Visiting Nurses Improve Treatment Compliance, Offer Hope to TB Patients
Since the breakup of the Soviet Union in the early 90’s, Ukraine has experienced a rapidly growing tuberculosis (TB) epidemic, deepening year by year and exacerbated by rising rates of multi-drug resistant strains and HIV co-infection. With new TB cases doubling during the past decade, and approximately 40,000 cases reported annually over the last five years, Ukraine has the second highest rate of new cases in Europe. The majority of new cases are detected among people of working age; this age group also accounts for more than 10,000 deaths per year. The impact of this trend on economic growth potential and national security is stark.
A number of health system barriers have impeded the effectiveness of efforts to control TB in Ukraine. Inappropriate treatment regimens, inadequate laboratory services, and a lack of TB drug resistance surveillance and TB-HIV integrated services are among the key deficiencies of the country’s TB control system.
Since 2000, USAID has been the leading and the most consistent donor in fighting TB and TB/HIV in Ukraine, providing assistance to the Government of Ukraine to overcome key barriers and improve TB case detection, treatment, and outcomes. USAID’s funding of the first pilot project, implemented by the World Health Organization (WHO) in Donetsk to introduce the Directly-Observed Treatment Short-course (DOTS) Strategy, was critical to securing the Government of Ukraine’s commitment to endorse the WHO Stop TB Strategy as a part of its National TB Control Program. With USAID support, the project has been rolled-out to eight more regions over the last five years.
USAID’s partnerships with local public and private organizations have helped the program to proceed and find additional in-country resources. In January 2008, USAID signed a $20M partnership with the Foundation for Development of Ukraine to eradicate TB. Since 2005, USAID, through its implementing partner PATH, has collaborated with the Ukrainian Red Cross Society (UCRS) Visiting Nurse Service to increase patient compliance with TB treatment regimens to improve outcomes. USAID-supported UCRS activities have also focused on improving communication and counseling skills and coordinating care with medical services.
A TB patient, who wishes to remain anonymous, was visited every other day during his treatment by a Red Cross nurse through USAID's TB control program. “I have changed my attitude towards the life itself and people around me,” he says. “I thought nobody cared about me, and the whole world was against me. Nurses from the Red Cross talked to me in such a way that I realized I had future, and I needed to get treatment to survive. Now I believe in myself. I am trying to find a job, and I have hope.”
Preliminary data suggests that the likelihood of treatment default is substantially lower thanks to the combined efforts of USAID programs and Red Cross nurses. In two sites in Donetsk Oblast (Mariupol and Yenakievo), the percentage of patients who quit treatment declined from 22 percent to 0. USAID’s collaboration with UCRS has also strengthened volunteer groups that include patients and helped establish additional social support for TB patients.
Recently USAID launched a new four-year TB control program that involves the National Committee of the URCS. The Red Cross will continue to coordinate activities with TB medical facilities and will work to improve social support, community mobilization, and education and counseling.
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