculosis (RR-TB).

According to the WHO, Russia is one of the top three countries with the highest burden of extensively and totally drug-resistant tuberculosis, with higher rates in India and China only. In 2016, the share of XDR-TB in the new TB cases in Russia was 27%, and in recurrent TB cases – 65%. It means that now there is no effective treatment for many people. Only 31% of people recover from XDR-TB. The cause of drug-resistant TB is first of all associated with treatment interruptions. The main reason of patients “dropping out” is the lack of social support.

“Patients should not only be treated but should also be provided with comprehensive social support. The treatment is long and hard, it takes over a year. It leads to many people losing their jobs. If people have no means of subsistence, they have to stop their treatment and go to work. The situation is even more complicated for people who have small children,” says Svetlana Prosvirina, member of TBpeople, the Eastern European and Central Asian network of people with experience of TB. “Such drop-outs are extremely dangerous as the bacteria which survive after the treatment interruption adjusts to the medications, which contributes to TB evolution to MDR-TB and XDR-TB.”

Coverage of people living with HIV with treatment is low

Experts agree that to curb the epidemic of tuberculosis by 2030, the government should make efforts to fight drug-resistant forms of TB and create conditions for the patients not to interrupt treatment

Tuberculosis is the main AIDS-defining disease and the leading cause of death among people living with human immunodeficiency virus. The risk of co-infection is related to the low immune function of people living with HIV, who need to receive antiretroviral therapy (ART) constantly to stabilize their immune responses. However, in Russia treatment coverage of people living with HIV remains extremely low. According to the Federal AIDS Research Centre of the Rospotrebnadzor Central Research Institute of Epidemiology, in 2017 the coverage rate was only 35.5%.

People who use drugs are also in a difficult situation. TB activists point out that TB treatment clinics often do not have a drug counsellor and sometimes do not even have a license to provide help to people who suffer from the abstinence syndrome (group of symptoms with varying combinations and severity, which develop when a person terminates using psychoactive substances or reduces the dose taken after their recurrent use, usually during a long-term and/or in high doses – editor’s note). Those symptoms make the patients refuse from further treatment, which not only leads to drug resistance but also creates pre-conditions for further transmission of the disease.

Ending TB by 2030

Experts agree that to curb the epidemic of tuberculosis by 2030, the government should make efforts to fight drug-resistant forms of TB and create conditions for the patients not to interrupt treatment.

“Comprehensive support of vulnerable populations, including the patients, is required to prevent the spread of tubercle bacillus,” says Kseniya Shenina, activist, member of the TBpeople Coordination Council.

Based on the conclusions of the Russian Public Mechanism for Monitoring of Drug Policy Reform, an important pre-condition to overcome the problem is the revision of the Russian drug policy in compliance with the “Support Don’t Punish” approach. Experts believe that the country urgently needs to approve recommendations of the numerous UN bodies on drugs and HIV, including recommendations of the Committee on Economic and Social Rights. Only compliance with these conditions will make the goal of ending tuberculosis by 2030 more feasible.

Do we Treat or Harm: how Ukraine is Fighting against Tuberculosis

Olga Klimenko in the children’s ward of the tuberculosis dispensary. Photos from the personal archive

Author: Yana Kazmyrenko, Ukraine

At the entrance to any public polyclinic in Ukraine, an announcement is greeting a patient: visit a doctor is possible after a fluorography only. The obligatory lungs X-ray maintains a semblance of the fight against tuberculosis. In Ukraine, most of the patients get to know their status very late. The country has not been able to take the tuberculosis epidemic under control for more than twenty years. Ukraine has the world record of multidrug-resistant forms of tuberculosis and is still treating patients, sending them to prolonged isolation in overcrowded dispensaries.

Olga Klimenko – an activist of TBpeople – Eurasian Network of People who have had tuberculosis – was diagnosed with this desease in 2015. By the time of hospitalization, she was sick for at least six months. In 2016, Olga published a book The world inside me. Confession of the tubercular woman in which she described her life experience with the disease.

Now Olga is trying to help patients with this diagnose. On the webpage of her community in Facebook The world inside me, requests appear every day: to transfer money for the purchase of inaccessible drugs, which for the most part are not licensed in Ukraine, to purchase washing machines for tuberculosis dispensaries or diapers for recumbent patients. Last month, Olga was “coaching” 34 patients.

