Interview with Yana Terleeva, the Head of the TB Prevention and Control Department at the Public Health Center of the Ministry of Health of Ukraine.

Ukraine is actively working to implement the Strategy for the Development of the TB Medical Care System for 2024-2026, aimed at reducing the incidence and mortality of tuberculosis, as well as developing person-centered support programs. What key steps have already been taken to implement this strategy? How does international support and funding contribute to the achievement of these goals? This will be discussed by Yana Terleyeva, Head of the Department of Tuberculosis Management and Control at the Centralized Health Center, in the first issue of the interview series “The Fight Continues: Ukraine’s Progress in Overcoming TB in the Context of War and Other Challenges”.

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Part 1. Implementation of the national strategy in combating TB: priorities, funding, and international cooperation

What stage of implementation is the Healthcare System Development Strategy for 2024–2026 currently at, and what other strategically important decisions are strengthening Ukraine’s fight against TB in the difficult conditions of war?

The Healthcare System Development Strategy for 2024–2026 was recently adopted and is currently in the initial stage of practical implementation. The approval of this document is an important step that demonstrates Ukraine’s consistent commitment to combating TB, despite the complex challenges caused by full-scale war.

The priority areas of work are ensuring continuous access to quality diagnosis and treatment, expanding preventive measures, particularly among high-risk groups, and strengthening the integration of TB care into the general healthcare system. Particular attention is paid to the introduction of modern approaches to treatment, including the expansion of the outpatient model and the use of the latest treatment regimens that meet international standards.

Keeping TB in the spotlight is an extremely difficult task.

This is especially true given that even before the full-scale invasion, this problem was not always given the priority it deserved. If TB were given sufficient attention at the global level, international organizations and the UN General Assembly would not have to regularly raise this issue, emphasizing the need for decisive action.

Despite all the challenges, Ukraine is showing unwavering determination to combat TB. The adoption of key strategic documents not only confirms the priority of this issue for the state but also demonstrates a desire for systemic change in the field of public health. Despite the difficult conditions caused by the war, Ukraine has set ambitious goals that are consistent with both the provisions of the UN Political Declaration and the current progress in the fight against TB at the national level.

In particular, the Law of Ukraine “On Combating Tuberculosis” was updated (editor’s note: it came into force in February 2024), the Strategy for the Development of the TB Medical Care System was approved, and an operational plan of measures for implementation in 2024–2026 was adopted to implement the State Strategy for Combating HIV/AIDS, TB, and Viral Hepatitis until 2030. This step-by-step plan contains specific measures aimed at effectively controlling TB and other infectious diseases. The proposed initiatives are designed to minimize the negative impact of the war on the public health system and comply with current international standards. This document is based on specific provisions of the political declaration and the updated WHO regional plan for the European region.

These steps confirm that, despite all the challenges, Ukraine is not only responding to the crisis but also implementing profound systemic transformations in the field of TB control. Updating the legislative framework, implementing modern strategies, and integrating international standards contribute to improving the effectiveness of measures to control and overcome the disease, ensuring the long-term sustainability of the national health system.

 

In your opinion, what are the biggest challenges in strengthening political leadership and cross-sectoral partnerships in Ukraine in the context of fulfilling the commitments of the UN Political Declaration on TB? What steps could help overcome these obstacles and ensure effective cooperation between all stakeholders?

The war has created unprecedented challenges for cross-sectoral partnerships, as its consequences have affected all areas of Ukrainian life, from the economy to healthcare. People who have lost their homes, jobs, and financial stability are forced to seek safer places to live and rebuild their plans for the future. This has caused the largest migration crisis since World War II: people are leaving the country or moving within the country, creating an additional burden on healthcare systems, particularly in western regions.

People who have been forced to leave their homes and relocate often do not have enough money to rent housing, so they are forced to live in densely populated areas. This creates additional threats, as crowding increases vulnerability to infectious diseases.

Another critical problem is the destruction of medical infrastructure. As of the end of December 2024, 1,938 facilities in 715 medical institutions had been damaged due to the actions of the Russian Federation, and another 297 facilities in 114 healthcare institutions had been completely destroyed. Among them are those specializing in the TB treatment, which significantly limits access to medical care, especially in frontline regions. This increases the risk of the disease spreading, as people are often unable to receive the necessary treatment in time.

In conditions of chronic stress and uncertainty, many people put their health on the back burner, which complicates TB prevention and its early detection.

This problem existed even before the war, when the culture of seeking medical help in a timely manner was not sufficiently developed. Today, the situation has become even more complicated.

Another significant challenge remains the financial dependence on international aid. The Global Fund, USAID, Stop TB Partnership, Red Cross, Doctors Without Borders, and other organizations play a key role in supporting tuberculosis programs in Ukraine. At the same time, the instability of funding, as demonstrated by the termination of USAID support, points to the need to create long-term financial sustainability mechanisms to ensure continuity of service delivery.

To improve cross-sectoral cooperation, it is necessary to strengthen the involvement of all ministries and agencies in the implementation of measures to combat TB, as the health sector traditionally remains the main player, although this disease requires a comprehensive approach. It is also important to expand prevention programs, strengthen communication with the population, and involve businesses in social initiatives. However, the most important thing is to create financially sustainable mechanisms that will ensure the fight against TB even in the most difficult conditions, as well as contribute to the preservation and continuous development of the human resource potential of specialists.

Ukraine is demonstrating consistency in implementing comprehensive reforms to the TB control system, but achieving long-term results requires the consolidation of efforts by the public sector, civil society, and international partners. Only through close cooperation between all stakeholders can the commitments set out in the UN Political Declaration be effectively implemented and a sustainable reduction in TB incidence in Ukraine be achieved.

