Tuberculosis In Ukraine Research Articles

Comparative assessment of the epidemic state of tuberculosis before and during the war in Ukraine

BACKGROUND. The war has a negative impact on patient care and the efficiency of the health care system; access to medical care is limited, coverage of preventive examinations and detection of tuberculosis (TB) are deteriorating. There is a threat of exacerbation of the epidemic situation with TB in Ukraine. OBJECTIVE. To assess the epidemic situation with TB during the war in Ukraine. MATERIALS AND METHODS. Comparison of data from the Ministry of health on TB (epidemiological indicators and indicators on detection, diagnosis and prevention) in the pre-war (2018-2021) and war (2022-2023) periods. RESULTS. The following were revealed: 1) a positive trend towards a decrease in epidemiological indicators of TB in 2018-2020, which slowed down in 2021 due to the COVID-19 pandemic, and a negative trend towards an increase in almost all indicators of TB incidence, separate indicators of mortality from TB and its prevalence in 2022-2023; 2) significant increase in the incidence of TB among contacts and children; 3) increase by ⅓-. of mortality from TB in certain regions; 4) correlation between regional rates of morbidity, mortality and prevalence of TB. In 2018-2023, the following decreased: fluorography examination, tuberculin diagnostics, detection of TB during preventive examinations (by 2-4 times), preventive vaccinations for children of the first year of life, detection of newly diagnosed and recurrent TB by smear, preventive treatment in contacts. CONCLUSIONS. Incidence is a marker of response to negative external factors and the main criterion for assessing the epidemic state of TB during the war. Fluorography examination, tuberculin diagnostics, detection of TB during professional examinations, preventive vaccinations for children of the first year of life, detection of newly diagnosed and recurrent TB by smear, preventive treatment of contacts are the main criteria for evaluating the activity of the anti-TB service during the wartime, since they are the first to significantly respond to the challenges of war.

Analysis of the Influence of Various Factors on the Prevalence of Tuberculosis in Ukraine

A medical approach to the analysis of socio-economic, medical and demographic factors affecting the prevalence of tuberculosis in Ukraine is insufficient for timely prognosing the prospects for the development of the tuberculosis epidemic and developing an appropriate plan to address its challenges. Objective — to analyse influence of various factors on tuberculosis prevalence in Ukrainian population. Materials and methods. For the analysis, data were collected over the past sixteen years, covering all regions of Ukraine, including information on the number of specialized hospitals, the number of fluoroscopic examinations per 100,000 people, vaccination data, the number of Mycobacterium tuberculosis excretors, the prevalence among urban and rural residents, and the percentage of different demographic groups (workers, health care workers, students, pupils, retirees, the unemployed, homeless people, released prisoners, private sector workers). Results and discussion. The analysis, conducted through the Stacking model, enables the identification of crucial variables that significantly influence the prevalence of tuberculosis. Evaluating the significance of each element in the model enables a deeper comprehension of morbidity dynamics and the optimization of intervention strategies. The creation and validation of machine learning models such as linear regression, random forests, and adaptive boosting have enabled accurate predictions of tuberculosis prevalence. The use of 5-fold cross-validation increased the reliability of the predictions, ensuring stability and accuracy across different demographic groups. Conclusions. The application of artificial intelligence in analyzing socioeconomic, medical, and demographic data has facilitated the identification of key factors influencing the prevalence of tuberculosis in Ukraine. Specifically, the analysis has verified the substantial effects of the quantity of specialized hospitals, the rate of fluoroscopic examinations, and the frequency of bacterial excretion on the prevalence rates.

Efficiency of Treatment of Tuberculosis Patients: Realities, Problems and Perspectives (Review)

