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 TB reached its peak in 2005 when official data increased three times compared with pre-epidemic period (approximately 100 cases for people). Tuberculosis (TB) epidemiy in Ukraine was officially pronounced by Ministry of Health in TB reached its peak in 2005 when official data increased three times compared with pre-epidemic period (approximately 100 cases for 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 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. 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 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 ), lack of financial support of the institutions, lack of qualified medical staff, and spreading of the chimioresistance of TB. 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 ), 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 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 population. 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 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 population.

N1. Case rate for active TB among Ukraine population in 2012 (for )

N2. Case rate for active TB among Ukraine population for cities and villages residents

N3.Number of registered cases of the established multiresistant TB 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)

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). 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 co- infected, that do not fully provide ART, which caused mortality. Lethal cases: 14.1% (goal <5%), of which 7.7% are TB/HIV co- infected, 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.) 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 TB- cases registration. Transferred 3.5%, which means disadvantages of the system of TB- cases registration.

Opportunistic Infections Total on : TB TB ex BI CD-4<200 HIV Slim CanBr CanES HS PCP TGCMV SK

Mortality rate TB AIDS TB+AIDS

TB+AIDS Morbidity (black) TB Mortality (blue) AIDS Mortality (red) TB+AIDS TB AIDS

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. 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. 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 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 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. To organize work places for medical staff according to TB control rules for TB prevention among them.