Barbara Molina-Moya

Crudu

Dudnyk

Irina Kontsevaya

Lorenzo Guglielmetti

Lytvynenko

Lönnroth

Matthew Burman

Olena Rzhepishevska

Vladyslav Nikolayevskyy

Journal of Public Health

Burman, Matthew

Nikolayenskyy, Vladyslav

Kontsevaya, Irina

Molina-Moya, Barbara

Rzhepishevska, Olena,

Guglielmetti, Lorenzo

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Tackling the MDR-TB epidemic in Ukraine : every little helps … and much more needed

Nikolayevskyy, Vladyslav

Rzhepishevska, Olena

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Tackling the MDR-TB epidemic in Ukraine: every little helps … and much more needed

Burman, M

Nikolayevskyy, V

Kontsevaya, I

Molina-Moya, B

Rzhepishevska, O

Guglielmetti, L

Queen Mary Research Online

Journal of Public Health | pp. 1–2CorrespondenceTackling the MDR-TB epidemic in Ukraine: every littlehelps … and much more neededDear Editor,The 2016 TBnet Academy, a meeting to support collabor-ation and learning about tuberculosis (TB) amongst stu-dents, doctors and researchers from across Europe, washeld in Odessa, Ukraine. We witnessed first-hand the com-mitment of local healthcare professionals to tackle theincreasing multi-drug-resistant TB (MDR-TB) burden.Ukraine is one of the WHO’s 30 high-burden countries forMDR-TB.1 In 2014, 8000 patients started on MDR-TBtreatment, accounting for 22% of all new TB cases.1We write this letter to share the progress being madelocally, to highlight the difficulties being faced, and to callfor ever stronger international collaboration to tackle theMDR-TB epidemic.Access to key laboratory diagnostics has improved signifi-cantly within Ukraine. Since 2011 rapid liquid culture(BACTEC MGIT, Becton Dickinson, USA) and moleculartools (GeneXpert, Cepheid, USA), procured by the GlobalFund, are being systematically introduced across the country.Ukraine has developed a national electronic TB register andinternational funding has improved the coverage of anti-retroviral therapy (ART) for HIV/TB co-infected patients.Local initiatives have led to the allocation of regional funds forthe renovation of TB facilities and have also developed newinternational collaborations (http://cordis.europa.eu/project/rcn/108387_en.html).Unfortunately, the impact of the military conflict and theresultant economic downturn puts the progress in TB con-trol at significant risk.2 Due to rising inflation salaries forhealthcare workers (HCWs) have effectively fallen by a thirdmaking the retention of HCWs skilled in TB ever more chal-lenging (http://data.worldbank.org/indicator/FP.CPI.TOTL.ZG?locations=UA). We also observed shortages ofdrugs (rifampicin), basic infection control equipment forstaff and limited access to HIV testing for TB patients.Many are only provided with one of the two tests requiredto be offered ARTs, thus denying access to live-saving treat-ment. Hospital facilities are still limited and overcrowdedwhile the management of MDR/extensively drug-resistant(XDR)-TB patients in communal rooms is a major risk fornosocomial transmission.3 Newly approved MDR-TB drugs,such as Bedaquiline and Delamanid, are not yet available inUkraine, despite the country participating in clinical trials toprove the efficacy of Bedaquiline. This lack of access to newand existing reserve drugs contributes to poor cure ratesamongst MDR/XDR-TB patients.4The End TB strategy identifies the need for ‘politicalcommitment’ to ‘support global TB… control’.5 Withincreasing political isolationism across Europe and beyond,one thing is clear: to tackle the rise of MDR-TB better inter-national collaboration is essential.Ukraine illustrates the benefits that international collabor-ation and support can bring to TB control within a country,but is a stark reminder of the threat to global health posed byMDR-TB. As a group of students and doctors, and research-ers from across Europe, we call for increased internationalfunding, collaboration and expertise exchange to ensure thatwe succeed in the fight against TB and MDR-TB.Submitted on behalf of the Attendees of the 2016 TBnetAcademy (a full list of attendees is available as supplementarydata).Supplementary dataSupplementary data are available at the Journal of PublicHealth online.References1 WHO. Global Tuberculosis Report 2015. Geneva: World HealthOrganization, 2015. http://apps.who.int/iris/bitstream/10665/191102/1/9789241565059_eng.pdf?ua=1. (20 June 2016, date lastaccessed).2 Dudnyk A, Rzhepishevska O, Rogach K et al. Multidrug-resistanttuberculosis in Ukraine at a time of military conflict. Int J Tuberc LungDis 2015;19(4):492–3. doi:10.5588/ijtld.14.0940.3 Crudu V, Merker M, Lange C et al. Nosocomial transmission ofmultidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2015;19(12):1520–3. doi:10.5588/ijtld.15.0327.4 Lytvynenko N, Cherenko S, Feschenko Y. Management of multi-and extensively drug-resistant tuberculosis in Ukraine: how well arewe doing? Public Health Action 2014;4(Suppl 2):S67–72. doi:10.5588/pha.14.0035.5 Lönnroth K, Migliori GB, Abubakar I et al. Towards tuberculosiselimination: an action framework for low-incidence countries. EurRes J 2015;45(4):928–52. doi:10.1183/09031936.00214014.© The Author 2017. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 1Matthew Burman1, Vladyslav Nikolayevskyy2,3,Irina Kontsevaya4, Barbara Molina-Moya5,Olena Rzhepishevska6, Lorenzo Guglielmetti7,81Centre for Primary Care and Public Health, QueenMary University of London, London, UK2Public Health England, National MycobacteriumReference Service South, London, UK3Imperial College, London, UK4Department of Medicine, Infectious Diseases andImmunity, Imperial College London, London, UK5Institut Germans Trias i Pujol (IGTP), UniversitatAutònoma de Barcelona, Barcelona, Spain6Department of Chemistry, Umeå University,Umeå, Sweden7Centre Hospitalier de Bligny, Briis-sous-Forges, France8Center of Immunology and Infectious Diseases,Sorbonne Université, Paris, FranceAddress correspondence to Matthew Burman,E-mail: m.burman@qmul.ac.ukdoi: 10.1093/pubmed/fdx01422 JOURNAL OF PUBLIC HEALTH

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