An analysis of data from global experience and professional publications on modern treatment of tuberculosis patients and its effectiveness was carried out.The analysis of literary sources of recent years indicates an urgent problem regarding tuberculosis in Ukraine (especially in the conditions of martial law and the conduct of active hostilities). With early diagnosis and timely treatment, the number of patients decreases by 8 %.The effectiveness of the treatment of patients with pulmonary tuberculosis and the influence of various factors on it were evaluated. The effectiveness of treatment of newly diagnosed pulmonary tuberculosis in Ukraine does not exceed 70 %.An increase in the level of resistance of tuberculosis mycobacteria to anti-tuberculosis drugs was noted, and its treatment efficiency was not high. The effectiveness of treatment of such patients in Ukraine does not exceed 40—45 %. The inclusion of second-line drugs in the treatment regimen of patients with iso­niazid-­resistant tuberculosis increases the effectiveness of treatment by 11.8 %. The overall effectiveness of treatment of patients with multidrug-resistant tuberculosis (MDR-TB) in the world is 52 %, and only 10 % of patients are cured. The treatment of MRTB is three times longer (20 months) than that of the sensitive form and is significantly more expensive. Antimycobacterial drugs (AMBs) were used according to an individual regimen (18—20 months), then new AMBs were used (6 months), later versions of modified standardized short-term regimens (9 months). The BPaL regimen (bedaquiline, linezolid, pretomanide) was implemented for patients with multiple and extensively drug-resistant tuberculosis for 6 months (26 weeks or 182 doses), resulting in a cure rate of 90 % [35].The methods of optimizing the management of patients with pulmonary tuberculosis (including correction of treatment) in the conditions of martial law, which can be achieved by improving antimycobacterial and pathogenetic therapy, revealing new mechanisms and deepening the known regularities of the course of the disease, are evaluated.

100 Years of Collapse Surgery for Tuberculosis in Ukraine

are institutions remains the most dangerous among all the common diseases. The urgency of the problem lies in the fact that, despite the significant number of antibacterial drugs, effectiveness of tuberculosis treatment of the lung does not achieve the planned efficiency. Moreover, growing resistance of mycobacteria to antibacterial drugs, especially for type of multiresistance and extended resistance, requires a significant part of patients to be transferred to palliative treatment. Phthisiosurgical methods (resection and thoracoplasty) remain an alternative to antibacterial therapy. The possibilities of resection surgery, taking into account the resistance of mycobacteria, are decreasing; only collapse surgical interventions can become relatively capable.Proposed in the last years of the 19th century century and the first years of the 20th , collapsosurgical methods of treating pulmonary tuberculosis were picked up as an idea by Ukrainian scientists and surgeons, who have developed and perfected a number of collapsosurgical operations, and over 100 years their use has proven their effectiveness. However, today they are used less and less, since most phthisiosurgical and phthisiatric beds have been reduced or eliminated. What’s next? Increase the amount and, of course, the toxicity of chemotherapy drugs? To what extent? What detoxification system of the body can withstand this? Thoracoplasty operations over 100 years of use have proven the effectiveness of single and combined intervention.Restoring the existing system of dispensary services for tuberculosis patients seems to be the most effective and cost-effective solution.In the current conditions, it is impossible to increase the effectiveness of antibacterial therapy given the ever-growing level of mycobacteria resistance, and the prospects are more than doubtful. Meanwhile, the use of collapse surgical interventions, especially combined ones, can significantly enhance the level of effectiveness up to the complete cure of tuberculosis patients.

Impact of the war in Ukraine on the epidemic situation with tuberculosis as a challenge for the world community

ABSTRACT. Since wars have a powerful impact on public health and the health care system, the purpose of this analysis of available scientific sources is to examine the impact of the war in Ukraine on the state of the tuberculosis problem in the world. The review presents the epidemic situation with tuberculosis before the start of the war in Ukraine. It is especially emphasized that Ukraine ranks second in Europe in terms of the burden of HIV infection / acquired immunodeficiency syndrome and fifth in the world in terms of the number of confirmed cases of tuberculosis with multiple drug resistance. It is emphasized that the COVID-19 pandemic has seriously undermined the progress achieved in the fight against tuberculosis worldwide. The expected worsening of the epidemic situation with tuberculosis in Ukraine due to the war and its impact on the world health care systems are substantiated, and attention is focused on the urgent need to coordinate the efforts of the world community to overcome such a challenge. Problematic issues regarding the readiness of international health care systems to combat tuberculosis in the conditions of war in Ukraine are analyzed. Studying the current state of the problem “tuberculosis and the war in Ukraine” will allow us to act in the direction of reducing the negative impact of the war on the epidemic situation with tuberculosis both in Ukraine and partially in the whole world.

