Skip Navigation



Health Policy and Planning Advance Access published online on December 4, 2008
Health Policy and Planning, doi:10.1093/heapol/czn045
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
24/1/55    most recent
czn045v1
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Vassall, A
Right arrow Articles by Zaleskis, R
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Vassall, A
Right arrow Articles by Zaleskis, R
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2008; all rights reserved.

Reforming tuberculosis control in Ukraine: results of pilot projects and implications for the national scale-up of DOTS

A Vassall1,*, Y Chechulin2, I Raykhert3, N Osalenko4, S Svetlichnaya5, A Kovalyova5, MJ van der Werf6, LV Turchenko4, E Hasker2, K Miskinis3, J Veen6 and R Zaleskis7

1 Royal Tropical Institute, Amsterdam, The Netherlands.
2 Project ‘Tuberculosis Prevention and Control in Kyiv City, Ukraine’, Kyiv, Ukraine.
3 WHO Pilot project office for TB control in Donetsk oblast, Ukraine.
4 Kyiv City TB department, Kyiv, Ukraine.
5 Donetsk Oblast Clinical Tuberculosis Hospital, Donetsk, Ukraine.
6 KNCV Tuberculosis Foundation, The Hague, The Netherlands.
7 WHO/EURO, TB Programme, Copenhagen.

*Corresponding author. Rijnbandijk 155, 4021 AH Maurik, The Netherlands. Tel: +31-344–689843. E-mail: Anna.Vassall{at}mottmac.nl

The period of economic transition has had severe consequences for health and health systems in Ukraine. The tuberculosis (TB) situation illustrates this. The strategy recommended by the World Health Organization (WHO) for TB, directly observed treatment short-course (DOTS), has the potential to provide real improvements in TB services, forming the basis of the response to the growing epidemic. In 2002, Ukraine, financially supported by USAID and the European Community (EC), began to introduce DOTS through pilot projects in Mariupol and Kyiv City. The aim of this study is to assess the feasibility, effectiveness, health service cost, patient cost, and the cost-effectiveness of these pilots, in order to inform the national scale-up of DOTS.

The study finds that DOTS is feasible and has the potential to be both effective and cost-effective in Ukraine. Following this study, Ukraine adopted DOTS as a national TB control strategy in 2005. However, the pilots also found that there are several evidence-related concerns and perverse economic incentives to both providers and patients that will need to be addressed if national scale-up is to be successful. These include concerns related to the treatment of MDR-TB, economic benefits to some patients to remain hospitalized, and payments to providers and health facilities that support current practices. These will need to be addressed if Ukraine is to develop an effective response to its emerging TB epidemic.

Key Words: Tuberculosis, DOTS, scale up, disincentives, MDR-TB

Accepted for publication 23 September 2008.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?




Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.