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| Reference: | 2690 |
| Country: | Ukraine |
| Multiple country event: | No |
| Region: | EURO |
| City: | Kiev |
| Start date: | 11 October 2010 |
| End date: | 22 October 2010 |
| Estimated duration: | |
| Status: | Completed - Complété |
| | (The mission has taken place) |
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| Title: | NTP review |
| Type: | Mission |
| Terms of Reference: | REVIEW OF THE NATIONAL TB PROGRAMME IN
UKRAINE, 11-22 OCTOBER 2010
Outline of the review
1. Background
After Russian Federation, Ukraine is the highest priority country in Europe for TB control. In 2008 (latest WHO estimates), Ukraine had TB (all forms) incidence of 100 (82-120) per 100,000 population, TB prevalence of 76 (19-150) per 100,000 and TB mortality of 15 (7.1-26) per 100,000. 16% (13.8-18.3) of the newly detected TB cases and 44% (40.0-48.7) of the previously-treated TB cases have multidrug-resistant TB (MDR-TB). Ukraine is among the 27 high-burden MDR-TB countries in the world. Ukraine has a HIV epidemic concentrated mainly in injecting drug users with average HIV infection in 1.6% of the adult population at reproductive age (15-49 years) in 2007. 323 people per 100 000 are detained in penal institutions (2008), which are known breeding grounds for TB and populated by injecting drug users. The prevalence of HIV among TB patients is estimated at 20% in 2007. A recent survey in Donetsk region showed HIV infection significantly associated to MDR-TB.
The current National TB Programme (NTP) was approved on 8 February 2007 by the law N° 648-V “On the approval of the national programme to fight TB for 2007–2011”. In the framework of its implementation, two bodies were established: 1) the “Committee on HIV/AIDS and other socially-dangerous diseases”, state body with strategic direction; and 2) the “Ukrainian Center for TB Control” under Ministry of Health (MOH) and with implementation responsibilities. NTP aims at decreasing TB morbidity and mortality, preventing multidrug resistant TB (MDR-TB), improving laboratory services, increasing treatment effectiveness and, institutionalizing training of health care workers. It has 15 objectives, each of them with indicators for monitoring progress and a budget of US$ 240 million. By 2011, NTP should achieve 95% DOTS coverage and 60% detection rate and 85% treatment success among the annual incident sputum-smear positive pulmonary TB cases.
Through USAID financial support and collaboration with the local authorities, WHO established a DOTS pilot project in Donetska region in 2001, which covered all region in 2003. From 2002 to 2004, KNCV has implemented a DOTS project in the capital city of Kiev with financial support from the European Commission. Since 2005 and under USAID support, WHO and PATH have been expanding DOTS in the additional 5 regions (Kharkiva, Khersona, Crimea, Dnepropetrovska, and Zaporizh’e). Since 2006 and under support of the Rinat Akhmetov Foundation for “Development of Ukraine” (FDU), WHO is assisting the implementation of the first MDR-TB pilot project of the country following Green Light Committee (GLC) recommendations in Donetska region. In 2008, USAID agreed to support PATH expanding DOTS to Kyiv city, Sevastopol city, Luganska and Odessa regions. In 2005, the DOTS population coverage was 30%; it was expanded countrywide in 2007 by a ministerial order. Where quality DOTS is implemented, the TB control targets of case detection and treatment success are improving but still insufficiently, due to the high levels of treatment defaulting and drug resistance.
Ukraine applied to The Global Fund (GF) in Round 9 with a 5-year TB project exceeding US$ 103 million. After ranked as category 3, Ukraine appealed to GF Board and got eventually the grant approved. The grant agreement for the first 2 years implementation is currently under negotiation.
By the end of December 2011, a new five-year national plan should be approved by the government of Ukraine. The Minister of Health, with official letter dated 16 February 2010 to WHO Country Office in Kyiv, officially requested WHO to organize an external review of NTP to be jointly performed by international and national experts. The recommendations of the review will be considered by MOH in developing the next NTP 2012-2016.
