Preparedness of outpatient health facilities for ambulatory treatment with all–oral short DR–TB treatment regimens in Zhytomyr, Ukraine: a cross–sectional study

Abstract

Introduction Ukraine has a high burden of drug-resistant tuberculosis (DR-TB). Mental health problems, including alcohol use disorder (AUD), are common comorbidities. As part of health reform, the country is moving from inpatient-care to ambulatory primary care for tuberculosis (TB). This study describes the preparedness of ambulatory care facilities in Zhytomyr oblast, Ukraine. Methods This is a cross-sectional study in which routine program data was collected during June 2018 and February 2020. Before discharge of every patient from the hospital, MSF teams assess outpatient facilities available using a standardized checklist. The assessment evaluates access, human-resources, availability of medicines, infection control, laboratory and diagnostic services, and psychosocial support. Results We visited 90 outpatient facilities in 23 districts and 1 city between June 2018 and February 2020. Forty health posts, 27 TB-units, 23 ambulatories including two family doctors and one polyclinic were included. All facilities provided DOT, but only nine (10%) provided weekend-services. All facilities had at least one medical staff member, but TB-training was insufficient and limited to TB-doctors. TB-medicines and storage space were available in all facilities, but only twenty two (24%) stored ancillary medicines. HIV-patients had to visit a separate facility to access HIV-care. Personal protective equipment for infection control was unavailable in 41 (46%) facilities. Basic laboratory services were available in TB-units, but only 3 (11%) performed audiometry. Only twenty (22%) TB-units had psychosocial support available, and 1 (4%) psychiatric support. Conclusions Outpatient facilities in Zhytomyr oblast are not yet fully prepared to provide comprehensive care for DR-TB patients. Integration of psychosocial services, treatment of co-morbidities and adverse events at the same facility are essential to establish high quality, patient-centered care.