In your opinion, does Ukraine have the potential to ensure adequate state funding for TB control programs in the post-war period? What steps do you think will be key to the sustainable implementation of vital TB treatment programs in such conditions?

In wartime, it is important to realistically assess the state’s ability to provide adequate funding for TB control programs. Currently, the main state priorities are focused on maintaining the front line, protecting sovereignty, restoring territorial integrity, and overcoming interrelated military, humanitarian, and food crises. In such circumstances, full state funding of TB control programs is an extremely difficult task.

In addition, funding for TB control measures is provided at several levels: state (at the level of the Ministry of Health, the Academy of Medical Sciences, the Ministry of Justice, and the Ministry of Defense) and local (at the level of local authorities and communities). This covers not only medical services but also social support for people with TB, ensuring the sustainability of TB facilities, and implementing support programs for those undergoing treatment. Each of these levels has its own challenges and tasks that need to be addressed. In the context of war, the state is doing everything possible to ensure the stable functioning of TB programs, but the support of international partners and donor organizations remains critically important.

Cooperation with international partners, attracting donor investments, and supporting civil society play a key role.

Complementary financing, in which the state’s contribution is supplemented by support from international partners and donor organizations, ensures the stability of TB services. This allows medical care to remain accessible to everyone who continues fighting TB in Ukraine, even in the extremely difficult conditions of war. The priority today is to expand preventive measures and protect the population from TB. The country has already purchased and made fully available modern disease prevention schemes that meet international standards. We have all the necessary capabilities to conduct modern TB diagnostics, as well as to access modern, innovative, short-term, and more effective drugs for the treatment of this disease.

The Ministry of Health has already taken an important step by securing funding for social support and treatment adherence programs from the state budget in 2023–2024. Although these resources are insufficient to fully cover the need, the very fact of state funding demonstrates the recognition of the priority of this area and the willingness to expand its support in the future.

Unfortunately, the war is still ongoing, and its long-term impact affects all areas of life, including the healthcare system. Once the fighting ends, the country will face new challenges, particularly in rebuilding its medical infrastructure and ensuring sustainable funding for TB programs.

It is already clear that donor support will remain critical even in the post-war period, as budget priorities will focus on large-scale reconstruction of the country.

One of the key challenges after the war is not only funding but also restoring the human resources capacity of the healthcare sector. A significant proportion of medical workers have been forced to leave the country, while those who remain are working under chronic stress and professional burnout. To ensure the sustainability of TB control programs, it is critical to consider the need for systemic support for medical professionals, including through the expansion of psychological support programs for patients, doctors, and medical staff.

Prior to the full-scale invasion, Ukraine had made significant progress in the fight against TB, making large-scale efforts to improve prevention and treatment. For the first time, full coverage with essential anti-tuberculosis drugs was achieved through the state budget. This was made possible by regularly updating standards and clinical protocols, which allowed for more modern approaches and shorter treatment regimens. The implementation of these changes not only increased the effectiveness of therapy but also optimized budget expenditures, expanding access to treatment for all patients. Ukraine was on the verge of a complete transition to state funding of TB programs, and given the previous optimization, there is every reason to believe that after the country’s recovery, this process will continue, ensuring stable access to treatment for all who need it.

However, the situation remains difficult and is likely to remain so in the coming years. Some challenges are related to changes in US policy on international support, the consequences of which are still being assessed. Since funding for programs to combat TB, HIV infection, and viral hepatitis depends largely on international partners, any changes in funding approaches could significantly affect the implementation of these programs.

An additional challenge in Ukraine remains the high prevalence of drug-resistant TB, which significantly exceeds the rates in most European countries.

 

The situation is complicated by concomitant HIV infection, viral hepatitis, and the need for replacement maintenance therapy. The combination of these factors creates an additional burden on the healthcare system and requires a comprehensive approach to overcoming TB.

Another key challenge remains the high prevalence of HIV infection, which directly affects the epidemiological situation with TB. Any interruptions in HIV programs can significantly slow down progress in overcoming TB, as the immunodeficiency caused by HIV significantly increases the risk of developing active TB.

The future of TB control programs is closely linked to the overall state of the public health system, the country’s political course, and ensuring uninterrupted access to essential medical and social services for all population groups, especially vulnerable groups.

 

What key achievements do you expect from the implementation of the national strategy and international commitments by 2030? How do you see the further development of the TB control system in Ukraine?

Combating TB by 2030 or even 2035 is an extremely ambitious goal. Without a significant breakthrough at the international level, including new investments, scientific discoveries, and innovative tools, the complete eradication of the disease will remain unattainable. The full-scale war in Ukraine only exacerbates this problem, but it is not its root cause.

It is important that the global community does not limit itself to political declarations, but creates real mechanisms for their implementation. With the available resources and approaches, the achievement of the stated goals seems unlikely — this is an objective expert assumption.

Expectations from the implementation of national strategies and international initiatives cannot be limited to technical solutions or medical approaches alone. Increased political attention to TB is a key factor, as addressing this issue must go beyond the scope of specialized ministries and become a nationwide task. It is important that commitments to overcoming complex social problems receive adequate attention in the process of shaping public policy.

The fight against TB should receive the same attention and support at the local level as it does at the level of nationwide initiatives or programs of the Cabinet of Ministers. One important area is the implementation of the “TB-Free Communities” initiative, which is outlined in the Strategy. Currently, the potential of communities to overcome the epidemic is underestimated, although it is local authorities and civil society that can play a key role in combating the disease.

