PATH support to Ukraine to implement the National Tuberculosis Program: final report including Child Survival and Health Grants Program. Final evaluation report. Cooperative Agreement No. GHS-A-00-03-00010-00.

Increased numbers of tuberculosis (TB) cases coupled with a rise in human immunodeficiency virus (HIV) and multi-drug resistant TB (MDR-TB) are a significant public health problem--as well as an economic threat--in Ukraine. TB rates more than doubled in Ukraine between 1992 and 2002 a result of the economic and social challenges that came with independence stabilizing by 2004 at 82 notified cases per 100000 population the eighth highest rate of 53 countries in the World Health Organization (WHO) European Region. This represents an estimated 40000 TB cases per year. Ukraine faces a number of challenges in TB control: strategies inconsistent with international recommendations and resource use that is not cost-effective. Ongoing use of mass photofluorography and annual tuberculin screening of children for active case detection multiple BCG (Bacillus of Calmette and Guerin) re-vaccination mandatory and lengthy hospitalization of smear-positive patients TB diagnosis restricted to specialists (even in cases confirmed by a laboratory) and long-term follow-up of patients after completion of treatment contribute to inefficient and ineffective TB control. All of these activities illustrate the underlying issue in TB control in Ukraine: namely that there has been a strong commitment to Soviet-style TB practices among both policymakers and providers and hence significant resistance to adopting the internationally-recommended TB control strategy (DOTS). It was in this context that international donors and partner organizations began work to support Ukraine in modernizing its TB control system in 2000. (excerpt)