Status of implementation of recommendations for section Treatment and case management
| Recommendations | Status | Implementation | Institution responsible for implementation | Deadlines |
| Treatment and case management | ||||
| General recommendations | ||||
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1. Outpatient treatment should be promoted in place of inpatient treatment. Prolonged and unnecessary hospital care should be avoided. Patients without severe clinical conditions and those that are sputum smear-negative should be treated outside hospitals. Ethical principles recognized internationally should be adopted and promoted actively. |
Partially
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MOH
UCDC
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31.12.14
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2. Standardized regimens should be consistently used and directly observed treatment (DOT) should be ensured throughout treatment. |
Implemented
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Standard treatment regimens are clearly specified in the unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care ”Tuberculosis” approved with the Order of the Ministry of Health of Ukraine dated 21.12.2012 No. 1091. (Section А.3.3 Pharmaceutical treatment regimen, pages 74-93). |
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3. Seasonal treatment should be stopped. |
Implemented
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Seasonal treatment is not set forth in the applicable unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care ”Tuberculosis” approved with the Order of the Ministry of Health of Ukraine dated 21.12.2012 No. 1091. |
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| Special recommendations | ||||
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4. The criteria for hospitalization should be reviewed, and it should be limited to severe and advanced forms of TB, MDR-TB in the intensive phase of treatment and sputum smearpositive TB if ambulatory DOT is not possible. |
Partially
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The unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care ”Tuberculosis” sets forth that TB patients without bacterioexcretion may be treated outpatiently (DOT) from the very beginning of therapy (article 75), if the patient`s clinical status allows that. However, in cases of bacterioexcretion, a patient is subject to mandatory hospitalization, which contradicts the latest WHO recommendations (WHO: TB treatment: recommendations. Fourth edition, 2009 (page 105)). |
UCDC
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31.12.14
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5. Surgery should be limited to MDR-TB and other conditions clearly described in the national guidelines. |
Partially
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The unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care ”Tuberculosis” clearly sets forth recommendations for surgical treatment (page 93), however, they are somewhat broader that the WHO recommendations (WHO: TB treatment: recommendations. Fourth edition, 2009 (page 105)). |
UCDC
|
31.12.14
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6. Patient-centred care should be provided with different options for treatment (in both the intensive and continuation phases), such as ambulatory care (in the closest primary health care facility available), hospital day care, home care (with DOT provided by visiting nurses) or hospital care. |
Partially
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All mentioned options of treatment provision are specified in the unified protocol; however, not all patients in practice are subject to DOT services. This may be connected with the fact that the clinical protocol also provides a possibility to hand over the drugs to a patient for a term of up to 10 days in case of very positive attitude to treatment (article 17). Handing over of drugs to a patient contradicts the definition of DOT services according to the WHO (WHO: Implementing the WHO Stop TB Strategy: a handbook for national tuberculosis control programmes. 2008 (page 32)). |
UCDC
|
31.12.14
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7. Support should be given to patients in order to enhance their adherence to, and improve the outcomes of, treatment through: (i) transport and food/hygiene packages; (ii) prescription of fixed-dose combination drugs; and (iii) broader involvement of the general health services for DOT. |
Partially
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a) Motivational sets of food products have been provided by the Ukrainian Red Cross Society under the round 9 grant of the Global Fund since 2011. The project aims to ensure medical and social support to TB patients with a risk of treatment interruption (10% of general number of TB patients of categories 1-3) and all MDR-TB patients who are treated for money of the Global Fund (2012 - 800 patients (nearly 12% of all registered MDR-TB patients), 2013 - 960 patients, 2014 - 3136 patients, 2015 - 3810 patients). In 2011, the project was launched in the first 6 regions of Ukraine (Dnipropetrovsk, Donetsk, Lviv, Mykolaiv, Kharkiv regions and the City of Kyiv), in 2012 the project was expanded to include 8 regions more (the Autonomous Republic of Crimea, Zaporizhzhia, Kyiv, Luhansk, Odesa, Kherson Regions and the City of Sevastopol), in 2013 the project was again expanded to include the remaining 13 regions (Vinnytsia, Volyn, Zhytomyr, Zakarpattia, Ivano-Frankivsk, Poltava, Rivne, Sumy, Ternopil, Khmelnytskyi, Cherkasy, Chernivtsi, Chernihiv regions). Social support to MDR-TB patients was commenced in 2013. Social support to the rest of patients not complying with the project criteria, within the framework of the Global Fund grant, must be realized with the financial support of local budgets and must be organized by the social welfare authorities. This component of treatment is not fully implemented. |
UCDC
|
31.12.14
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The unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care ”Tuberculosis” sets forth that TB patients without bacterioexcretion may be treated outpatiently (DOT) from the very beginning of therapy (article 75), if the patient`s clinical status allows that. the Order of the Ministry of Health of Ukraine No. 584 dated 10.07.2013 ”On Approval of Guidelines on Calculation of Bed Capacity at TB Facilities” was developed and approved upon the initiative of the Charity Foundation for Development of Ukraine. The trend of bed capacity reduction for TB patients at health care facilities of the Ministry of Health of Ukraine is the following (per 10 ths. of population):
2010 – 5.4;
2011 – 5.2;
2012 – 5.0;
2013 – 4.8* This witness of low bed capacity reduction. A possible reason for such situation is that the calculation of the facilities financing is made based on a number of beds rather than number of patients.
* Data sourced from the analytical statistical reference books “Tuberculosis in Ukraine” for the respective years.