WHO: Treating tuberculosis in Ukraine

From: Subject: WHO: Treating tuberculosis in Ukraine Date: Tue, 18 May 2004 10:12:00 +0300 MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_000_0000_01C43CC0.8F1F0A20"; type="text/html" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2800.1165 This is a multi-part message in MIME format. ------=_NextPart_000_0000_01C43CC0.8F1F0A20 Content-Type: text/html; charset="utf-8" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.who.int/features/2004/tb_ukraine/en/ =EF=BB=BF WHO: Treating tuberculosis in Ukraine

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11 May 2004

Treating tuberculosis in Ukraine

=20

Nikolai Vlasenko, a = multidrug-resistant TB=20 patient at the Donetsk hospital. =

A man in a green training suit shuffles down = an empty=20 hallway. The smell of cleaning products and food leftovers = hangs in=20 the air. He is tired. Walking is difficult. He has pain in = his=20 chest. He turns into his small hospital room and, relieved = of the=20 effort, sits down on his narrow bed.

The man, Nikolai, is a patient at the = tuberculosis=20 (TB) treatment centre in Donetsk, Ukraine. Formerly a Soviet = centre=20 for steel production and coal dismantling, life in Donetsk = has=20 steadily become more difficult over the last fifteen years. = Today,=20 poverty levels are rising and many people have lost their = jobs.

Nikolai has been hospitalized for two months = now. He=20 is likely to stay in hospital for a long time because he is = infected=20 with a strain of TB that is resistant to most of the = available first=20 line anti-TB drugs. Treating this so called = multidrug-resistant TB=20 (MDR-TB) is much more difficult and expensive than curing = =E2=80=98normal=E2=80=99=20 TB. Even then, a cure of MDR-TB, and Nikolai=E2=80=99s = survival, is not=20 guaranteed.

Multidrug-resistant tuberculosis (MDR-TB)

Multidrug-resistant TB (MDR-TB) is the = disease caused=20 by TB bacilli that are resistant to at least isoniazid and=20 rifampicin =E2=80=93 the two most powerful anti-TB drugs. It = results from=20 inconsistent or partial treatment of TB, and develops when = public=20 health programmes fail to deliver regular and reliable = treatment to=20 TB patients. The end of the Soviet state left the people in = the=20 newly independent states in Eastern Europe and the Russian=20 Federation with uneven access to health care. According to a = recent=20 WHO report TB patients in parts of Eastern = Europe=20 and Central Asia are now ten times more likely to have = MDR-TB than=20 those in the rest of the world.



	Ukraine = country=20 profile Tuberc= ulosis=20 fact sheet

=E2=80=9CWe have some second line drugs for = our MDR-TB=20 patients, but we don=E2=80=99t know which of them work. = There are few data=20 on MDR-TB in Ukraine,=E2=80=9D says Dr Swetlana Lebschiva, = Assistant=20 Professor for TB and Pneumology at the University of = Donetsk, who=20 works at the TB hospital. She adds that some of the TB = patients=20 leave the hospital before the end of their treatment, only = to return=20 in poor condition and resistant to drugs.

Tuberculosis control: DOTS

Until the year 2000, TB prevalence in = Ukraine grew=20 annually by 15% to 20% as a result of the more and more = difficult=20 economic and social situation. This year, for the first = time, the=20 trend was reversed. =E2=80=9CThe main reason of this success = lies in the=20 introduction of an internationally recommended TB treatment=20 strategy, called DOTS,=E2=80=9D says Dr Oleg Karatajev, = Chief Health=20 Administrator for Donetsk and the surrounding region.

What is DOTS?

3D"Anti-TB =20
Anti-TB drugs used in=20 DOTS
DOTS is the=20 internationally recommended TB control strategy. It is = composed of five elements:=20 -=20 political commitment to sustained TB control
- a = regular=20 supply of anti-TB drugs
- sputum smear diagnostic=20 microscopy services
- individual patient monitoring = systems
- standardized treatment regimes with = direct=20 observation of therapy (DOT).
Patients=20 with infectious TB are identified using microscopy = services.=20 Then health workers, community workers and trained = volunteers=20 observe and record patients taking the full course of = the=20 correct dosage of anti-TB medicines. The treatment has = to be=20 followed for six to eight months.
If=20 administered accurately, DOTS can treat TB with a = success rate=20 of nearly 99% and can help to avoid the development of = MDR-TB.
More on DOTS =

