You're reading: Ukraine struggles with Soviet legacy of tuberculosis treatment

A quarter of people who have tuberculosis in Ukraine are unaware they have the disease.

Every third child detected with tuberculosis (TB) has a multidrug-resistant form of the TB, a form of the disease resistant to most antibiotics, making it difficult and costly to treat.

And Ukraine has one of the worst rates of infection by multidrug-resistant tuberculosis, with more than 8,000 new cases registered in the country every year.

These sad figures are all related to the fact that Ukraine still has outdated methods of treatment for tuberculosis – a relic of the country’s Soviet past and failure to reform healthcare, experts say.

Yana Terleyeva from the Public Health Center of the Ministry of Health of Ukraine said many Ukrainians still see tuberculosis a disease of the poor, and think TB patients should be isolated in special TB hospitals.

“But in fact, there is no typical tuberculosis sufferer now,” Terleyeva said. “Anyone can get ill with TB.”

In 2016, there were 29,000 new cases of tuberculosis recorded in Ukraine, including 822 cases among children.

Back in Soviet times, people with tuberculosis were sent to special hospitals for several months. Ukraine still maintains these hospitals, although they are ineffective in many cases, and costly for the state budget.

Hospital treatment for regular tuberculosis lasts about four months, but for multidrug-resistant TB it can be six months or even more. As a result of this, many patients leave hospital without finishing their treatment, which encourages the development of multidrug-resistant TB.

“Ukrainian tuberculosis hospitals have some of the worst treatment records,” Terleyeva said, adding that in many cases the patients were infected with the multidrug-resistant forms of TB at these very hospitals – from other patients.

The hospitals are able to cure only 40 percent of the cases of multidrug-resistant TB, while the World Health Organization sets the standard cure rate for such institutions at 70 percent.

So now Ukraine’s health ministry is trying to transfer most TB patients to home-based treatment programs, where they can continue normal life while still taking the necessary medication.

Doctors now believe that the compulsory yearly lung X-ray screening of all people – another Soviet norm – is also unnecessary. They say that these tests are necessary only for the target groups, including HIV-positive people, who have a much higher chance of contracting TB.

Another problem is the lingering stigma that surrounds the disease: school teachers or catering workers are likely lose their jobs if they fall ill with TB, which causes sufferers to try to hide their condition even from relatives.

In fact, under a normal treatment program, the patient can’t infect anyone else and doesn’t need to be isolated, Terleyeva said.

Dmytro Sherembey, the head of the All-Ukrainian Network of People Living with HIV, said that 15 years ago he was diagnosed with tuberculosis in both lungs, and had a low chance of survival.

“I was sent to a hospital with 50 percent weight loss. I didn’t have much chance of survival, since I had HIV in addition to suffering from TB,” Sherembey said.

In fact, tuberculosis is the cause of death of 60 percent of people with HIV. And despite the overall number of new cases of TB falling in Ukraine, the number of people infected with both TB and HIV is growing.

But Sherembey said the new strategy of the health ministry, which was adopted in 2016, has already shown some good results. The ministry has increased spending on TB treatment, allowed international organizations to procure TB medication on its behalf (resulting in a 50 percent decrease in drug costs) and started the transfer from hospital to outpatient treatment.

“The faster and more radical we are here, the more lives will be saved in Ukraine,” Sherembey said.