War in Ukraine: an immense threat to the fight against tuberculosis

Extract

As reported by the Global Tuberculosis Network in the European Respiratory Journal, coronavirus disease 2019 (COVID-19) has distressingly resulted in a plateauing of the global decrease in tuberculosis (TB) incidence as well as entailed a surge in mortality for the first time in a decade [1, 2]. As the COVID-19 pandemic response is gradually being integrated into healthcare systems worldwide, the war in Ukraine poses a new threat to TB control in Europe. Over the years, an admirable progress in combating TB has been achieved globally and regionally, although optimal control of TB was not yet fully in sight in Ukraine or Russia [3]. Incidence and mortality rates have been falling steadily in both Ukraine and the Russian Federation, and between 2010 and 2020, the number of TB deaths in Russia has fallen by as much as 10% per year [4]. Nevertheless, the eastern areas of the World Health Organization European region, including Ukraine and Russia (and also bordering countries such as Belarus and Moldova), account for the largest burden of multidrug-resistant (MDR)-TB in the world and also have a relatively high burden of drug-susceptible TB [4]. Russia and Ukraine have the second and fifth highest rates of confirmed individuals with extensively drug-resistant (XDR)-TB [4], respectively, along with high prevalences of latent TB infection [5]. Even before the military conflict, the diagnosis and treatment of patients with M/XDR-TB in Ukraine was limited by availability of diagnostic tools and medicines [6]. Together with HIV, social determinants, and other risk factors for TB, drug-resistant TB is among the major challenges in controlling TB in the European region, and there is a dire need to ramp up case-finding [7]. The reported proportion of HIV/TB co-infection is 22% and 24% among patients with a known HIV status for Ukraine and Russia, respectively, which is also highly unsettling [4].