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Three Keys to Ukraine’s TB Challenge.

October 27, 2014
Dr. Kartlos Kankadze offers three interventions that could help Ukraine manage its TB burden, an issue of growing concern with a rise in multidrug-resistant TB and HIV co-infection.

Although nearly eradicated in the developed world, tuberculosis (TB) still causes the deaths of nearly 1.4 million people every year. Historically, post-Soviet states have maintained a high prevalence rate of TB, and Ukraine is no different. In addition, the country is facing increasing rates of multi-drug-resistant (MDR)-TB, which is more difficult and much more expensive to treat.

The World Health Organization’s 2013 Report features Ukraine as a country with a high MDR-TB burden, making it a top priority for assistance in TB management. With a high prevalence of HIV/TB co-infection cases — which cause one in five HIV-related deaths globally — Ukraine’s rise in MDR-TB cases also exacerbates a serious challenge in the fight against HIV/AIDS.

Yet, there is reason for hope. Ukraine has begun to align its health care system with the European Union (EU) as part of implementation of the EU Association Agreement with Ukraine. Since 2012, Chemonics has been helping Ukraine make progress in its longstanding battle with TB and supporting adoption of EU and global TB care practices through USAID’s Ukraine Strengthening TB Control Project (STbCU) project.

Below, STbCU Chief of Party Kartlos Kankadze, a program manager and medical practitioner with 20 years of experience in health program management and clinical practice, shares three activities the project is working on to help make a difference in Ukraine’s fight against TB.

Move TB and HIV case management to primary care doctors

Ukraine has maintained an unchanged, Soviet-era health system since achieving independence in 1991. Care is specialized and hospital-based, meaning patients with HIV or TB seek care in separate hospitals, which significantly increases costs. Treating TB and HIV cases together in the primary care setting would benefit patients and reduce costs. Because co-infection rates are high in Ukraine, this is one solution that would alter the landscape for individuals who are suffering from both diseases.

“There is a network of TB hospitals and HIV hospitals in Ukraine, but it’s a parallel system and they don’t communicate well,” said Dr. Kankadze. “The Soviet system has created a sub-specialty that doesn’t need to exist. If a person has medical education and can practice medicine, there’s nothing that is extraordinary that they could not manage an HIV, TB, or co-infection case.”

Bridging this parallel system is one way USAID and STbCU are helping Ukrainians living with HIV and TB receive better treatment and care to manage co-infection.

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“Without a doubt, the single greatest challenge — that is also an opportunity — is Ukraine’s health policy. With proposed reforms for deregulation and decentralization, there is a great opportunity for Ukraine to tackle the TB challenge with the full support of the government."

STbCU Chief of Party Kartlos Kankadze

Implement evidence-based interventions

Each day, 84 Ukrainians are diagnosed with TB, and many more are left undiagnosed or misdiagnosed due to low-quality laboratory diagnostics. Sometimes the simplest solution is the best.

For health projects worldwide, the World Health Organization offers global guidelines to ensure the appropriate use of evidence for health interventions. Through STbCU, HIV-positive Ukrainians now have access to a simple survey based on these guidelines that is designed to help identify TB symptoms — one of the most efficient methods for conducting regular TB screening among people living with HIV.

“This was an evidence-based intervention that we helped develop,” said Dr. Kankadze. “Part of the challenge is getting health care providers and the health system to adhere to what are the best practices. Being able to integrate a WHO best practice into the delivery of health services is a major accomplishment. 

Support proposed health reforms for deregulation and decentralization

Ukraine is in the midst of a substantial change in health policy. The Association Agreement of Ukraine with the European Union that was ratified on September 16, 2014 outlines a framework for Ukraine to align its laws more closely with the European Union. Included in that alignment will be changes to decentralize and deregulate the Ukrainian health system. These changes are expected to be outlined in a roadmap that will be finished by December 2014.

“Without a doubt, the single greatest challenge — that is also an opportunity — is Ukraine’s health policy. With proposed reforms for deregulation and decentralization, there is a great opportunity for Ukraine to tackle the TB challenge with the full support of the government,” said Dr. Kankadze.

Having a legal framework that will reform health care and medicine registration for TB and HIV patients will make it easier for them to receive proper care and treatment. Projects with a mandate to help Ukrainians living with TB and HIV will also see the benefits.

“We are delivering impact with confidence. Our project ends in 2017, and we are confident that we can deliver the impact we promised that is within our control. Reforms to the health system will greatly help Ukraine,” said Dr. Kankadze.