Clinical and Epidemiological Features of Tuberculosis in Ukraine (Review)

The analysis of professional publications regarding the clinical and epidemiological features of tuberculosis in contemporary conditions was conducted. Literature review indicates that tuberculosis remains a pressing issue in Ukraine, particularly amidst the conditions of military conflict and active hostilities. The characteristics of multidrug-resistant tuberculosis (MDR-TB) in children and adolescents from areas of drug-resistant tuberculosis infection have been studied. The onset of MDR-TB in children is often acute, while in adolescents, it tends to be insidious. Children and adolescents are particularly susceptible to the development of MDR-TB. Annually, 1.1 million patients under the age of 15 are diagnosed with tuberculosis, with approximately 700 children dying from tuberculosis daily.The features of detection and course of clinical forms of extrapulmonary tuberculosis and the profile of drug resistance of the pathogen in different age groups were analysed based on literature data. In 2022, more cases of extrapulmonary and disseminated forms of tuberculosis were registered compared to 2019 — 15.6 % and 8.1 %, respectively. Pulmonary tuberculosis was detected in 34.7 % in 2019 and 38.9 % in 2022.In contemporary conditions, the spread and development of tuberculosis are influenced by HIV infection and coronavirus disease 2019 (COVID-19). HIV infection contributes to a tuberculosis epidemic, affecting the course and outcomes of its treatment. Stigmatisation regarding COVID-19 and fear of quarantine hindered and delayed patients seeking medical care, limiting their mobility and leading to a decrease in most medical services for the diagnosis, treatment and prevention of tuberculosis.The situation in Ukraine (prevalence of HIV infection and COVID-19, military actions in the country, population migration, presence of refugees and internally displaced persons) has also contributed to the development and spread of tuberculosis, increasing the incidence and mortality rates from this disease, and progressing its burden. Among refugees, internally displaced persons and the population of territories where these individuals are located, tuberculosis, COVID-19 and HIV infection may concurrently spread.

DIFFERENTIAL DIAGNOSIS OF TUBERCULOSIS AND NON-SPECIFIC PULMONARY INFILTRATS (Lecture)

Following the reformation of healthcare system and the dissolution of the specialty "Phthisiology," the extensive anti-tuberculosis efforts in Ukraine now fall under the purview of family doctors and specialists across various fields. According to the Law of Ukraine “On Overcoming Tuberculosis in Ukraine”, enacted on 14.07.2023 under No. 3269-IX, Paragraph 4 (Article 4), individuals afflicted with tuberculosis or latent tuberculosis infection are entitled to specialized medical care. This includes the treatment of all forms of tuberculosis and associated conditions across a spectrum of healthcare institutions. Compliance with this legal mandate necessitates that doctors of various specialties possess not only proficiency in contemporary tuberculosis treatment methods, which will be facilitated by the regional tuberculosis control center, but also competence in diagnosing tuberculosis in its various presentations. When health issues arise, patients typically seek assistance first from primary care specialists. The “Pulmonary infiltrate syndrome” is an X-ray syndrome characterized by the presence of shadows in the lungs exceeding 1 cm in diameter. There are numerous causes for such changes in the lungs. Given that the lungs are the most common site for tuberculosis, particularly in the form of infiltrative shadows, which may signify not only tuberculosis but also pneumonia, tumors, lung infarction, eosinophilic infiltrate, and other conditions, the question of their differential diagnosis becomes quite relevant. The increasing frequency and subtle clinical presentation of the “Pulmonary infiltrate syndrome” necessitate proficiency in the clinical aspects and diagnosis of its most common manifestations. The key differential diagnostic features that distinguish infiltrative pulmonary tuberculosis from other nonspecific infiltrates include contact with a tuberculosis patient or a history of tuberculosis, often subacute onset, heterogeneous infiltrative shadow in 1, 2, or 6 segments with a connection to the lung root, moderate leukocytosis, lymphopenia, elevated ESR, presence of acid-fast bacilli in sputum or bronchial lavage, specific endobronchitis, positive response to antitubercular therapy, and lack of improvement with other nonspecific treatment methods.

Modern Features of the Epidemiological Situation of Tuberculosis in Ukraine (Review)