Communities have a deeper understanding of local needs, which allows them to implement prevention and treatment programs more effectively. If systematic efforts are made at the community level, this will create a cascade effect that will ensure a consistent transition from national initiatives to specific local actions. This approach could be an effective tool for overcoming TB in Ukraine.

Our further expectations are that important reforms in the healthcare system will continue, and TB will become an integral part of them. We hope that in the process of implementing these reforms, it will be possible to strengthen the position of the TB service, improve its activities, and provide people with TB with quality medical services. To this end, it is necessary to continue developing medical guarantee programs, taking into account the specifics of the post-war period. It is particularly important to recognize that medical programs in frontline regions require a different approach than in relatively stable parts of the country. In addition, a significant portion of these programs is implemented with the support of international partners, so their sustainability and focus on quality must remain key priorities.

The expected changes also concern the focus of the fight against TB. Over the next few years, we aim to focus more attention not only on treatment programs, where significant progress has already been made (70% of patients receive outpatient treatment, and a stable supply of medicines and access to services is ensured), but also on developing effective programs at the primary healthcare level. It is important that this level be more integrated and provide a comprehensive approach that covers prevention, early detection, and diagnosis of TB and HIV, access to substitution maintenance therapy programs, and treatment of viral hepatitis. We hope that it is at this level that comprehensive approaches to combating these diseases will be implemented, because, despite the strengthening of the regulatory framework, it is here that the greatest challenges remain.

The issue of financing is no less important. We expect that a comprehensive approach will ensure its sustainability and significantly reduce the level of catastrophic costs for families with someone suffering from TB.

It is important that people receive the necessary help and support and have real opportunities for recovery, and that the treatment process itself does not create significant financial difficulties for them.

We also expect that the new strategy will strengthen information policy. In particular, it provides for the creation of national plans, as well as the adaptation of regional information policy plans to the specific needs of each region. The involvement of the public and other stakeholders will play a key role in shaping public awareness, overcoming stigma, and increasing responsibility for one’s own health. Thus, the communication component of the fight against TB must move to a qualitatively new level.

One of the key areas we are focusing on is strengthening programs to combat discrimination and stigma, as well as ensuring that all decisions are evidence-based. Recognizing the importance of research and generating new data is the foundation for effective TB control policies. This is also in line with one of the main principles of the global strategy to eliminate TB, which is enshrined in Ukraine’s state policy.

At the same time, achieving these goals requires a rethinking of approaches to research. Currently, research is not a priority due to limited resources, which are mostly directed toward treatment and the provision of consumables. However, together with the WHO, we have developed a plan for priority research on TB, the implementation of which will provide answers to critical questions, particularly regarding barriers to access to medical services and effective ways to overcome them.

Our strategic goal is to focus more attention on the development of scientific research and to involve all stakeholders in this process: medical and preventive institutions with invaluable experience in implementing short treatment regimens, government agencies, international partners, academic institutions, and patient organizations. This will not only increase the focus on research but also provide the necessary resources for its implementation.

 

Part 2. Overcoming challenges in the fight against TB: access to treatment, combating stigma, and protecting vulnerable groups.

Given the increased risks to public health during the war, particularly the factors contributing to the spread of TB, what new approaches are being implemented to ensure access to treatment, especially in conditions of mass displacement?

Given the growing risks to public health during the war, particularly the factors contributing to the spread of TB, Ukraine has taken a strategically important step—the transition to a new standard of medical care. One of the key changes has been the introduction of shorter treatment regimens, which is critically important in conditions where rocket attacks disrupt logistics and complicate access to treatment. Shortened treatment regimens give people with TB a better chance of recovery, even in difficult circumstances — this is one of the most significant innovative solutions in this area.

On all international platforms where Ukraine has the opportunity to speak out, we emphasize that this is the first and most important step that all countries must take. The war in Ukraine has global consequences — its impact is felt in Europe, Asia, and beyond. In fact, there is no country where our people with TB are not present. Ukraine was able to update medical care standards quickly, adapt procurement programs, train medical workers, and provide patients with the necessary medications.

At the same time, a number of European countries still use 18-month treatment regimens, while in Ukraine, this process has been reduced to six months. As a result, some patients are forced to return home under shelling to continue treatment according to modern standards. This is an issue that needs to be addressed immediately at the international level.

Another important innovation was the regulatory regulation of a multidisciplinary approach to supporting people with TB. Now, not only medical workers are involved in the treatment process, but also social workers, representatives of the non-governmental sector, psychologists, and, if necessary, the patient themselves. Previously, such approaches were mainly supported by international organizations, but today they have become an integral part of state policy and are enshrined in the relevant regulatory act. In times of crisis, when the humanitarian and social needs of people with TB become critical, it is the teamwork of various specialists that helps to ensure successful treatment.

At the same time, access to medical care remains a serious challenge, as more than 20% of the population, especially in frontline areas and in places where internally displaced persons (IDPs) live in compact communities, have limited opportunities to receive treatment. To address this problem, Ukraine is actively introducing mobile clinics that provide access to diagnosis, treatment, and support for people in the most difficult conditions.

These clinics operate thanks to the support of the Global Fund, the Public Health Center, the Centers for Disease Control and Prevention, the Public Health Alliance, the 100 Percent Life network, the Red Cross Society, WHO, Doctors Without Borders, TBPeopleUkraine, and local communities.

Such approaches not only ensure continuity of treatment but also make it more accessible and responsive to people’s needs, especially in regions with high risks of TB spread.

