Annual Report: Challenge TB - Ukraine Year 2

During Year 2 (October 1, 2015 – September 30, 2016), the project continued to expand and improve a patient-centered approach to MDR-TB care based on high-quality ambulatory treatment and other MDR-TB control services. The project extended patient-centered approach activities to a new project partner oblast (Kyivska oblast) and developed recommendations on improving the process of active case-finding and management of TB among close contacts. The project also developed the draft Implementation Protocol on New Drugs Introduction and a preliminary version of an operational research (OR) protocol for introducing shortened treatment regimens for MDR-TB treatment. These documents were developed in close collaboration with the National TB Institute and the Ukrainian Center for Socially Dangerous Disease Control (UCDC). The project aimed to achieve the objective of improved MDR-TB treatment success rates (TSR) in project oblasts. To enhance the capacity of TB and primary health care providers in side effects management, two workshops in guidelines principles were conducted for 56 participants. The participants developed regionally specific models of the multidisciplinary patient-oriented approach to side effects management for further implementation in the project regions. To enhance monitoring and prevention of adverse reactions (ADR) among patients being treated for MDR-TB, limited procurement of laboratory supplies as well as audiometers to diagnose and quantify the degree of hearing loss were procured within CTB in Year 2. The project also initiated a series of all-Ukrainian webinars on various topics as an efficient way of information sharing. Two webinars on guidelines principles and the pharmacovigilance system in Ukraine were conducted in collaboration with the National TB Institute and the State Expert Center of the MOH. More than 200 participants from 23 oblasts in Ukraine took part in the webinars. The audience was presented with a brief overview of the clinical guidelines and pharmacovigilance system in Ukraine. Analysis of e-TB manager data from CTB Project oblasts demonstrates gradual improvement of ADR reporting, although it is not yet good enough. During the reporting period, the CTB project developed two documents on introducing new drugs and shorter drug regimens for the treatment of MDR-TB and XDR-TB. These documents were developed in close collaboration with the National TB Institute and UCDC. The project collected reviews of suggested pre-XDR/XDR treatment regimens and enrollment/exclusion criteria based on international evidence and recommendations from the World Health Organization (WHO)-Ukraine, WHO-Euro, KNCV, and USAID. The project's objective of improved MDR-TB treatment success rates (TSR) in project oblasts is expected to be achieved by 2019. The patient-centered care for MDR TB patients focused on outpatient model is expected to be routinely used in CTB supported areas, increasing the treatment success rate by 10%. At least 2000 eligible MDR TB patients will be initiated on a shorter MDR TB treatment regimen and regimens with new drugs.