Objective — to study the epidemiological situation of tuberculosis in Ukraine from 2018 to 2022. Materials and methods. This research utilised a comprehensive source base including official statistical data from the State Statistics Service and the Ministry of Health of Ukraine, scholarly articles from both international and domestic researchers, materials from periodicals and international conferences and internet resources. Additionally, the insights and analyses were enriched by involving six experts and organisers from the phthisiatric service. These experts were instrumental in interpreting statistical data and identifying causal relationships within the dynamics of the epidemiological indicators. Results and discussion. From 2018 to 2022, the incidence of tuberculosis (TB), including its recur­rences, in Ukraine decreased by 27.3 %. During this timeframe, TB incidence among children aged 0—14 years fell by 16.9 %, and among adolescents aged 15—17 years, it dropped significantly by 45.8 %. Despite these overall reductions, a notable increase in TB incidence was observed across the Ukrainian population by approximately 3.5 % and specifically among children aged 0—14 years by 25.4 % in 2021, compared to 2020. The Odesa Oblast reported the highest morbidity rate across all Ukrainian regions over this five-year period, although it experienced a 36.0 % reduction from 2018 to 2022. Importantly, the prevalence of all forms of active TB across the Ukrainian population decreased by 40.7 % from 2018 to 2022. This decline was also reflected among children aged 0—14 and 15—17 years, with decreases of 34.1 and 49.7 %, respectively. Statistically, the highest morbidity rate among healthcare institution employees in Ukraine was observed in 2018, reaching 6.0 per 10,000 employees. Conclusions. Since 2020, a concerning trend has emerged in Ukraine with an increase in the incidence of tuberculosis by almost 3.5 %, and a sharp rise of 25.4 % among children aged 0—14 years in 2021, reversing the previously declining trend. This uptick is likely influenced by the COVID-19 pandemic. Despite this, there was a notable decrease in the prevalence of all forms of active TB across Ukraine's entire population by 40.7 % from 2018 to 2022. The highest morbidity rate among healthcare workers was observed in 2018, at 6.0 per 10,000 workers. A significant concern remains TB's impact on the working-age population, leading to permanent disability. However, the rate of primary disability due to TB among the adult and working-age population showed a decrease in 2022 by 11.4 and 3.9 %, respectively. The underdiagnosis of TB, potentially exacerbated by the COVID-19 pandemic and the ongoing conflict, poses a significant challenge to controlling the disease.

ЯК ВПЛИНЕ ВІЙНА В УКРАЇНІ НА ЕПІДЕМІЧНУ СИТУАЦІЮ З ТУБЕРКУЛЬОЗОМ: МІРКУВАННЯ ФАХІВЦІВ

To determine the leading trends regarding the impact of the war in Ukraine on the situation with tuberculosis (TB) in real time, professional sources of information were analyzed. Publications regarding the impact of the war in Ukraine on the epidemic situation with TB are mainly of an overview nature. An increase in morbidity, mortality and worsening of other epidemiological indicators are predicted. Possible spread of multidrug-resistant tuberculosis (MDR-TB) and TB/HIV confections is of special concern, as even before the war Ukraine ranked second in Europe for the burden of HIV infection, fourth for the spread of TB and fifth in the world for MDRTB. The impact of war on the health of the population and the medical care system is determined by many factors, including damage to the country's infrastructure, overcrowding, deterioration of sanitary conditions, forced displacement of the population, insufficient availability of medical care, lack of adequate supply of water and food, mental overload, financial difficulties etc. The war affects patient care and the effectiveness of the health care system, which means poor TB detection rates, coverage of preventive examinations, and limited access to health care in general. This problem requires an immediate and comprehensive research and develop a set of measures to restore the full provision of medical care for this disease. Establishing the determinants of TB risk caused by the war will allow offering practical health care measures that should reduce the negative impact of the war on the epidemic situation with TB in Ukraine. Key words: tuberculosis, epidemic situation, war.

Treatment outcomes and risk factors for an unsuccessful outcome among patients with highly drug-resistant tuberculosis in Ukraine

ObjectivesTo describe demographics, clinical features, and treatment outcomes of patients with highly drug-resistant tuberculosis (TB) in Ukraine, and to evaluate risk factors for an unsuccessful outcome. MethodsData from patients with multi-, pre-extensively, or extensively drug-resistant TB were collected prospectively from TB dispensaries in 15 out of 24 Ukrainian oblasts (regions) from 2020 to 2021. Treatment outcomes were evaluated using WHO definitions. Risk factors for an unsuccessful outcome were identified using a multivariable logistic regression model. ResultsAmong 1748 patients, the overall proportion of successful outcomes was 58% (95% confidence interval [95% CI] 56–60) (n = 1015/1748), ranging from 65% (95% CI: 62–69) (n = 531/814) for multidrug-resistant TB to 54% (95% CI: 49–58) (n = 301/563) for pre-extensively drug-resistant TB and 49% (95% CI: 44–55) (n = 183/371) for extensively drug-resistant TB. Results were similar across oblasts, with few exceptions. The strongest risk factors for an unsuccessful outcome were extensively drug-resistant TB (adjusted OR [aOR] 3.23; 95% CI: 1.88–5.53), total serum protein below 62 g/L in adults and below 57 g/L for children and adolescents (aOR 2.79; 95% CI: 1.93–4.04), psychiatric illness (aOR 2.79; 95% CI: 1.46–5.33), age at TB diagnosis >65 years (aOR 2.50; 95% CI: 1.42–4.42), and alcohol misuse (aOR 2.48; 95% CI: 1.89–3.26). DiscussionThe overall proportion of successful outcomes among Ukrainians treated for highly drug-resistant TB was 58%, notably better compared with previous years, but still low for extensively drug-resistant TB. Risk factors for unsuccessful outcomes highlight that addressing socioeconomic factors in TB management is crucial. Efforts in maintaining TB dispensaries during and following the ongoing war are highly warranted.