Thanks to modern technology, mobile clinics have not only brought medical care closer to people but also made it high-tech and comprehensive. They are equipped with portable X-ray machines, which allow for rapid on-site diagnosis and the implementation of integrated screening programs covering TB, HIV, and viral hepatitis. The work of such clinics is often combined with vaccination campaigns and other primary health care services, which significantly increases their effectiveness.

The mobile clinic format has proven to be in high demand among the population, demonstrating its relevance and effectiveness in providing access to essential medical services.

According to research and the National Tuberculosis Program, rural residents had limited access to medical care even before the war, and the war has only exacerbated this problem. At the same time, the experience of providing mobile services gained during the full-scale war will be extremely valuable in the post-war period.

The use of mobile clinics will allow for a more systematic response to challenges that existed even before the war and will help expand access to medical care in the regions that need it most.

 

In your opinion, what areas should be considered a priority for strengthening cooperation between civil society organizations (CSOs) and the state to effectively implement the national TB control program? How can we work together to achieve our common goal—a life free of this disease for Ukrainians?

Civil society has always played a key role in the fight against TB, and its importance has only increased in times of war. Recently, there has been even greater cohesion among civil society organizations (CSOs), which have taken on a significant share of the responsibility for responding to the current challenges. This applies not only to medical issues, but also to other important aspects, such as social support, logistics of medicine supply, and advocacy for patients’ rights. During the war, we have repeatedly seen how civil society, often at the risk of their own lives, has stepped up to the plate to deliver medicines, coordinate aid, or perform critical tasks beyond their traditional functions.

In order to achieve the common goal of ensuring that Ukrainians live TB-free lives, it is necessary to strengthen the interaction between CSOs and government agencies. It is important to identify several priority areas where this cooperation can be most effective.

The first area is the expansion of information campaigns and strategic communication in the field of TB response. In the context of the war, the information space has become another battlefield, and it is important to ensure high-quality, scientifically sound and accessible information about TB.

Civil society plays a critical role in overcoming misinformation, fighting stigma and shaping the right public opinion about modern TB treatment and prevention methods.

The use of digital platforms, social networks, interactive formats, and adaptation of communications to the needs of different population groups will allow to effectively disseminate reliable information and neutralize the influence of fakes that can be a tool of hybrid warfare.

Thus, strengthening the information component of the national TB program will be an important tool not only in the healthcare sector, but also in strengthening society’s resilience to information manipulation and in shaping the right behavioral model for the prevention and treatment of the disease.

The second area is overcoming barriers to access to healthcare. Patient organizations can play a key role in ensuring communication between government agencies and people with TB, as well as between specialized medical institutions and people undergoing treatment. Such organizations have a unique opportunity to quickly identify problems with access to healthcare services and help solve them in real time. The use of various communication platforms, such as OneImpact, implemented by TBPeopleUkraine, as well as the involvement of paralegals and other resources, helps to eliminate systemic barriers to health care services and protect the rights of people with TB.

The third area is social support and building adherence to treatment. This component plays an important role in ensuring successful treatment adherence, especially among vulnerable populations. Ukraine has been implementing social support models for many years, which have proven to be effective and can be part of a sustainable national response to TB. It is important that these programs continue and expand with the support of international organizations, the non-governmental sector, and donor funding.

The fourth area is humanitarian aid. NGOs assume a significant part of the responsibility for addressing humanitarian issues that directly affect the effectiveness of treatment. This includes the provision of housing, food, hygiene products, and employment assistance to people undergoing treatment or affected by the war. Involvement of humanitarian aid in the social support system will help stabilize the living conditions of people with TB and increase their adherence to treatment.

The fifth direction is to strengthen international activities. Civil society has significant potential to attract international support and investment to fight TB. Effective representation of Ukrainian organizations at the international level allows not only to draw attention to national challenges, but also to strengthen trust in Ukraine and its TB program.

It is important that the civil sector continues to advocate at the global level, promoting the expansion of financial and technical support from international partners.

To summarize, the role of civil society in the fight against TB is multidimensional – it is not limited to local initiatives. CSOs perform a critical function in overcoming barriers to access to healthcare services, providing social support, providing humanitarian assistance and attracting international support.

Further strengthening the partnership between government and civil society is essential to building an effective and sustainable TB response in Ukraine.

Only by joining forces will we be able to ensure a comprehensive approach to overcoming the disease and create a system in which everyone affected by TB has equal access to quality health care and social protection.

 

How do you assess changes in overcoming TB stigma at your level? Have you faced any difficulties in implementing anti-stigma approaches in your professional activities? What lessons or recommendations do you think could strengthen these processes in the future?

Ukraine has made significant progress in a comprehensive approach to overcoming the stigma associated with TB. An important step was the revision of legislative initiatives that established new standards for the treatment of people with the disease. There are no secondary aspects in the fight against TB, and we are very attentive not only to strategic documents but also to feedback from people who are affected by it. It is important to understand their needs and take into account their expectations from the healthcare system.

An approach focused on the individual needs of each person with TB is a key element in the fight against stigma. It is important not only to talk about ensuring access to treatment, but also to shape the public perception of TB as a curable disease and of people who are fighting it as those who need support, not judgment. This means that drug treatment alone is not enough – a comprehensive approach is needed, including social support, psychological assistance, and protection of the rights of people with TB.

Every step in this direction matters. We managed not only to update the legislation, but also to introduce gender-oriented algorithms for testing and medical care that take into account the individual needs of different groups of the population. An important achievement was the development of an information strategy to combat stigma, as well as a clear plan for its implementation.