“I do not know when and where I contracted tuberculosis. No one knows. Everyone remembers the last long-lasting flu after which he or she felt weakened and broken down. Ukrainians usually do not go to the doctor, we go to the drug store and buy a full set of antiviral drugs. We remove symptoms, but do not cure diseases,” says Olga.

During the treatment, Olga had good and bad times. The most difficult was the separation from her daughter: the girl was sent to a special boarding school for children who were in contact with infected people, where her homegrown girl spent six months with children from dysfunctional families. Olga still did not forgive doctors who did not tell her that after two weeks from the start of the treatment she was not contagious anymore.

Ukraine is breaking records

Olga’s story is typical for Ukraine where the epidemic of tuberculosis is spreading for several years. More than 30 thousand of Ukrainians are diagnosed with a not active tuberculosis and more than 10 thousand – with an active form. Every day 90 people get their status. These figures are underestimated: according to the World Health Organization (WHO), every fourth patient in the country stays undiagnosed.

Back in 1995, WHO announced that Ukraine has exceeded the epidemic threshold – 50 cases per 100,000 people. Since then, the situation has only worsened – the conflict in the East of the country forced 1.5 million residents of Lugansk and Donetsk regions to resettle. In these regions, there were 15% of Ukrainians who were diagnosed with tuberculosis. Every fifth TB patient is HIV-positive.

Tuberculosis for export

The resettlers are at risk of tuberculosis in Ukraine. Photo by UNIAN

Compared to the other post-Soviet countries, indicators of Ukraine look particularly depressing. If in Ukraine the incidence rate according to the data for 2016 was 67.6 per 100 thousand people, in Belarus it was at the level of 39.9, in Kazakhstan – 52.2, in Poland – 17. The European average is 12 people per 100,000 population.

In the top 20 countries of the world, tuberculosis has already become an exotic disease. The epidemic in Ukraine frightens the neighbors – about 5 million Ukrainians work in the EU countries and Polish media write that a visa-free regime with the EU will allow tuberculosis to migrate to Europe. Warsaw is even discussing the possibility of medical control on the border with Ukraine.

Resistant mycobacteria

Director of the Public Health Center of the Ministry of Health of Ukraine Vladimir Kurpita says that the prevalence of multidrug-resistant tuberculosis (MDR-TB) is the main feature of the Ukrainian epidemic.

Many patients refuse to continue treatment the moment they start feeling better. They do not want to spend at least six months in the dispensary and to be unemployed, staying on the verge of poverty. Due to discontinued treatment the health situation worsens – mycobacteria becomes resistant to drugs. To treat this form, more toxic drugs should be used, the duration of treatment gets longer and it becomes several times more expensive. Now in Ukraine, 85% of the funds allocated for tuberculosis are spent for treatment of multidrug-resistant tuberculosis.

According to Kurpita, treatment of regular tuberculosis lasts six months and costs the state about 30 euros, compared to the treatment of a complicated form of infection, which takes up to 20 months, and the price for that reaches 400 thousand euros. Currently, there are 1.2 thousand cases of such highly resistant bacteria diagnosed in Ukraine. In this sad rating, only India overtakes Ukraine.

Family doctors will start to treat tuberculosis

Experts agree that it is possible to defeat tuberculosis if compulsory hospitalization will be replaced by outpatient treatment. This step may reduce the chance for reinfection in the hospital. Now patients at different stages of recovery are getting treatment in hospital rooms for 5-7 people for years, and they have the risk of catching a nosocomial infection at any time.

A health reform that is currently ongoing in Ukraine, involves the transfer of patients with non-active tuberculosis under the responsibility of family doctors. The last ones are supposed to get extra paid for each of the cured patients.

“The main idea is that doctors will be in closer contact with patients, will know their health history. Responsible people will receive their pills and will lead a familiar lifestyle,” explains Olga Klimenko.

She dreams for three Ukraine-wide days off not because of some celebration but because of a mass medical examination for the all Ukrainians so that people could find out that they have some dangerous disease before it gets to the last stage.