Tuberculosis of the Skin: Modern Clinical and Epidemiological Features and the Necessity of a Multidisciplinary Approach for Timely Diagnosis and Comprehensive Therapy (Review)

The seriousness of the global significance of tuberculosis, an infection that is both old and new, was discussed extensively at the UN General Assembly meeting in New York in the summer of 2023. This seemingly purely medical issue received widespread attention for the public's understanding of the corresponding «Political Declarations on Tuberculosis» and the agreement on key issues related to combating tuberculosis. It was emphasized that the sphere of public health encompasses the unequivocal preservation of human health as the primary objective in the social development of any specific state. This clearly includes measures aimed at preventing the occurrence of tuberculosis and other infectious diseases.Objective — to conduct an analysis of professional publications of recent years regarding the modern clinical and epidemiological features of the clinical course of skin tuberculosis and to determine organizational measures to ensure the sanitary and epidemiological well-being of the public health of the population of Ukraine in wartime conditions and the conduct of active hostilities. And also to remind doctors of various specialties about the significant diversity of modern clinical manifestations of various forms of skin tuberculosis. Materials and methods. Official documents and scientific publications related to public health policy, approaches to overcoming the tuberculosis epidemic, incidence dynamics and forms of skin tuberculosis in Ukraine were analyzed. Results and discussion. The content of the analyzed professional publications indisputably proves that the problem of tuberculosis has gone far beyond the scope of the purely medical field and has acquired the status of national significance. A modern approach to improving the state of public health requires the constant coordination of the efforts of different people, who at the same time have a wide range of professional skills in many different disciplines, as well as the ability to work fruitfully with others in joint multiprofessional teams to achieve a common goal — to overcome the tuberculosis epidemic. Conclusions. Analysis of scientific publications of recent years on the problem of skin tuberculosis indicates an urgent need to consider this disease in the state Public Health system as a general infectious disease of the whole organism, in which pulmonary and formally extrapulmonary (skin) lesions are pathogenetically linked in a single chain of pathological changes. This requires an interdisciplinary ap­proach and systematic methodological cooperation of phthisis doctors, dermatovenerologists and family doctors in the aspect of timely diagnosis and complex therapy of this infection.

Predicting the Risk of Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome in HIV-Infected Patients with Central Nervous System Tuberculosis

Objective — to identify risk factors associated with the development of Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome (TB-IRIS) in HIV-infected patients with central nervous system tuberculosis. The analysis assessed the relationship between the risk of develo­ping TB-IRIS with neurological manifestations and the following factors: 1) viral load before antiretroviral therapy (ART) initiation; 2) CD4+ lymphocyte of blood before ART initiation; 3) duration of antituberculosis therapy before starting ART; 4) presence of active tuberculosis at the time of ART initiation. Materials and methods. 112 cases of neurological TB-IRIS were analyzed. These patients were treated and observed during the 1 year in anti-tuberculosis facilities in Kyiv and Kyiv region in 2017—2021. All patients received ART in accordance with the HIV treatment protocols adopted in Ukraine. Treatment according to the standard of tuberculosis treatment adopted in Ukraine. The logistic regression model construction method was used to analyze. Statistical processing of the obtained data was carried out using free software — the EZR package (version 1.61; https://www.jichi.ac.jp/).The study was carried out as part of the applied research work 0121U107800 «Predicting the development of the incidence of tuberculosis in Ukraine in connection with the COVID-19 pandemic», funded by the Ministry of Health of Ukraine. Results and discussion. After calculations, two factor signs were identified, associated with the of deve­loping TB-IRIS with neurological manifestations: the baseline level of CD4+ lymphocytes in 1 μl of blood at the beginning of treatment and the presence of active tuberculosis at the time of ART initiation. Conclusions. It was found that the risk of developing TB-IRIS with neurological manifestations is significantly associated (p < 0.05) with the following factors: 1) the level of CD4+ lymphocytes in 1 μl at the beginning of treatment; 2) presence of active tuberculosis at the time of ART initiation.

