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Every year, March 24 is celebrated as World Tuberculosis Day. This date was not chosen by chance, because on this day in 1882, Robert Koch, at a meeting of the Physiological Society in Berlin, made a report “Etiology of Tuberculosis”, in which he presented convincing data on his discovery of the causative agent of tuberculosis, which was called Koch’s bacillus. Today, this bacterium is known as Mycobacterium tuberculosis. For this discovery, R. Koch was recognized as worthy of the Nobel Prize in 1905.
Tuberculosis is one of the oldest and most dangerous diseases that occur in humans, and in terms of the number of victims it exceeds smallpox and plague. According to WHO, about 4,000 people lose their lives to tuberculosis every day and 28,000 people get sick with tuberculosis.
According to WHO estimates, a quarter of the world’s population is infected with tuberculosis bacilli, most of these people are not sick or contagious, but are at risk of developing the disease in the future. This depends, first of all, on several factors, the most important of which is the person’s immunological status.
Therefore, on World Tuberculosis Day, the attention of the world community is drawn to the critical tasks for achieving the global goals of the Tuberculosis Strategy.
According to reports from the State Institution “Center for Public Health of the Ministry of Health of Ukraine” and comparative epidemiological characteristics, in 2024 the number of newly registered tuberculosis (TB) cases in Ukraine, including its relapses, was 18,140, or 44.2 per 100,000 population, which is 8.7% less than the similar indicator in 2023 (19,851, or 48.4 per 100,000 population).
The TB incidence rate among children aged 0–14 years was 7.6 per 100,000 of the child population (in absolute terms — 434 cases, which is 2.6% of the total number of registered TB cases in 2024), which is 27.1% less than the rate in 2023 (10.4 per 100,000 of the child population).
The TB incidence rate among adolescents (15–17 years inclusive) decreased by 9.9% — from 16.0 to 14.4 per 100,000 people of the corresponding age group (178 cases in 2024 versus 196 in 2023).
The incidence of tuberculosis among healthcare workers in Ukraine decreased to 149 people in 2024 (2023: 156).
The implemented changes are the result of adapting the best evidence-based global experience and the desire to make medical care more accessible and effective. The Center for Public Health tells what changes occurred during 2024 and how they affected the medical system.
Changing the approach from counteraction to complete elimination of TB.
On February 11, 2024, the Law of Ukraine “On Overcoming Tuberculosis in Ukraine” came into force. It guarantees accessible and high-quality services for the diagnosis, prevention and treatment of TB and their free of charge.
The document contributes to the improvement of tuberculosis diagnostics. It is provided by a three-level network of laboratories headed by the central one, which, among other things, carries out quality control of the work of laboratories for microbiological diagnostics of TB of the first and second levels.
In addition, the law provides for the right to an additional annual paid leave for employees of regional phthisiopulmonological centers.
In general, the Law of Ukraine “On Overcoming Tuberculosis in Ukraine” approves multi-branch and multi-sectoral cooperation of central ministries and departments with relevant local executive bodies not only in the medical field, but also in the sphere of social protection, education and others. It strengthens people-oriented approaches to the detection and treatment of the disease through further development of regulatory legal acts. Improving nutrition in inpatient facilities for people with tuberculosis.
In May, the Cabinet of Ministers adopted Resolution No. 571 of May 17, 2024 “On approval of nutritional standards in regional phthisiopulmonological centers, rehabilitation, palliative and hospice departments that provide medical services in a hospital setting for people with tuberculosis.”
In such facilities, the nutrition system is being improved in accordance with the recommendations of the World Health Organization. Balancing the diet with all the necessary macro- and microelements is necessary to improve well-being, strengthen the immune system, and recover as soon as possible from TB.
The Cabinet of Ministers of Ukraine, by Order No. 564-r of June 18, 2024, approved the Operational Plan of Measures for the Implementation of the State Strategy in the Field of Combating HIV/AIDS, Tuberculosis and Viral Hepatitis for the Period Until 2030 in 2024–2026.
The Cabinet of Ministers of Ukraine, by Order No. 726-r of August 2, 2024, approved the Strategy for the Development of the System of Anti-Tuberculosis Medical Care for the Population for 2024–2026 and its Implementation Plan.
During 2024, the Ministry of Health of Ukraine determined the regulations of the work and approved the orders of the laboratory network for TB diagnostics.
— “Some issues of the formation of a three-level laboratory network for tuberculosis diagnostics in the system of anti-tuberculosis medical care for the population” dated 03/12/2024 No. 422;
— “On approval of the Regulations on the third-level microbiological laboratory for tuberculosis diagnostics” dated 07/04/2024 No. 1160;
— “On approval of the State Sanitary Norms and Rules “Establishment of microbiological laboratories for TB diagnostics and ensuring biological safety in their work”” dated 09/12/2024 No. 1585.
The orders allow to improve the organization and provision of quality tuberculosis diagnostic services.
Changes in the approach to outpatient treatment of people with TB in primary health care institutions are reflected in the order “On Approval of the Procedure for Providing Outpatient Treatment Services for People with TB in Primary Health Care Institutions” No. 1923, signed by the Minister of Health of Ukraine Viktor Lyashko on November 16, 2024.
This document determines that the entire path of treatment until a person with TB recovers will be accompanied by a special multidisciplinary team, which includes a family doctor, a tuberculosis specialist, community members, and civil society institutions.
The improvement of anti-TB medical care continues.
Ukraine was one of the first in the world to start treatment for drug-resistant tuberculosis (DR-TB) according to the innovative BPaL/BPaLM regimen and achieved its effectiveness of 90%.
The BPaLM regimen is the latest treatment regimen for DR-TB, consisting of tablet forms of the drugs bedaquiline, pretomanid, linezolid and, in some cases, moxifloxacin. The name of the regimen was given by the abbreviation of the first letters of the names of these drugs. Thanks to the BPaL regimen, the total duration of treatment for patients with DR-TB is reduced by almost three times – to 6–9 versus 18–24 months. Thus, patients no longer need to receive painful injections for many months, and most importantly, this regimen gives a much better chance of recovery.
Ukraine began implementing the BPaL/BPaLM treatment regimen in 2022, first as part of an operational study, and after the approval of new standards of medical care “Tuberculosis” – to apply it in routine practice.
Our country presented its experience in implementing BPaL/BPaLM for DR-TB in March 2024 at a virtual meeting of the participants of the WHO platform for information exchange and support of this new treatment regimen.
Ukraine already has amazing results in implementing BPaL/M, because according to the operational study, the treatment success rate is 90%. For comparison: the effectiveness of treating drug-resistant tuberculosis according to old regimens in 2021 was only 63.7%. The study lasted from July 2022 to January 2023 and included 358 people with drug-resistant tuberculosis who received treatment according to the BPaL regimen. Of these, 318 recovered (89.8%), 7 died (2%), 13 patients had ineffective treatment (3.7%), 16 dropped out of the study (4.5%).
Such a high result was made possible thanks to the daily coordinated work in extremely difficult conditions of the regional phthisiopulmonology centers, which were the clinical sites of this study, in close cooperation with the Yanovsky National Institute of Phthisiology and Pulmonology, with the assistance of the Ministry of Health of Ukraine, coordination of the Center for Public Health and technical support in four regions of the international charitable foundation “Organization of Optimal Technologies in Health Care”.
We join the numerous congratulations to our phthisiologists on their professional holiday and wish them good health, success in their vital work under the peaceful sky of Ukraine, happiness, and warm family comfort!
Professor Nina Macegora
Ukr