In Ukraine, DOTS was implemented as a pilot = project in=20 Donetsk at the end of 2001. =E2=80=9CBefore DOTS, only TB = specialists were=20 able to detect cases, by using expensive x-rays. Only a few = cases=20 could be detected and treated, and the patients had to stay = at the=20 hospital for at least one year,=E2=80=9D explains Dr Maja = Goroschko, Deputy=20 Director of the Donetsk hospital. =E2=80=9CWith DOTS, = general practitioners=20 are trained to detect TB using a simple sputum test. If a = patient is=20 infected, he is transferred to a TB dispensary. This is a = huge=20 difference: now everyone who develops infectious TB can be = detected=20 and treated.=E2=80=9D

=20

Multidrug-resistant TB patients in = their room=20 at the Donetsk = hospital

The major challenge for implementing DOTS = widely=20 across Ukraine is the fact that DOTS has two phases. During = the=20 first phase, when patients are still contagious, they stay = at the=20 hospital. On average, this period lasts two months. After = that, when=20 they can no longer transmit the disease, they continue with = their=20 treatment from home. Trained workers or volunteers in local = clinics=20 provide them with medicines.

Although the changes needed to apply DOTS = across=20 Ukraine will be a long process, DOTS is already having a = positive=20 impact in the country. =E2=80=9CSince we started DOTS our = success rate in=20 treating TB has risen from 57% to 81%. This is a major step = up that=20 will also help to get the development of MDR-TB under = control,=E2=80=9D says=20 Dr Goroschko.

Dr Kestutis Miskinis, Medical Officer at the = WHO TB=20 Control Office in Ukraine, agrees. =E2=80=9CIn order to = control TB and=20 MDR-TB in the long term we need to move forward with DOTS=20 systematically. In regions where DOTS is not implemented, = doctors do=20 not have to follow any protocol with regard to the use of = first and=20 second line drugs. Drugs that are prescribed to MDR-TB = patients=20 often have not even been tested before and there are no = regulations=20 for a recommended dosage. If we do not expand DOTS, these = factors=20 will contribute to mounting levels of drug resistance in the = country.=E2=80=9D

HIV and TB

Ukraine and other countries in Eastern = Europe and=20 Central Asia where MDR-TB prevalence is high, also = experience the=20 world=E2=80=99s fastest growing HIV infection rates. This = rapidly expanding=20 combined epidemic presents an enormous public health = challenge.=20 People living with HIV/AIDS are many times more susceptible = to=20 developing all forms of TB. =E2=80=9CWith people=E2=80=99s = immune systems=20 compromised, MDR-TB has a perfect opportunity to spread = rapidly and=20 kill,=E2=80=9D explains WHO Assistant Director-General of = HIV/AIDS, TB and=20 Malaria, Dr Jack Chow, =E2=80=9CWe cannot control one = without controlling=20 the other, and we must begin to scale up TB/HIV = collaborative=20 activities to provide a synergy of prevention, treatment and = care=20 for co-infected patients.=E2=80=9D

At the beginning of April, WHO and the = Ukrainian=20 Ministry of Health held a workshop in Donetsk to explore = ways of=20 ensuring an effective joint HIV/TB response. The gathering = is the=20 latest in a line of WHO initiatives aimed at assisting = countries=20 scale-up TB control programmes. Already, preparations for = the=20 formation of a high level working group, made up of = international=20 and national TB specialists, are gaining pace. Ukraine could = be the=20 test bed that sees innovative and modern TB control = practices put in=20 place.

"Ukraine has the capacity to rapidly scale = up and=20 modernize TB control," says Dr Mario Raviglione, Director of = WHO's=20 Stop TB Department. "If Ukraine can do this, we will see the = threat=20 from the TB/HIV co-infection and MDR-TB reduce. But for this = to=20 happen, the political will must be in place."

Nikolai, at the Donetsk TB dispensary, might = not be=20 aware of the complex public health issues behind the seven = pills he=20 takes three times each week. The pain in his chest is still = there.=20 It is simply a matter of living, or dying.

RELATED SITES

- Tuberculosis
- Stop TB = Partnership

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