culosis creeps ?nto Eastern Europe – A danger for an ep?demy ?s apparent.
Tuberculosis, or TB, was once considered to be on track for global eradication, along with smallpox. By the late 1980s, however, a disturbing upswing in the number of new cases was detected worldwide. A report by the World Health Organization released in March 2005 shows the number of new TB cases stabilizing or even declining in most regions of the world, but not in Africa or Eastern Europe. Today:
Every second, a person is newly infected with TB. Around 1/3 of the world’s population—nearly 2 billion people—have TB. An active, untreated TB case can infect up to 15 more people each year.
In Ukraine many factors fuel the TB epidemic. The number of TB strains that are resistant to multiple drugs is higher in parts of Eastern Europe than almost anywhere else, making treatment difficult. The rising rates of HIV infection also are beginning to influence the number of new TB cases (TB is the most common opportunistic infection and the leading cause of death among AIDS patients). In addition, the country’s health systems suffered a setback during years of political, social, and economic transition. As a result, TB detection in Ukraine is based on an outdated screening technique—miniature chest x-rays instead of simpler, less expensive lab tests. Finally, infected individuals who do not get treated may pass the disease to others.
There ?s a need for accurate information to health care providers, patients, the public, and policy- and decision-makers. Ukra?n?an author?t?es need to onduct surveys and focus group discussions with these groups to help better understand their knowledge and attitudes ?n order to g?ve information they need.
Many individuals with TB experience discrimination because TB is considered a disease of poverty, associated with the homeless, drug users, alcoholics, and prisoners. Infected individuals fear that if they are officially diagnosed, they may lose their job. Some women are afraid that their husbands will abandon them. Many also wrongly believe that TB is incurable or that treatment is expensive.
Doctors feel hampered by poor diagnostic equipment, supply shortages, and lack of funding. They also have trouble finding up-to-date information in their native language. Many of them do not have all the information they need about DOTS, a strategy for TB control recommended by the World Health Organization.
Data from Wikipedia are from 2003 ?llustrates the ?ncrease ?n numbers and ?t has become worse s?nce th?s stat?st?cs was revealed to the publ?c.
22 August 2006 ( ranked by 137 nations ) the percentage of adults (aged 15-49) living with HIV/AIDS. The adult prevalence rate is calculated by dividing the estimated number of adults living with HIV/AIDS at year end by the total adult population at year end.
- rank 50 : Ukraine 1.4%
- rank 55 : Estonia 1.1%
- rank 57 : Russia 1.1%
- rank 69 : Latvia 0.6%
- rank 71 : USA 0.6%
- rank 84 : Belarus 0.3%
- rank 94 : Kazahstan 0.2%
- rank 96 : Moldova 0.2%
- rank 100 : Belgium 0.2%
However, it is certainly true that diagnosed cases of AIDS are increasing throughout the FSU. The Russian figures are almost certainly swelled by the high genuine incidence of TB. TB is known to generate large numbers of false positives for HIV tests and is one of the illnesses which is used as a part of the diagnosis of AIDS. (It is almost as simple as stating that if you have TB, you lose weight and show a tendency toward an immune deficiency then one has AIDS. At that point all the symptoms are listed as being AIDS and not the underlying and genuine illnesses. This is the real economic value of AIDS to health systems and why many health services are not unhappy to be told by UNAids that prevalence is high and rising.)
Don’t forget that HIV and AIDS are different things. HIV is a retrovirus that can be detected and AIDS is a cluster of symptoms that is usually, but not always associated with a high count of HIV in the blood.
All the above noted, a concern that we have in Estonia is that up until recently HIV has been almost totally confined to injecting drug users from the very poorest strata of society and also to have been geographically confined. Recently, for the first time ever, the number of cases of HIV/Aids diagnosed in Tallinn was the same as Narva. This may be a serious development. What I do not yet know is whether the geographical change accompanies a socio/economic change as well. If it does, then no matter what the real incidence of HIV, we do have a problem, if one accepts the hypothesis that HIV is a causaton of the symptoms called AIDS.
USAID has Ukraine as one of ?ts top-priority countries in Europe for improved tuberculosis (TB) control. Ukraine’s estimated TB case rate of 106 cases per 100,000 population is the eighth highest in Europe and Eurasia. According to the World Health Organization’s (WHO’s) Global Tuberculosis Control Report 2008, Ukraine had an estimated 49,308 TB cases in 2006, an increase of 4.6 percent from the previous year. Of these, about 44 percent were cases of sputum smear-positive (SS+) TB.
In 2005, WHO called for redoubled efforts to scale up effective TB control using DOTS (directly observed treatment, short course) throughout the European region. In November 2005, the Ministry of Health (MOH) issued an order adopting DOTS as the basis for national TB control policy. The new National TB Control Program (NTCP) for 2007–2011 now supports rapid expansion of DOTS coverage, with the goal of moving from 29 percent in the USAID-supported pilot regions in 2007 to 100 percent by 2011. Although Ukraine currently reports 100 percent DOTS coverage, the quality of DOTS services requires significant improvement in many areas; at present, only approximately 50 percent of the population has access to quality DOTS.
Intensified measures are needed to contain Ukraine’s growing TB problem, which is exacerbated by increasing cases of multidrug-resistant (MDR) TB and one of the fastest-growing HIV epidemics in the world. According to WHO, nearly 16 percent of new TB patients have MDR-TB, the third highest proportion in the world. ¹ By the beginning of 2008, extensively drug-resistant (XDR) TB was also reported in Ukraine. Both TB and HIV are concentrated in the southern and eastern oblasts (provinces) of the country, and TB-HIV co-infection is a growing challenge. Results of surveillance in 2006 in Donetsk Oblast indicate that 16 percent of TB patients in the civil sector are co-infected with HIV. Among prisoners, nearly 24 percent of TB patients are co-infected. More than 60 percent of AIDS deaths are attributable to TB. While outdated practices still exist, recent policy changes indicate a growing government commitment to improved TB treatment standards and coordination with HIV services.
Key USAID partners include PATH, WHO, the World Bank, the MOH, the F.G. Yanovsky Institute of Tuberculosis and Pulmonology of Academy of Medical Sciences of Ukraine, oblast and city authorities in the target regions, the All-Ukrainian Network of People Living with HIV/AIDS, Futures Group International, and numerous local nongovernmental organizations.