Shifting Stigma: Why Ukrainian Health Care Workers Favor a High Barrier Treatment Modality for Tuberculosis

This research article seeks to understand how the cultural context of tuberculosis (TB) care in Ukraine influences healthcare workers’ perception of their patients and the choices they make in offering TB treatment. Specifically, we aim to explore healthcare workers’ predilection towards inpatient treatment of TB in Ukraine in lieu of other, evidence-based treatment approaches. Based on qualitative research with TB care providers in Ukraine, we argue that a preference for inpatient treatment instead of the standard outpatient regimen is rooted in the care workers’ assessment of the patient’s desire to get well. In other words, the preferred treatment modality is not based on any biological characteristic of TB infection; instead, it is based on the perceived strengths and weaknesses of patients’ psychology.

Tuberculosis in Ukraine during the COVID-­19 pandemic

Objective — to study the situation with tuberculosis in Ukraine in 2020—2021 compared to 2019.
 Materials and methods. Searched and statistically analyzed data from official statistical reports and analytical collections on tuberculosis for 2019—2021 in Ukraine.
 Results and discussion. The COVID-19 epidemic, to eliminate which the main material and human resources in health care were directed, aggravated the epidemiological situation with tuberculosis in Ukraine; there was a reduction in anti-tuberculosis activities, human resources and infrastructure of anti-tuberculosis institutions. This has led to a decrease in TB incidence, prevalence and mortality, while in other parts of the world, TB incidence and mortality rates and the effectiveness of treatment have increased significantly.
 Conclusions. During the COVID-19 pandemic, the majority of health resources have been devoted to fighting it. Anti-tuberculosis measures were secondary and were being phased out. This led to a decrease in statistical indicators of the incidence of all clinical forms of tuberculosis and mortality from it, including multi-resistant, and its relapses, as well as co-infection — tuberculosis/HIV/AIDS. The incidence of tuberculosis among medical workers decreased. The prevalence of all forms of active tuberculosis among Ukrainians had the same trend as the incidence.

Modern algorithms of geno-phenotypic diagnosis of tuberculosis in Ukraine

BACKGROUND. To ensure timely and accurate detection of tuberculosis (TB), including TB with multiple drug resistance in Ukraine, the document “Health Standards for TB” (Order of the Ministry of Health of Ukraine № 2161 of 06.10.2021), which the basis of laboratory diagnosis of TB is the use of modern molecular genetic methods and tested in the Central Reference Laboratory of Ukraine for microbiological diagnosis of TB.
 RESULTS AND DISCUSSION. The article presents complex algorithms for the diagnosis and monitoring treatment of pulmonary TB using rapid molecular genetic methods. The basic principles and approaches to the diagnostic process, on which the domestic normative document is based, corresponds to those recommended by World Health Organization experts for the countries of the European region. When testing for TB, a molecular genetic test must be performed to detect the presence of Mycobacterium tuberculosis DNA in the diagnostic sample. Then (depending on the capabilities of the laboratory) one or another technology is used to detect mutations associated with the resistance of M. tuberculosis to the maximum possible range of AMBP I and II lines. After receiving the results of seeding in the automated system BACTEC MGIT, which is currently the gold standard for the study of drug sensitivity of M. tuberculosis to AMBP I and II lines, the treatment regimen is adjusted if necessary according to the phenotypic test of drug sensitivity.
 CONCLUSIONS. According to the latest international guidelines for the diagnosis of TB, preference should be given to molecular genetic diagnostic tests and culture studies in liquid nutrient media. Microscopic and cultural studies are important and remain necessary to monitor treatment.

