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Tackling Ukraine’s Tuberculosis Crisis.

October 14, 2016
Improved diagnostic technology is transforming how the Odesa Oblast region of Ukraine tackles its growing rate of multidrug-resistant tuberculosis.

With a single cough or sneeze, bacteria that carry tuberculosis (TB) are released into the air and start spreading the potentially life-threatening infection. Although curable, active TB creates symptoms that prompt a hospital visit, such as chronic cough, weight loss, and sputum (thick mucus coughed up from the respiratory tract).

In contrast, latent infections of TB leave little to no symptoms at all, but if a person’s immune system weakens, what was once latent TB could easily become active. And if hospitals have limited resources to provide reliable diagnoses, TB can become a widespread public health crisis.

In September 2016, the United Nations General Assembly convened a high-level meeting to address the growing threat of anti-microbial resistance — diseases that are resistant to antibiotics. Anti-microbial drugs like antibiotics are designed to treat infections such as TB, but resistance makes such treatments ineffective. More than 700,000 people die each year from anti-microbial resistance, and of that 200,000 are from multi-drug resistant TB (MDR-TB). In the Odesa Oblast (region) of Ukraine, the rate of MDR-TB is especially alarming.

With 674 new cases of MDR-TB detected in the Odesa Oblast in 2014 alone, MDR-TB has quickly become an epidemic. For high-risk groups such as people living with HIV, a weak immune system makes TB harder to diagnose, faster to spread, and more likely to return after being treated. With the growing challenge of MDR-TB and TB/HIV co-infection, local health care providers in the Odesa Oblast need the resources to reliably and rapidly diagnose TB.

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days reduction time in diagnostic procedures for TB

Odesa Oblast health care providers have struggled to initiate proper treatment of MDR-TB fast enough, particularly due to limited access to modern technology for quick detection. Low awareness of early TB symptoms among local health care providers compounded this problem and contributed to an average treatment delay of 125 days. Facing these obstacles to TB diagnosis, local health care providers and government officials looked to the USAID Strengthening Tuberculosis Control in Ukraine project, implemented by Chemonics, for support.

Together, these groups told us, we know what needs to be done: Our patients need better access to TB detection equipment so we can reach more of them faster. And medical professionals treating people with HIV need a more efficient referral system for TB diagnosis and treatment.

The project responded to this challenge by developing screening questionnaires for people living with HIV, ensuring that HIV patients will be referred more quickly for TB diagnosis and care. And crucially, the project provided better access to the state-of-the-art GeneXpert system and training.

The GeneXpert machine detects resistance to specific drugs used as a means of first-line treatment of TB. In a patient’s journey to TB diagnosis, health care providers play a vital role in sharing information, recognizing symptoms, conducting accurate tests for infection, and ultimately leading the patient to a full recovery. With easy-to-use screening questionnaires and sophisticated technology like the GeneXpert machine, health care providers are supported throughout the diagnosis process, particularly when they face complex cases such as MDR-TB.

“Before, we used less sensitive diagnostic techniques and often tuberculosis remained undiagnosed,” explains Dr. Svitlana Yesypenko, head of the Odesa Oblast TB/HIV aids facility. “Now one fourth of HIV-positive patients with MDR-TB are detected thanks to a new procedure. We would not have been able to detect their TB if we had used our previous approaches.”

Health care providers in the Odesa Oblast are now being trained to use the GeneXpert diagnostic technique. Laboratory staff in the region’s TB facilities are better able to detect MDR-TB cases and are using the internationally recognized standard diagnostic procedures to provide timely, and life-saving, early diagnoses to people living with HIV.

“Before, we used less sensitive diagnostic techniques and often tuberculosis remained undiagnosed. Now one fourth of HIV-positive patients with MDR-TB are detected thanks to a new procedure. We would not have been able to detect their TB if we had used our previous approaches.”

Dr. Svitlana Yesypenko, head of the Odesa Oblast TB/HIV aids facility

As the USAID Strengthening Tuberculosis Control in Ukraine project introduces easy-to-use referral mechanisms and provides sophisticated technologies in laboratory diagnostics and infection control, at-risk patients can foresee a path to a full recovery. The Odesa Oblast may face a difficult burden of active tuberculosis infections, but with the right combination of technology and patient-centered approaches, local communities and health care providers are in a stronger position to tackle TB.

“Our patients today are lucky, although most of them are not aware of this,” says Dr. Yesypenko. “They don’t know that diagnostic procedures that now only take 21 days would have taken them 125 days a year ago. More available GeneXpert diagnostics and proper referrals have resulted in a six-fold decrease in diagnostic time. For HIV-positive people with drug-resistant TB this difference often determines if they die or live.”

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