2. Objectives of the review
> To assess the TB epidemiological situation in Ukraine and the features of NTP with reference to the TB Millennium Development Targets, the implementation of the Stop TB Strategy and the linkages with the health system.
> To develop specific recommendations for the development of the new NTP Plan 2012-2016.
> To prepare a comprehensive WHO report of the review.
3. Operations
The NTP review is scheduled from 11 to 22 October 2010. The international and national experts participating in the review will analyse all relevant documents already available (publications, mission reports, etc.), conduct site visits (of relevant institutions and facilities) and interviews (to policy makers, health providers and beneficiaries, general population, main national and international partners) at national level as well as in 8 regions selected based on their geographic distribution: Dnipropetrovsk, Kirovogradsk, Volynsk, Mykolaivsk, Sumsk, Kyivsk, Lugansk and Chernivetsk.
The large documentation available from WHO piloting the DOTS Strategy and the Programmatic Management of MDR-TB in Donetsk region, as well as other relevant pilot TB projects by other organizations, will be considered for secondary data review.
Eight teams are organized to work in the field, each of them lead by an international expert. Logistics support will be provided by the WHO Country Office in Kyiv and national and regional health authorities. The first week of the review will be spent visiting regions and the second week back in Kyiv working on the reports of the visits in the regions and in having meetings and visits at central level.
The final report of the review will follow a specific structure. The first draft report will be ready by November and final report by December 2010.
List of the international members of the review
1. Amy Bloom, Senior Technical Advisor, USAID, Washington DC, USA
2. Pierpaolo de Colombani, Medical Officer, Communicable Diseases, WHO European Regional Office, Copenhagen, Denmark (Team Leader)
3. Andrei Dadu, Technical Officer, Communicable Diseases, WHO European Regional Office, Copenhagen, Denmark
4. Connie Erkens, Senior TB Consultant
Unit National, KNCV Tuberculosis Foundation, The Hague, Netherlands
5. Ann-Lise Guisset, Technical Officer, Country Policies, Systems and Services, WHO European Regional Office, Copenhagen, Denmark
6. Malgorzata Grzemska, Medical Officer TB, WHO Headquarters, Geneva, Switzerland
7. Vaira Leimane, Director, WHO Collaborating Centre for Research and Training in MDR-TB. Riga, Latvia.
8. Olexandr Polishchuk, Technical Officer, WHO European Regional Office, Copenhagen, Denmark
9. Girts Skenders, Head Supranational TB Reference Laboratory, Riga, Latvia
10. Jacob Veen, WHO Temporary Adviser (Team Leader)
11. Erika Vitek, Epidemiologist, International Research and Programs Branch, CDC, Atlanta, USA
12. Grigory V. Volchenkov, Head Doctor, Vladimir Region TB Dispensary, Vladimir, Russia
13. Olya M. Duzey, Principal Program Associate, Center for Pharmaceutical Management, Management Sciences for Health
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| Training Opportunity: | No |
| Website: | |
| Purpose 1: | TB programme planning and review / regional meetings |
| Purpose 2: | |
| Purpose 3: | |
| Other purpose: | |
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| Entered by: | WHO/CO |
| Partner 1: | |
| Partner 2: | |
| Partner 3: | |
| Contact name: | Pierpaolo de Colombani, WHO EURO; Olena Kheylo, WHO CO UKR |
| Contact email: | pco@euro.who.int; okh@who.org.ua |
| Other agencies: | |
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| Funding needs: | No |
| Funding source: | USAID |
| Other funding source: | |
| Available funding: | $ 0 |
| Funding gap: | $ 0 |
| Global Fund reference: | |
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| Comments: | |
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There are no documents attached associated with this event. There are no experts (roster) associated with this event. There are no experts (non-roster) associated with this event.
Date Created: 14 July 2010
Entered By: Pieter Desloovere
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