Every year, a number of activities are implemented to overcome stigma through various channels and tools. These activities involve representatives of various segments of the population. Numerous partners are involved in these activities – from ministries and politicians to educational institutions, communities and NGOs. Today, we not only formulate policies, but also rely on clear data on the level of stigma and mechanisms to overcome it.

 

To achieve sustainable change, we use evidence-based approaches based on regular stigma surveys. The results of the 2021 and 2024 surveys show positive dynamics: public attitudes toward TB are gradually changing for the better. An important achievement was that Ukraine became the first country to conduct a study on the medical and social needs of children with TB. It made it possible to adapt and implement practices based on caring for the youngest patients, which is extremely important for the development of a humane attitude to treatment.

At the same time, we realize that changing public attitudes towards TB is a complex and lengthy process. However, gradual positive changes are already taking place. While in 2021, 39% of people with TB reported feeling stigmatized, according to the latest data, this figure has dropped to 27%. The reduction in stigma among healthcare workers is a significant achievement. This is an important indicator, as the attitude of the medical community has a significant impact on patients’ adherence to treatment, their trust in the healthcare system, and their willingness to seek help at early stages of the disease.

Over the past five years, public attention has been focused on global crises: the COVID-19 pandemic, war, and economic instability. In this context, it has become even more difficult to draw attention to the problem of TB.

The fight against stigma cannot be a one-time campaign – it must be a continuous process integrated into the healthcare system, education and social programs.

We want people who have overcome TB to have support and to be able to speak boldly and openly about their experiences, because the personal stories of those who have gone through treatment can change public perception of the disease and break down prejudices. However, stigma creates a vicious circle: those who could help overcome it are often afraid of being judged.

Another challenge is the stigmatization of Ukrainians abroad. Mass migration due to the war has shown that even in developed countries, the level of prejudice against TB remains high. Our fellow citizens often face a double stigma – as migrants and as people diagnosed with TB. This once again emphasizes the need for international cooperation aimed at fostering a tolerant attitude towards TB at the global level.

Despite all the challenges, it is important to recognize the support of the international community. Many governments, despite their own challenges, are working to adapt their medical systems, implement updated protocols, and ensure that Ukrainians have access to treatment abroad.

The conclusion is obvious: the fight against stigma is a long journey that requires systematic work, involvement of different sectors and constant dialogue. But the main thing is that we hear people facing TB, see progress and will try to keep it.

 

Tuberculosis remains a disease closely linked to socioeconomic factors. What steps is Ukraine taking to ensure that prevention, diagnosis and treatment programs take these factors into account?

TB remains a disease closely linked to socioeconomic factors. Despite significant medical progress, poverty, social insecurity and inequality continue to be among the main factors in its spread.

TB can affect anyone, not just socially vulnerable groups. At the same time, social protection reforms do not always keep pace with the changing situation, and the war only exacerbates the existing challenges. We have made significant progress in improving medical approaches to TB treatment, but poverty, inequality, humanitarian crises and the effects of war create conditions for the further spread of the infection. Economic difficulties make it much more difficult to implement mass treatment programs such as those implemented in response to the COVID-19 pandemic. TB is no longer the “sentence” it was in the past, but remains a disease of social inequality.

To this end, Ukraine is working to strengthen the Intersectoral Cooperation and Accountability Mechanism, in particular through the active participation of the National Council on HIV/AIDS and TB. Cooperation between government agencies, civil society and international partners allows for more effective response to challenges and expanded access to healthcare.

While work on long-term systemic changes is underway, mobile outpatient clinics focused on screening and prevention of socially important diseases, including TB, continue to operate in Ukraine. In February 2025, their number increased to 19 thanks to the cooperation of the Ministry of Health of Ukraine and the Global Fund to Fight AIDS, Tuberculosis and Malaria through UNICEF. Specialized mobile outpatient clinics are equipped with modern diagnostic equipment thanks to the support of the Public Health Center.

These outpatient clinics play a key role in providing medical services in regions where access to inpatient medical facilities is limited due to war or internal displacement.

Particular attention is paid to places of compact residence, such as dormitories, psychoneurological clinics, and penitentiary institutions, where the risk of infection is increased due to the shared use of premises.

The work of mobile outpatient clinics allows for timely detection of the disease at early stages and reduces the likelihood of its spread among the most vulnerable populations. This is one of the important components of Ukraine’s comprehensive response to the social challenges associated with TB.

 

In recent years, Ukraine has seen an increase in the incidence of TB among children. What measures are being taken to improve TB prevention, early diagnosis and treatment among children, especially in times of war?

The increase in the incidence of TB among children in Ukraine is an important signal, but it should be considered with the specifics of children’s statistics in mind. Any fluctuations in this age group can have a significant impact on the overall picture, as rates among children traditionally remain low. In addition, it should be remembered that the COVID-19 pandemic has significantly limited access to healthcare services, which has led to a 30% decrease in the reported incidence of tuberculosis worldwide.

 

Recently, Ukraine has seen several important changes in approaches to the treatment and prevention of TB among children. A new WHO guideline focused on pediatric practice was developed, which became the basis for updating national standards of medical care. This made it possible to introduce modern methods of diagnosing, detecting and treating TB, taking into account the characteristics of the child’s body.

Key innovations in diagnostics include: stool testing as a non-invasive method that is more comfortable for children; the use of more sensitive ultra-cartridges for laboratory diagnostics that increase the efficiency of TB detection; and increased access to modern molecular genetic diagnostic methods. Programs to develop human resources and improve treatment routes have already contributed to some stabilization of the situation among children.

