Ukraine
Ukraine has the highest burden of HIV/AIDS in Eastern Europe (1.2 percent of adults in 2014[1]) and one of the highest rates of multi-drug resistant tuberculosis (MDR-TB) in the world. In 2012, an estimated 14 percent of new cases and 32 percent of previously treated cases of TB were MDR-TB[2]. Tuberculosis (TB) treatment default rates are high, as is the rate of TB/HIV co-infection. In 2011, 62.5 percent of people newly diagnosed with AIDS were also diagnosed with TB, and 13.8 percent of those with TB were HIV-positive.[3]
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To learn how this work is continuing after the MEASURE Evaluation project, please visit TB DIAH. |
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The United States Agency for International Development (USAID) in Ukraine is testing and investigating strategies to help combat these problems. One such mechanism is the Strengthening Tuberculosis Control in Ukraine (STbCU) project. Its goal is to decrease the burden of tuberculosis in Ukraine in partnership with the Government of Ukraine, and national and international stakeholders. The project works to improve the quality of TB services, including detection and treatment of TB and multi- and extensively-drug resistant TB (XDR-TB), as well as support prevention and treatment to counter the rapid growth of TB/HIV co-infection. The project began in March 2012 and builds on over 10 years of USAID’s TB assistance in 10 geographic priority areas.
In 2014, the MEASURE Evaluation project began an impact evaluation to study two STbCU programmatic priorities: (1) providing social support services to improve TB treatment adherence; and (2) improving integration of TB and HIV services to reduce mortality through early diagnosis and treatment for TB-HIV co-infected patients. To evaluate the impact of these program efforts, MEASURE Evaluation designed two independent but complementary studies: the Social Support study and the TB-HIV Integration study. Both studies employed a mixed-methods approach, with a quasi-experimental quantitative evaluation design complemented by qualitative descriptive work to inform the findings.
The baseline study showed that social support services played a positive role in health outcomes for a majority of the individuals who received services in the oblasts studied, although some of the most at-risk groups were less likely to have accessed those services. Additional analyses to control for provider referrals will improve these estimates. The integration analyses support the recommendation for early antiretroviral (ART) initiation to reduce mortality. However, the absence of systematic recordkeeping to allow for tracking of patients between services restricted our ability to draw conclusions for the combined population of co-infected persons regardless of service entry point.
MEASURE Evaluation also conducted an endline survey to examine treatment adherence and outcomes among those receiving social support and changes in mortality due to early diagnosis and early treatment among TB/HIV co-infected patients served by integrated programs.
Related Content
Evaluating the impact of social support services on tuberculosis treatment default in Ukraine
Strengthening Tuberculosis Control in Ukraine: Impact Evaluation Baseline Survey, Ukraine 2014
Tuberculosis Co-Infection with HIV Responds to Concurrent Treatment
Ukraine Country Profile: Health Information System Indicators
[1] http://www.unaids.org/en/regionscountries/countries/ukraine
[2] European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2014. Stockholm: European Centre for Disease Prevention and Control, 2014.
[3] ibid
