Abstract
Ukraine has gaps in Tuberculosis (TB) service coverage, especially in key populations (KPs). We compared effectiveness of three different strategies for active TB detection among KPs and their linkage to TB treatment during three time periods. The KPs included people who inject drugs (PWID), sex workers (SW), men who have sex with men (MSM) and groups at-risk of TB (ex-prisoners, Roma and homeless). The active case finding included decentralized symptom screening and specimen collection (2014, strategy-1), decentralized screening with patient referred for specimen collection (2015-2017, strategy-2) and strategy-2 plus GeneXpert (2018, strategy-3). In total 680,760 KPs were screened, of whom 68% were PWID. TB case detection per 100,000 populations was 1,191 in strategy-1, 302 in strategy-2, and 235 in strategy-3. The number needed to screen (NNS) to identify one case was respectively 84, 332, and 425. TB detection was highest among homeless (range: 1,839-2,297 per 100,000 population). The lowest detection was among the MSM and SW. Between 2014 and 2018, 82-94% of all diagnosed TB patients in KPs started TB treatment. The active case finding in KPs increased detection of TB cases in Ukraine, and the majority of diagnosed KPs initiated TB treatment. Centralization of diagnosis reduced the effectiveness of TB screening. Each region in Ukraine should assess the composition and the needs of KPs which will allow for adoption of specific strategies to detect TB among KPs with high TB prevalence.
Highlights
Ukraine has gaps in Tuberculosis (TB) service coverage, especially in key populations (KPs)
In total 680,760 members of key populations were screened during the 4.5 years
The active case finding in key populations increases detection of TB cases and reassuringly, the majority of those who are diagnosed initiated TB treatment
Summary
Ukraine has gaps in Tuberculosis (TB) service coverage, especially in key populations (KPs). Conclusions: The active case finding in KPs increased detection of TB cases in Ukraine, and the majority of diagnosed KPs initiated TB treatment. Two of the three targets set by the World Health Organization’s (WHO) Global Plan to End TB are to ensure that 90% of all TB cases worldwide are detected and placed on treatment and 90% of those detected achieve treatment success. These targets are inclusive of the key populations; better coverage and equity of TB services targeting these groups are urgently needed [4]
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