At the same time, it should be remembered that children are often infected through contact with adults with TB, and therefore the deterioration of the situation among the latter automatically affects the level of childhood morbidity. That is why Ukraine has started implementing family-oriented approaches to create a safe and supportive environment for children fighting TB.

We can proudly say that Ukraine has moved away from the Soviet practice of long-term inpatient treatment of children.

Thanks to changes in legislation, most children with TB, who rarely have bacterial excretion, can now be treated at home. This allows them to attend kindergarten or school, remain in their usual social environment, enjoy their childhood, and have support and understanding.

This comprehensive approach, which combines modern clinical protocols, social support and innovative diagnostic methods, is an important step towards reducing the burden of TB among children and building an effective, person-centered healthcare system.

However, it is important to note that stigma against children with TB remains an acute problem. Stigmatization of such children is particularly difficult because it creates significant psychological pressure, and its consequences can be much more serious due to the vulnerability of the child’s psyche. Children who face prejudice may experience isolation, emotional stress and difficulties with social adaptation, which negatively affects not only their emotional state but also their adherence to treatment.

That is why overcoming stigma should be a priority for the state, NGOs and the Ministry of Education and Science of Ukraine. It is necessary to change the public perception of TB and develop a tolerant policy towards children with any disease, starting from the earliest age, from kindergarten. This requires the systematic integration of educational programs that will shape the right attitude towards TB among children, their parents and teachers. Implementation of this policy requires long-term work, and it will take several more years to achieve tangible changes. However, important steps have already been taken to improve the situation.

To summarize, children in Ukraine can now be treated mostly on an outpatient basis, receiving modern, effective medicines in pediatric dosages available on the market. They also have access to social support and psychological support programs, which are an integral part of comprehensive treatment and rehabilitation. This is an important progress in creating a person-centered healthcare system that takes into account not only physical but also emotional and social needs.

 

How is support organized in Ukraine for children at risk, including children from displaced families, orphans, and those in difficult social conditions? Are there specialized social support programs for such children?

Ukraine has special programs to support children, implemented through social protection organizations and with the participation of partner institutions. These programs help children adapt, receive the necessary social support and attention they need.

One such initiative is Superhero Schools, a network of free schools in medical facilities for children undergoing inpatient treatment. Here, they can take their minds off diagnoses and procedures by immersing themselves in learning and being in a comfortable environment. Thanks to the support of the Cabinet of Ministers of Ukraine, the Office of the President and the First Lady, the program has been operating since 2022, including in one of the TB facilities.

In addition, the charitable organization TBPeopleUkraine, with the support of international partners, has created multidisciplinary resource rooms and psychological spaces for children and adolescents being treated for TB or LTBI. Currently, such rooms are operating in five regions – Odesa, Rivne, Kropyvnytskyi, Lutsk and Zaporizhzhia – providing a safe environment for learning, psychological support and social adaptation. Another important initiative was the Ukrainian comic book “The Power of Friendship: How Zlata Overcame TB” created by the Partnership “Stop TB. Ukraine”. It helps children better understand the disease, overcome fears and stereotypes, and feel supported during treatment.

However, despite the effectiveness of existing support programs, they are not enough to fully address the challenges faced by children – especially in times of war. Over the past three years, more than 13,000 children in Ukraine have become orphans; many of them remained in the occupied territories or were separated from their parents. In such circumstances, when children experience the loss of home, parents and a normal childhood, the risks to their physical and mental health increase significantly.

No program or form of government support can give children back their lost childhood, but it is our responsibility to provide them with proper care, support and prevent the development of diseases such as TB. If a child is already infected, he or she must receive timely and high-quality treatment in safe conditions.

That is why in recent years, government policy has focused on strengthening preventive treatment. We are actively promoting the importance of preventive therapy, reducing the duration of treatment regimens and improving TB detection methods.

Key innovations include quantiferon tests, which have already been implemented in all Centers for Disease Control and Prevention; new skin tests for TB diagnosis, which will become available this year through international procurement; and updates in diagnostics and treatment planned for 2025, which will expand the possibilities for early detection and effective treatment of the disease.

The development of modern approaches to the prevention, diagnosis and treatment of TB among children from socially vulnerable groups remains one of the main priorities of the state health policy.

We demonstrate that even in the most challenging times, it is possible to implement innovative technologies that have proven to be effective and can change approaches to combating TB. Their effectiveness has been confirmed by the World Health Organization (WHO) and the Stop TB Partnership, which is a strong proof of the reliability of these solutions and their compliance with international standards.

 

Part 3. Innovations in TB Control in Ukraine: Vaccination, New Treatments and Accessibility.

Is the development of new TB vaccines a priority of the WHO End TB Strategy? Does Ukraine participate in international research related to TB vaccination? What are the prospects for updating the national vaccination program and what steps should be taken to ensure that the country is ready to introduce a new vaccine when it becomes available?

A number of national TB control programs in different countries, as well as the WHO and the Stop TB Partnership, recognized that the existing BCG vaccine had limited effectiveness in preventing adult TB and needed to be replaced. This realization was an important global step that intensified the process of developing new vaccines and helped to unite the efforts of governments, the scientific community, the pharmaceutical sector and donor organizations.

In particular, a global initiative was created to accelerate the development of new vaccines, bringing together leading pharmaceutical companies, research centers and international partners. As a result, several promising vaccine candidates have already reached the third phase of clinical trials and demonstrate efficacy of more than 50% in preventing the development of TB.

