Using patient–centered approach for improving adherence to treatment in DS/DR–TB patients in Ukraine

• Published in: European journal of public health Vol. 30; no. Supplement_5
• Main Authors: Geliukh, E, Tabunshchyk, V, Kamenska, N, Islam, Z
• Format: Journal Article
• Language: English
• Published: Oxford Oxford Publishing Limited (England) 01.09.2020
• Subjects: Appeals; Clinical outcomes; Cohort analysis; Counseling; Documents; Food; Health services; Hospitals; Housing; Intervention; Legal services; Medical treatment; Medicine; Needs assessment; NGOs; Nongovernmental organizations; Patient compliance; Patient-centered care; Patients; Public health; Service restoration; Social services; Social services delivery; Social workers; State budgets; Treatment compliance; Treatment outcomes; Treatment programs; Tuberculosis; Ukraine
• ISSN: 1101-1262; 1464-360X
• DOI: 10.1093/eurpub/ckaa165.404

Abstract Issue/problem Ukraine is among 30 high MDR-TB burden countries with about 6500 laboratory confirmed MDR-TB cases annually. Ukraine provides full coverage for first- and second-line TB drugs from the state budget. Nevertheless, successful treatment outcomes are one of the lowest in EECA region - 49% in MDR/RR-TB cases and 37% in XDR-TB. High rates of lost to follow-up (15.8%), treatment failed (18%) and died (15.9%) among MDR-TB cases contribute to unsuccessful treatment outcomes. Description of the problem A new intervention was introduced aimed at improving patients' adherence to treatment. Medical-psycho-social services (MPSS) provision based on patient-centered approach is provided to all patients. In 2018, project funded by GFATM was launched in 8 oblasts of Ukraine. All patients are assessed on treatment adherence before discharge from hospitals. Those with low adherence are referred to NGOs. MPSS starts from the patient's needs assessment followed by development of individual plan of support. MPSS is provided during the whole period of outpatient treatment and may include DOT/VOT, social workers' permanent support, food kits, psychologist counselling, transport and/or cell reimbursement, housing, documents restore, legal services and other services as per patients' needs. Electronic depersonalized database SyrEx is used for the project related notes. Results Total amount of TB/DR-TB patients treated in 2018-2019 is 8640 and 4246 accordingly. Cohort analysis is used for treatment outcomes assessment. Intervention allowed reducing the number of patients lost to follow up in DS/DR-TB (to 1.2% and 2.5% accordingly), treatment failed (to 5.4% and 10.9%) and number of died (to 2.1% and 3.2%) Lessons MPSS based on patient-centered approach improved successful treatment outcomes: to 91% in DS-TB patients and 82.3% in DR-TB. Further initiative scale-up is required as well as transition of MPSS services from donor funding to domestic.