🦠 In Ukraine, tuberculosis (TB) continues to present a serious public health challenge, with high rates of multidrug-resistant TB (MDR-TB), late diagnosis, and persistent barriers to effective care. Despite awareness campaigns and international support, the country has struggled to bring the epidemic under control for over two decades.
🏥 Fluorography at the Front Door: Outdated Screening and Delayed Diagnosis
At most public clinics in Ukraine, patients are required to undergo a mandatory chest X-ray (fluorography) before seeing a physician. While intended as a preventative measure, this practice often results in delayed and passive detection of TB rather than proactive outreach. Many patients, like Olga Klimenko, a TB survivor and activist with TBpeople Eurasia, only learn of their illness after months of advanced infection.
Olga’s case reflects a common pattern: self-medication, symptom suppression, and late-stage diagnosis. She was hospitalized six months after developing symptoms, separated from her daughter, and treated in a system that initially offered little clarity about her condition or infectious status.
“I didn’t know when or how I contracted TB,” says Olga. “Most people just self-medicate after a long-lasting flu and avoid doctors altogether.”
📉 Ukraine Leads in Drug-Resistant TB Rates
Ukraine currently reports over 10,000 cases of active TB annually, with another 30,000 classified as non-active. However, the World Health Organization (WHO) estimates that one in four TB cases remains undiagnosed. Since crossing the epidemic threshold of 50 cases per 100,000 people in 1995, Ukraine’s incidence has remained alarmingly high—67.6 per 100,000 in 2016—well above neighboring countries like Poland (17 per 100,000) and the European average (12 per 100,000).
Of particular concern is the prevalence of multidrug-resistant TB (MDR-TB). Patients frequently discontinue treatment prematurely, often due to poor hospital conditions or financial hardship. As a result, drug-resistant strains develop, requiring longer, more toxic, and costlier therapies. According to Ukraine’s Public Health Center, 85% of TB funding now goes toward MDR-TB treatment.
Standard TB treatment lasts six months and costs ~€30. Treating advanced drug-resistant TB can take up to 20 months and cost the health system as much as €400,000 per patient.
💊 The Human Toll Behind the Numbers
Despite the designation of TB care as “free” under Ukrainian law, many patients face informal payments, logistical barriers, and substandard hospital infrastructure. Overcrowding in TB dispensaries—where patients with different stages of recovery share space—adds to the risk of nosocomial (hospital-acquired) infections.
Olga now supports patients through her Facebook group, The World Inside Me, which regularly receives requests for financial assistance to purchase unlicensed medications, basic necessities like washing machines or adult diapers, and psychosocial support. In a recent month, she mentored 34 patients navigating treatment challenges.
🚑 Reform in Motion: From Dispensaries to Family Doctors
In response to mounting public health concerns, Ukraine is currently implementing healthcare reforms aimed at shifting TB care to the outpatient level. Patients with non-active TB will soon be managed by family physicians, who will receive performance-based incentives for each successfully treated case.
This approach is designed to:
“When doctors have a relationship with the patient, they’re more likely to ensure treatment is completed,” explains Olga.
She envisions a country-wide campaign in which citizens are given paid days off for universal health screenings, enabling early detection of TB and other chronic conditions—before they reach life-threatening stages.
🌍 Regional Impact: A Public Health Risk Beyond Borders
With millions of Ukrainians working or migrating across the EU, neighboring countries have raised concerns about the transnational spread of TB, particularly resistant strains. Discussions in Poland have included proposals for border health checks due to fears surrounding Ukraine’s ongoing TB epidemic.
🔍 Looking Ahead: A Call for Holistic Action
Ukraine’s TB crisis highlights the importance of early diagnosis, community-based care, and targeted public health investment. While the nation grapples with economic and political instability, the burden of TB—especially MDR-TB—threatens to derail broader progress in healthcare.
With global support, innovation, and a people-centered approach, Ukraine has the potential to transform its TB response from one of the world’s most challenging to a model of recovery.
📖 Reference
AFEW International. (2023). Ukraine’s TB epidemic: Barriers, resilience, and the road ahead. Retrieved from https://afew.org/ukraine-tb-eng
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