Transcript Tuberculosis: the Main Opportunistic Infection in Ukraine Tetyana

Tuberculosis:
the Main Opportunistic
Infection in Ukraine
Tetyana Loginova
Kiev City Narcological Hospital
"Sociotherapy"

Tuberculosis (TB) epidemiy in Ukraine was officially pronounced by Ministry
of Health in 1995. TB reached its peak in 2005 when official data increased
three times compared with pre-epidemic period (approximately 100 cases
for 100 000 people).

During last 15 years, Governmental measures towards TB prevention
included anti-TB medications purchases, as well as consequent realization
of two “Global Governmental programs of countermeasures towards TB”
that allowed to slow further spreading of epidemy in Ukraine, and lowered
TB number to approximately 25 % compared with its worst situation in
2005. Based on WHO, there are certain advances in Ukraine, which
undoubtedly helped to slow TB epidemy. In the official report on Global TB
struggle in 2012, Ukraine fortunately did not make it to the list of 22
countries with largest TB numbers.

To date, there are 102 cases of TB-infection registration and four lethal
cases on a daily basis. This situation is caused by social-democratic and
medical conditions, such as lowering of the population level and the
presence of the sick imprisoned people (over 10 000), lack of financial
support of the institutions, lack of qualified medical staff, and spreading of
the chimioresistance of TB.

In 2012, TB infection had a tendency of growth compared with 2011 (with
about 1.3% increase, that is, 67.2 to 68.1 on 100 000 population). The
decline of the epidemic situation with TB is also caused by HIV/AIDS factor
in Ukraine. Over 30% of HIV-infected patients are infected with TB, and
over 40% of them die because of HIV/AIDS. HIV infection is a powerful
factor that allows development of the TB active form in carriers of latent
infection, as well as increase of possibility of TB relapse. Based on
Governmental Statistic Service, mortality indicator in 2012 was 15.1 to
100 000 population.
N1. Case rate for active TB among Ukraine
population in 2012 (for 100 000)
N2. Case rate for active TB among Ukraine
population for cities and villages residents
N3.Number of registered cases of the established
multiresistant TB
8000
6934
7000
6000
5000
4056
4305
4000
3329
3000
2000
1000
0
2009
2010
2011
2012
Thank to adjusted diagnostics by using modern methods
(GeneXpert &Bactech), detectability of the multiresistant TB
increased.
N4.Efficacy of treatment by using positive smear at
primer TB diagnostic, registered in 2011 (in accord
with cohort analysis)
Перерване
лікування; 7,5%
Вибув або
переведений; 3,5%
Діагноз
"туберкульоз"
знятий; 0,3%
Невдале лікування;
19,6%
Ефективне
лікування; 55,0%
Померло хворих;
14,1%
Low rate of the treatment efficacy is caused by high
rates of:




Unsuccessful treatment: 19.6% (goal: 3-5%), which indicates
insufficient monitoring of the treatment, spreading of the TB/HIV
co-infections in high level of multiresistant TB (9.8% cases – failure
with transfer to 4th category).
Lethal cases: 14.1% (goal <5%), of which 7.7% are TB/HIV coinfected, that do not fully provide ART, which caused mortality.
Interrupted treatment of 7.5% (goal 3%), which indicates low
adherence of the patients and unsatisfactory social support of TB
patients during the therapy (nutritional, social and medical support,
etc.)
Transferred 3.5%, which means disadvantages of the system of TBcases registration.
Opportunistic Infections
Total on 01.01.2013: 24090
TB
10000
5000
TBex
2000
BI
CD-4<200
HIV Slim CanBr
CanES HS
PCP
TG
CMV
SK
Mortality rate
7000
TB
5000
AIDS
3000
TB+AIDS
2010
2011
2012
TB+AIDS Morbidity (black)
TB Mortality (blue)
AIDS Mortality (red)
7000
TB
5000
TB+AIDS
AIDS
3000
2006
2008
2010
2012
Conclusions
For effective TB detection, diagnostics, and treatment,
following points can be summarized:





To reduce the consequences of TB epidemics, anti-TB
institutions have to be integrated into the AIDS centers, and
their funding should be considerably increased.
Everybody from marginalized group of population has to be
examined by X-ray minimum once a year.
To implement new mobile X-ray equipment for examination of
large population groups in villages and marginalized people
(drug addicts, alcoholics, homeless).
To extend implementation of modern laboratory methods
(GeneXpert and Bactech) in practice for quick diagnostic
tuberculosis, to isolate TB patient and to start treatment on
time.
To organize work places for medical staff according to TB
control rules for TB prevention among them.