RETROSPECTIVE ANALYSIS OF THE MAIN EPIDEMIOLOGICAL INDICATORS OF TUBERCULOSIS IN IVANO-FRANKIVSK REGION DURING 2011-2021

The diagnosis and treatment of tuberculosis have changed over the past few years. Tuberculosis remains the leading infectious cause of death worldwide, while drug-resistant tuberculosis poses a significant threat to the population. The epidemiological situation on tuberculosis in Ukraine has experienced stabilization of some indicators in recent decades. It remains, however, tense and predictably unfavorable as the indicators are continuously exceeding the epidemic threshold.
 The aim of the research: to analyze the epidemiological situation on tuberculosis in Ivano-Frankivsk region during 2011-2021.
 Materials and Methods. When writing this article, official sources, including the assessment of the indicators in Ukraine from the analytical and statistical reports of the Public Health Center of the Ministry of Health of Ukraine were analyzed and studied. We performed a retrospective cohort analysis. Data regarding the region were obtained from the annual reports of the Ivano-Frankivsk Regional Phthisiopulmonological Center of Ivano-Frankivsk Regional Council.
 Results. Despite the reduction in all key epidemiological indicators, the situation on tuberculosis in Ivano-Frankivsk region remains tense. During 2011-2021, the incidence of pulmonary tuberculosis (new cases + recurrent cases) gradually reduced by 59%. Tuberculosis mortality rate reduced from 10.9 cases per 100,000 population in 2011 to 3.3 cases per 100,000 population in 2021. We share the leading Ukrainian scientists’ opinion that the indicators of TB incidence exceed the epidemic threshold despite the reduced number of new cases. Considering the global Covid-19 pandemic and the martial law in Ukraine, one should not expect positive epidemiological changes in the next few years [3, 12, 13]. The identification of destructive TB forms, indicating late diagnosis and more advanced disease stage, helps us to understand this situation. From 2016 to 2021, the incidence of destructive TB forms increased from 34.3% to 56.0% of all pulmonary TB cases, while the proportion of cavity formation was almost the same (24-27%) during 2011-2015.
 During 2011-2021, the incidence of tuberculosis among the rural population ranged from 2% to 20%, being higher as compared to urban residents. During 2011-2014, the incidence of tuberculosis and HIV/AIDS co-infection increased from 2.2 to 4.1 cases per 100,000 population, reducing to 1.0 case per 100,000 population by 2021. The incidence of extrapulmonary tuberculosis reduced from 5.4 to 2.7 cases per 100,000 population, possibly due to inadequate diagnosis, reforms, and the coronavirus infection. During 2014-2021, the incidence rate of tuberculosis among all the healthcare workers in Ukraine reduced from 6.7 to 1.47 cases per 10,000 healthcare workers. However, during 2014-2018, the indicators ranged from 6.7 to 5.6 cases per 10,000 healthcare workers. During 2013-2020, the incidence rate of newly diagnosed multidrug-resistant tuberculosis, including extensively drug-resistant tuberculosis, reduced by 177 cases, or from 260 to 49 patients.
 Conclusions. Over the past 10 years, there has been a slight reduction in the incidence of all active tuberculosis forms. However, they remain above the epidemic threshold, i.e., the tuberculosis epidemic has stabilized. Assessing the situation in our country, no positive changes in the tuberculosis epidemic in the coming years should be expected. The awareness of TB knowledge among all the population segments and control of TB situation during the period of healthcare reforms in Ukraine, according to which the anti-tuberculosis service is being reorganized, restructured, and reformed, are advisable.

ВИЯВЛЕННЯ СПЕЦИФІЧНИХ АНТИТІЛ З ВИКОРИСТАННЯМ ЗЛИТОГО ПРОТЕЇНУ MPT83-MPT63 ПРИ ДЕСТРУКТИВНОМУ ТУБЕРКУЛЬОЗІ ЛЕГЕНЬ

Introduction. The development of effective test systems for tuberculosis (TB) diagnosis and the study of factors influencing their sensitivity and specificity constitute urgent tasks given the unstable epidemiological situation with TB in Ukraine and the world. The study aimed to determine the clinical and laboratory features of pulmonary TB that may affect the sensitivity of IgG TB antibody detection in human serum by the immuno-enzyme test system “IB-Chem Anti-Mycobacterium tuberculosis”, which was developed at the Palladin Institute of Biochemistry of the NAS of Ukraine and uses recombinant fusion protein MPT83-MPT63 as an antigen. Methods. Sera of 62 patients with chemoresistant pulmonary TB were tested for TB antibodies using an indirect enzyme-linked immunosorbent assay. Dependence of the obtained results on clinical symptoms and signs of pulmonary TB, the frequency of different types of antibiotic resistance, cellular and biochemical parameters of blood were analysed. Results. The sensitivity of the immuno-enzyme test system “IB-Chem Anti-Mycobacterium tuberculosis” for detecting human IgG TB antibodies using recombinant fusion protein MPT83-MPT63 was found to constitute 71.0%; it reached 81.3% in patients with destructive pulmonary TB. Conclusion. The developed test system should primarily be used for the TB diagnosis in patients with destructive changes in the lungs where the diagnostic efficiency of this test system reaches high indicators.

Tuberculosis: fasten your seat belts, we are entering a turbulence zone!