We hope that, despite all the difficulties and uncertainties, civil society organizations, the business sector and governments will find the resources and opportunities to continue working on the development of a new vaccine, so as not to lose the progress made and not to find ourselves in a situation where we will have to wait decades for its availability.

Ukraine is closely monitoring this process to adapt national vaccination strategies in a timely manner and prepare the healthcare system for the possible introduction of the new vaccine as soon as it is approved and available on the market.

The vaccine is a powerful tool in combating TB, and all countries should be interested in its development and implementation. Even countries in the Western European region with developed healthcare systems are not fully protected from the spread of TB.

European countries also face challenges that affect the spread of TB, including migration and demographic changes. Higher incidence rates among migrants create additional risks that require effective early detection and prevention programs. At the same time, the aging of the population is another factor that contributes to the activation of latent TB, as the immune system weakens with age, which increases the risk of developing the disease. While in Ukraine, the vast majority of people with TB are men aged 20-40, in the Western European region, a significant proportion of them are older people.

Given these factors, each country should closely monitor the situation and prepare for the introduction of new vaccines. Ukraine, although currently not directly involved in the development of vaccines, can play an important role in their rapid introduction, as well as in developing access mechanisms, adapting programs, preparing vaccination schedules and providing funding.

This is a complex and multi-component process that requires an integrated approach, but today it is necessary to keep this issue in focus, ensure the dissemination of relevant information and engage all stakeholders in a dialogue.

Vaccination should become an integral part of the global TB strategy, and it is important that Ukraine is ready to change and implement new solutions as soon as they appear.

 

How is Ukraine implementing innovative approaches, including new treatment regimens recommended by the WHO? What impact do these innovations have on the treatment of drug-resistant forms of TB?

Ukraine is actively implementing innovative approaches to combating TB, focusing on the needs of people and relying on WHO recommendations and the experience of international partners. This has helped to significantly change approaches to treatment, shorten its duration and improve outcomes for people undergoing treatment.

Five years ago, treatment of drug-resistant TB lasted from 20 to 36 months, which created a significant burden on the healthcare system and on the patients themselves. Today, this period has been reduced to 6-9 months. Similar changes have been made to the treatment of sensitive TB, where instead of the mandatory 6 months, some regimens allow for a reduction to 4 months. There has been an even bigger breakthrough in the field of prevention: while previously preventive treatment lasted 3, 6 or 9 months, today there are effective regimens that last only 1-3 months. Ukraine is one of the leaders in the European region in terms of the pace of introducing modern, innovative and shortened treatment regimens for drug-resistant TB. In cooperation with the WHO European Office, we conducted two large-scale operational research studies on the introduction of short modified regimens of MSTR and BPAL even before BPAL became part of the treatment program and was recommended by WHO for routine use.

A distinctive feature of the Ukrainian approach is the speed of innovation and the national scale of change.

Ukraine is the only country that has implemented new regimens at the national level, without dividing people with TB into those who “deserve” shorter treatment and those who do not.

We have ensured equal access to the most effective therapies for all, which was made possible by the strong work of regional phthisiopulmonary centers, coordination of the Public Health Center and the involvement of the State Institution “National institute of phthisiology and pulmonology named by F.G. Yanovsky of the National Academy of Medical Sciences of Ukraine”.

Today, Ukraine has a unique experience of implementing innovations in the most difficult conditions. Despite the war, we have not only conducted large-scale studies, but also achieved a BPAL treatment success rate of 85-89% in all regions. This confirms both the high level of organization of the healthcare system and the professionalism of Ukrainian doctors.

In addition to the direct impact on treatment effectiveness, Ukraine has significantly strengthened its scientific potential.

All 25 regional phthisiopulmonary centers in the country can now serve as bases for surgical or even clinical research, which creates a powerful resource for further international cooperation.

Despite all the challenges, especially those caused by the war, Ukraine demonstrates its readiness to adapt to changes, implement new approaches and respond promptly to the emergence of new therapeutic opportunities. We have the experience, expertise and determination to move forward, and when even more effective or shorter treatment regimens become available, we are ready to implement them.

 

What changes in the Medical Guarantees Program to ensure access to health care for people with TB are expected in 2025? What specific steps are planned or need to be taken to create a high-quality, comprehensive and person-centered treatment pathway?

We are convinced that for an effective TB response, it is important to have strong regional TB centers, as they are the ones who organize the provision of medical care in each region. Throughout the year, we regularly visit TB centers or communicate with them online to get up-to-date information on the situation in the regions and understand the challenges facing the TB control system.

Currently, many regional centers continue to function thanks to the enthusiasm of medical leaders who, despite limited funding, ensure the implementation of TB programs. We realize that in the context of the economic crisis and the war it is difficult to count on a significant increase in government funding for these institutions, but this issue cannot be ignored.

The activities of phthisiology and pulmonology centers are currently funded mainly by the Medical Guarantees Program, but local budgets and international technical assistance projects also play a significant role.

Despite this, in some regions the situation with TB centers is critical. This problem existed even before the full-scale war, which exacerbated it even more, as damage to medical infrastructure and mass migration significantly affected the availability of specialized care.

We hope that after the war is over, every region will have a facility that meets European standards. This requires significant investments, as the TB service has already gone through a difficult path of reform. We have optimized unnecessary facilities and beds, and thanks to the reform, 25 powerful centers have been created that have the necessary equipment or the ability to refer patients to other facilities. However, returning to the issue of stigma, our TB patients are not always waiting for expensive diagnostics in other institutions, and this is a serious problem.

