Reforming tuberculosis control in Ukraine: results of pilot projects and implications for the national scale-up of DOTS

Abstract

The period of economic transition has had severe consequences for health and health systems in Ukraine. The tuberculosis (TB) situation illustrates this. The strategy recommended by the World Health Organization (WHO) for TB, directly observed treatment short-course (DOTS), has the potential to provide real improvements in TB services, forming the basis of the response to the growing epidemic. In 2002, Ukraine, financially supported by USAID and the European Community (EC), began to introduce DOTS through pilot projects in Mariupol and Kyiv City. The aim of this study is to assess the feasibility, effectiveness, health service cost, patient cost, and the cost-effectiveness of these pilots, in order to inform the national scale-up of DOTS. The study finds that DOTS is feasible and has the potential to be both effective and cost-effective in Ukraine. Following this study, Ukraine adopted DOTS as a national TB control strategy in 2005. However, the pilots also found that there are several evidence-related concerns and perverse economic incentives to both providers and patients that will need to be addressed if national scale-up is to be successful. These include concerns related to the treatment of MDR-TB, economic benefits to some patients to remain hospitalized, and payments to providers and health facilities that support current practices. These will need to be addressed if Ukraine is to develop an effective response to its emerging TB epidemic.

Tuberculosis

“…In one study, in the LMIC group, India consistently had the lowest costs for hospitalization and Ukraine had the highest costs for hospitalization and outpatient care (Laurence, Griffiths, and Vassall 2015). In Ukraine, high hospitalization costs, where patients also incurred costs, led to treatment default (Vassall and others 2009). In 2013, in countries with a high burden of TB and MDR TB (excluding China and Russia), almost 38 percent of funding (US$919 million) was allocated to hospital inpatient and hospital outpatient care of drug-susceptible TB (WHO 2013b).…”

Household costs of illness during different phases of tuberculosis treatment in Central Asia: a patient survey in Tajikistan

“…In urban Ukraine, total illness-related costs of TB varied from $57 to $450 depending on the TB control strategy and on the locality [27]. These costs were often outweighed by the social benefits provided to TB patients.…”

Reforming sanitary-epidemiological service in Central and Eastern Europe and the former Soviet Union: an exploratory study

“…We did not examine services for those with HIV/AIDS and tuberculosis, since these were not part of the historical san-epid system and still function as autonomous but centrally directed sub-systems with their own convoluted funding sources. Furthermore, these services have been the subject of extensive research already [14-16]. …”