The article outlines the main aspects of the impact on the situation with the incidence of tuberculosis in Europe as a result of the Russian-Ukrainian war. On the basis of foreign sources, the main links of this influence are highlighted, in particular, epidemic, resource, personnel, etc. The author expresses his opinion on the problematic aspects of the health care reform in terms of controlling the incidence of tuberculosis in Ukraine, as well as on the possible steps that would allow the situation to be brought under control.

Analysis of the incidence rate for the newly registered active extrapulmonary tuberculosis in Ukraine and Sumy region

Objective — to study of the condition and analysis of the incidence rate for the newly registered with active extrapulmonary tuberculosis among the residents of Sumy region in the period 2004—2020.
 Materials and methods. A statistical analysis of the incidence of tuberculosis of Sumy region residents registered in 2004—2020 was retrospectively studied and conducted.
 Results and discussion. According to the results of a retrospective statistical analysis of the incidence of tuberculosis during 2004—2020 in Sumy region 9664 patients with tuberculosis were registered. In terms of TB incidence rates, Sumy region was at an average level among other regions of Ukraine.The incidence of tuberculosis in Sumy region from 2004 to 2019 remained at the same level (46.4 and 47.4 per 100 thousand population, respectively). The decrease in morbidity in these years in Ukraine from 72.0 to 47.6 per 100 thousand population, compared to Sumy region is not evidence of positive dynamics. It is rather negative, as it is related to the exclusion from the statistical exchange of the occupied territories of Donetsk and Luhansk regions and Crimea.The share of children in the overall structure of tuberculosis in Sumy region increased from 2.2 % in 2004 to 2.7 % in 2020.The number of patients with extrapulmonary tuberculosis in Sumy region is 14.6 %, and in Ukraine 10.7 %.At the same time, 68 % of children under 14 years of age in Sumy region who fell ill with tuberculosis during the studied (2004—2020) years had extrapulmonary localization of tuberculosis, which is 11.3 % more than in Ukraine as a whole. Unfortunately, the tendency to reduce the incidence of tuberculosis, including extrapulmonary in this age group is not observed. The same applies to adolescents aged 15—17. The predominance of extrapulmonary tuberculosis (68.0 %) in children and adolescents aged 15—17 years (27.9 %) in Sumy region and in 56.7 % and 15.9 % respectively in Ukraine is evidence of significant organizational miscalculations in the tuberculosis industry and in the provision of medical care in Ukraine in general.
 Conclusions. The incidence of tuberculosis in Sumy region from 2004 to 2019 remained at the same level (46.4 and 47.4 per 100 thousand population, respectively).The number of patients with extrapulmonary tuberculosis in Sumy region is 14.6 %, and in Ukraine 10.7 %. The share of extrapulmonary tuberculosis (68 %) in children and adolescents aged 15—17 (27.9 %) in Sumy region and 56.7 % and 15.9 % in Ukraine, respectively, is a very unfavorable indicator, which indicates the lack of specialists in Ukraine from extrapulmonary tuberculosis.

Results of the implementation of new methods for diagnosing tuberculosis among children in 12 regions of Ukraine

Objective —improve the efficiency and quality of diagnosing tuberculosis (TB) in children by expanding the testing of «non-invasive» samples, developing an algorithm for integrating the potential of testing such samples into routine pediatric TB services in various settings, and mastering the skills of conducting laboratory procedures for testing fecal samples.
 Materials and methods. As part of the project «Supporting efforts to combat tuberculosis in Ukraine», implemented by the PATH organization with financial support from the United States Agency for International Development (USAID), a pilot implementation of the diagnosis of pulmonary TB in children has begun, using Xpert MTB/RIF Ultra cartridges for a fecal sample as a primary diagnostic test.At the stage of diagnosis, before starting treatment with anti-tuberculosis drugs, all children under 5 years of age were examined, as well as children under 15 years of age with a preliminary diagnosis of tuberculosis, who cannot produce sputum or who have difficulty obtaining other diagnostic material.
 Results and discussion. The intermediate results obtained are quite encouraging for the implementation of such tests throughout the country. The use of faecal samples, which do not require invasive manipulation, may have a positive impact on laboratory confirmation of TB diagnosis in the pediatric population, with 12.8 % having a positive result, and 8.5 % of studies having a positive test result only with faeces and a negative with gastric lavage.
 Conclusions. The results of the implementation of the method will help to identify and justify the necessary changes to the algorithm for diagnosing TB in children under 5 years of age or children under 15 years of age who cannot produce sputum or in case of difficulty in obtaining other diagnostic material.