Tuberculosis related lethality structure in Kharkiv, Ukraine: impact of COVID 19

Abstract

Ukraine is one of the leading countries with the highest tuberculosis (TB) burden in the world, and in 2020 we had met with the decrease of TB incidence rates (42,2 compare to 53,7 per 100000 population in 2019).

We aimed to analyze the impact of COVID 19 on the structure of the TB lethality.

Materials and methods. We compare the following indicators: 1) number of deaths and TB-inpatient lethality, 2) number of days spent in the hospital before the lethal outcome, 3) HIV-TB co-infection among the given cases. All the indicators were for 2019, 2020 and 2021 of TB dispensaries which collect TB-related data from the whole 2,5 million city Kharkiv, Ukraine.

Results: During 2019 there were hospitalized and treated 942 TB patients, 70 were died (7,4 %), and among them 18 (25,7 %) – HIV-TB co-infected, in 2020 hospitalizations were decreased – 708, with 47 (6,6 %) lethality and 13 (27,7 %) HIV-TB co-infected deaths. In 2021, than the quarantine restrictions almost lifted, the number of hospitalizations decreased again – 588 patients were treated in TB hospitals, lethality extremely increased - 68 (11,7 %) with 27 (39,7 %) HIV-TB co-infection deaths.

The survival curve analysis, made by life expectancy in days or weeks after hospitalization, are approximately the same in 2019 and 2020, but are quite different in 2021 - among the lethal outcomes, there is a slightly higher proportion of patients who died after at least 30 days of the treatment (17 % in 2019 versus 25 % in 2021).

Thus, increasing lethality and proportion of TB-HIV coinfection together with the decrease in the number of treated patients may indicate on hidden process of TB increased incidence. Active TB case-finding is urgently needed in Ukraine.