Regarding the Medical Guarantee Program, Ukraine has made significant progress in providing outpatient TB treatment.

If ten years ago only a few patients had the opportunity to be treated at home, today 70% of people with TB are treated on an outpatient basis from day one.

This is an important step in the development of a patient-centered treatment model, but the issue of effective organization of this approach remains open.

The key aspect is who provides medical support to the patient. Currently, people with TB mostly go to TB specialists, although it would be more logical and effective to have them treated by family doctors who know the patient’s history, health status, family situation, and can detect side effects in time.

Most adverse reactions are related to taking anti-TB drugs, but they can affect various organs and systems of the body, and it is the family doctor who can detect this effect in time and provide the necessary assistance. Of course, in cases where specialized intervention is needed, a TB specialist should be involved, but this does not mean that the treatment of a person with TB should be completely separated from primary care.

However, according to the Center for Public Health, only about 22% of patients receive treatment from their family doctor. This indicates a systemic problem of insufficient integration of services under the Medical Guarantees Program, which limits the possibility of effective comprehensive patient care.

The Medical Guarantee Program does not currently require family doctors to manage TB, which creates additional barriers to the implementation of person-centered approaches to TB treatment. We are convinced that Ukrainian family doctors are highly qualified specialists who can provide TB treatment, dispense medications, accompany patients while taking medications, and timely refer people with TB to TB specialists or social workers if necessary.

We are deeply concerned about the decision made this year, as it contradicts the patient-centered approach and does not take into account the real capacities of the country. At the same time, according to the Center for Public Health, this is not an excessive burden on family doctors: according to our calculations, on average, it is one or two TB patients per family doctor every year. We have accurate data and a good understanding of the real situation, so we believe that this decision needs to be revised and advocated for change.

TB treatment is a team effort that should combine the efforts of family doctors, TB specialists, people undergoing treatment, and NGOs.

Effective cooperation between all parties is the key to successful treatment and ensuring a systematic response to the challenges associated with the optional TB management at the primary level in Ukraine.

We share the opinion that family doctors are capable of professionally managing people with TB in accordance with the standards of TB care. How can they learn this if they are not involved in the treatment of real patients? Our position remains unchanged: family doctors should play a key role in the management of people with TB, and for additional support, each person undergoing treatment can have a dedicated TB specialist who will provide advice and support.

At the same time, telemedicine, which could become an important tool for rapid care through video communication with a TB doctor, is still not fully utilized, although it has significant potential, its implementation and active use remain a matter of organizational decisions and political will.

The biggest challenges remain the financing of the Medical Guarantee Program and the mandatory TB management by family doctors.

In the future, we see opportunities to further improve the quality of TB services, but this requires the introduction of electronic tools, data collection, and continued work with family doctors to improve their knowledge.

Quality indicators are already clearly defined in the standards of medical care, and it is important that they become part of the responsibility under the Medical Guarantee Program. It is necessary to develop and integrate effective tools that will contribute to the achievement of high standards of care. We recognize that these changes will take time, but they need to be started now so that they become an integral part of the healthcare system in the future.

 

How has the introduction of a comprehensive approach, including outpatient treatment, social support for patients and free access to medicines, affected the effectiveness of the fight against TB in Ukraine?

Previously, the implementation of an integrated approach, including outpatient treatment, social support for people with TB and free access to medicines, was carried out only in the format of separate initiatives that did not cover the whole country. In 2023, when the Ministry of Health, with the participation of the Center for Public Health, regulated key aspects of implementation, the integrated approach became a full-fledged part of public policy. This resulted in the consolidation of mechanisms for outpatient treatment, social support and free access to medicines, which significantly improved the effectiveness of TB treatment, TB control measures with active public involvement and the implementation of the TB-Free Community initiative.

That is why the greatest impact is expected now, when the new model of care organization is systematically implemented. But where this approach is already being used, its effectiveness is evident: people affected by TB recovered faster, treatment success rates were higher, and treatment interruptions were less frequent. Moreover, the multidisciplinary approach affects not only individual outcomes but also the overall effectiveness of the TB program, as it improves coordination between healthcare facilities, social services, communities, and other important parts of the healthcare system. This allows for a faster response to people’s needs, reduces the risk of complications and relapse, and supports the sustainability of treatment outcomes in the long term.

It is important to understand that a multidisciplinary approach is not only about overcoming barriers to access to health care, but also about addressing the social and psychological needs of people with TB in a comprehensive manner.

As we have already emphasized, taking into account the patient’s psycho-emotional state is critical for effective treatment. That is why this approach is one of the most evidence-based and effective. It is necessary to focus on its implementation, to unite all stakeholders around the person undergoing treatment, rather than to distribute responsibility between separate structures.

One of the doctors put it very well: “We have to work in a way that makes our work sound like a song in which the patient plays the main part.” This is exactly how a multidisciplinary team should function, with each specialist playing their own role, but all together creating a single harmonious system that helps the patient to go through the path to recovery. If all teams worked with this approach, we could make even more progress in combating TB in Ukraine.

 

The interview was conducted by:

• Nataliia Zhdanova, the Head of Communications at TBPeopleUkraine
• Yevgeniia Kuvshynova, the Executive Director of the AUCO “Convictus Ukraine”, Deputy Chair of the Steering Committee of the Partnership “Stop TB. Ukraine”

This material was created by the Partnership “Stop TB. Ukraine”, the secretariat of which is the AUCO “Convictus Ukraine”, with the support of the Stop TB Partnership within the framework of the 12th round of the Challenge Facility for Civil Society