Ukraine’s parliament is discussing the National Program to Combat Tuberculosis for 2007-11, a document that, if passed, will be one of the cornerstones of the national public health strategy. It is crucial to adopt a program for the prevention and treatment of tuberculosis because the previous scheme of this scale ended last year, and there is still no clear-cut plan of anti-TB measures for 2006.
Last Friday representatives of the civic organizations Ukrainians Against Tuberculosis and Health Without Borders told The Day about the advantages and prospects of the new documents.
An epidemic by World Health Organization standards broke out in Ukraine in 1995, when the number of tuberculosis patients exceeded 1 percent of the total population. Since then there have been almost no positive changes: the incidence of this disease has increased more than twice, and over 550,000 people are registered in hospitals as suffering from various forms of tuberculosis. Experts estimate that another million or so unrecorded Ukrainians may be suffering from this disease. Statistics are anything but upbeat: Koch’s Bacillus is claiming about 40,000 of our compatriots every year.
The new anti-tuberculosis program takes a more serious approach to such important questions as correct diagnosis and effective treatment. Experts say that one major advantage of the new plan over the old one is that it is exclusively oriented to one disease, while all the previous TB projects also included HIV/AIDS, cancer, and other serious illnesses.
“This program exclusively targets tuberculosis, so there is every reason to believe that it will be more effective than the previous one,” says Vitalii Rudenko, who heads the board of directors of Ukrainians Against Tuberculosis. “A single All- Ukrainian Tuberculosis Control Center will be established, the register of patients will be updated, and diagnostic and treatment methods are also going to change.”
First and foremost, serious changes are supposed to be made to the system of diagnostics and identification. Experts forecast that the number of tuberculosis patients first identified in the outpatient stage will increase from 20 percent in 2007 to 60 percent in 2011 and all patients without exception are expected to be bacteria-free after outpatient treatment.
In addition to fluoroscopy, the basic diagnostic method, wider use will be made of sputum smear microscopy, by far the most effective method that tracks TB at earlier stages. Urgent control measures also include developing national standards for laboratory diagnostics. Emphasis is being placed on increasing the number of patients who have undergone positive treatment to 85 percent (the current figure in Ukraine is 70 percent), while the number of people who have interrupted their treatment should drop to 5 percent. More than 20,000 people in Ukraine are afflicted with severe tuberculosis and about 6,000 with drug-resistant tuberculosis, but the number of new patients is expected to be drastically reduced within five years.
“The advantage of this program is not only that it is aimed at concrete results,” says Ihor Horbatenko, chairman of the board of directors of the international organization Health Without Borders. “This is the first time in the anti-tuberculosis policy that urgent, top-priority, and desirable measures have been clearly distinguished. This means that the program’s most vital parts — identification and treatment of patients — will be adequately funded.”
The drafters of the program hope that it will bring about an annual one-percent drop in the TB incidence rate and shrink the numbers of people who have interrupted their treatment. As a result, drug-resistant forms of this illness will decline. A total of UAH 1.2 billion will be earmarked from Ukraine’s state budget and a World Bank loan for diagnosing, preventing, and treating the disease.
But the action program will have no effect unless people begin caring for their health. “Tuberculosis is a social disease, but people in the risk group often do not know that tuberculosis treatment is free of charge,” Rudenko notes. “Very few people see a doctor when they start coughing, while those who have started a course of treatment are not always aware of the consequences of interrupting it.”
Meanwhile, tuberculosis is indifferent to material well-being or pretty faces. Most TB sanatorium patients are people of working age, who ignored medical advice and failed to have an early checkup.
