Abstract
BackgroundUkraine has a high burden of drug-resistant tuberculosis (DR-TB). Mental health problems, including alcohol use disorder, are common co-morbidities. One in five DR-TB patients has human immunodeficiency virus (HIV). As part of health reform, the country is moving from inpatient care to ambulatory primary care for tuberculosis (TB). In Zhytomyr oblast, Médecins Sans Frontières (MSF) is supporting care for DR-TB patients on all-oral short DR-TB regimens. This study describes the preparedness of ambulatory care facilities in Zhytomyr oblast, Ukraine, to provide good quality ambulatory care.MethodsThis is a retrospective analysis of routinely collected programme data. Before discharge of every patient from the hospital, MSF teams assess services available at outpatient facilities using a standardised questionnaire. The assessment evaluates access, human resources, availability of medicines, infection control measures, laboratory and diagnostic services, and psychosocial support.ResultsWe visited 68 outpatient facilities in 22 districts between June 2018 and September 2019. Twenty-seven health posts, 24 TB-units, 13 ambulatories, two family doctors and one polyclinic, serving 30% of DR-TB patients in the oblast by September 2019, were included. All facilities provided directly observed treatment, but only seven (10%) provided weekend-services. All facilities had at least one medical staff member, but TB-training was insufficient and mostly limited to TB-doctors. TB-treatment and adequate storage space were available in all facilities, but only five (8%) had ancillary medicines. HIV-positive patients had to visit a separate facility to access HIV-care. Personal protective equipment was unavailable in 32 (55%) facilities. Basic laboratory services were available in TB-units, but only four (17%) performed audiometry. Only ten (42%) TB-units had psychosocial support available, and nine (38%) offered psychiatric support.ConclusionOutpatient facilities in Zhytomyr oblast are not yet prepared to provide comprehensive care for DR-TB patients. Capacity of all facilities needs strengthening with trainings, infection control measures and infrastructure. Integration of psychosocial services, treatment of co-morbidities and adverse events at the same facility are essential for successful decentralisation. The health reform is an opportunity to establish quality, patient-centred care.
Highlights
Ukraine has a high burden of drug-resistant tuberculosis (DR-TB)
Despite gaps in strategies to treat and retain patients, limited studies examine the quality of routine DR-TB care, including access to patient-centred services, quality of treatment monitoring, follow-up of adverse events and psychosocial services [3]
As the country-wide decentralisation of TB-services and all-oral DR-TB treatment roll-out starts, we aimed to discuss the readiness of outpatient facilities in Zhytomyr oblast, Ukraine, for quality decentralised care for DR-TB patients
Summary
Ukraine has a high burden of drug-resistant tuberculosis (DR-TB). Mental health problems, including alcohol use disorder, are common co-morbidities. In Zhytomyr oblast, Médecins Sans Frontières (MSF) is supporting care for DR-TB patients on alloral short DR-TB regimens. This study describes the preparedness of ambulatory care facilities in Zhytomyr oblast, Ukraine, to provide good quality ambulatory care. In 2018, only one third of estimated patients with drug-resistant tuberculosis (DR-TB) were initiated on second-line regimens, and only 56% among them were treated successfully [2]. Despite gaps in strategies to treat and retain patients, limited studies examine the quality of routine DR-TB care, including access to patient-centred services, quality of treatment monitoring, follow-up of adverse events and psychosocial services [3]. The World Health Organization (WHO) proposed a checklist with minimum requirements to assess implementation sites of new TB-drugs on capacity to provide good quality of care [10]
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