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Republic of Moldova continues anti-tuberculosis treatment of Ukrainian refugees

“We were awakened at night by explosions. They continued in the morning. There was smoke and military equipment in the street. We understood that the war had begun. It was scary.”

Hanna, an 18-year-old student from Ukraine, is one of 3 tuberculosis (TB) patients who fled to the Republic of Moldova after the Russian invasion of Ukraine in February 2022. A month earlier, Hanna had received her TB diagnosis.

“I never thought I would catch this disease because I had never heard of it before,” she says. “However, my family decided that it was important for me to continue my treatment under normal conditions, so 2 days after the outbreak of the war, I spoke to my doctor and told him that I was going to Republic of Moldova.”

Her doctor in Odessa discharged her and gave her tuberculosis medication for a month, allowing Hanna to cross the border without interruption of her treatment. She agreed to contact the non-governmental organization SMIT as soon as she arrived in the country. SMIT would act as an intermediary platform between Hanna’s doctor in Ukraine and the national tuberculosis program in Moldova.

Continuity of treatment

At this stage, the joint national TB/HIV technical working group had already met to identify measures to ensure continuity of HIV and TB treatment, testing and diagnosis among Ukrainian refugees. The Ministry of Health of the Republic of Moldova has agreed to continue providing supervision and medical assistance to refugees suffering from tuberculosis or other illnesses.

In this context, a referral mechanism for TB and HIV patients has been created between countries. Dr Valentina Vilc, head of the national TB program in the Republic of Moldova, says the fact that refugees can take TB drugs with them until they reach services in the country is a huge advantage.

“All patients arrived with records, including detailed descriptions of the disease, examination data and prescribed treatment,” she explains. “Here, patients are examined and continue their treatment on an outpatient basis. If the person needs hospital treatment, he will be hospitalized at the Institute of Phthisiopulmonology “Chiril Draganiuc”.

A patient-centered approach

The day after her arrival in the Republic of Moldova, Hanna was indeed referred to the Institute of Phthisiopneumology, which is the main tertiary health center for tuberculosis and lung diseases in the Republic of Moldova. “I was thoroughly examined, had an X-ray and had all the tests – blood, urine, sputum,” she recalls.

“For now, I am continuing the treatment on an outpatient basis, then I will be examined again. I am in constant contact with the doctors.

In the meantime, Dr. Vilc points out that any humanitarian crisis is a risk factor for the spread of TB, and not just in one country. She explains that stopping treatment for drug-susceptible TB can lead to the development of drug-resistant TB (DR-TB). If this happens, she warns, the disease will return in an even worse form and will be very difficult, if not impossible, to cure if treatment for drug-resistant TB is then discontinued.

“When patients are stressed and overloaded, priorities change and there is a high risk that they will stop their treatment. In this case, latent TB infection can progress to active TB, which can quickly become drug resistant. This is why it is necessary to provide support based on the patient’s needs and to respond to the problems that are critical and vital for him.

To this end, asylum seekers with active tuberculosis are assisted by refugee organizations to find accommodation in the country upon arrival. Their treatment can be organized remotely through video observation, and they can then continue treatment for TB and drug-resistant TB, including modified shorter treatment regimens. They are followed according to identical treatment protocols in the Republic of Moldova and Ukraine.

“Difficult does not mean impossible”

More than 50 tuberculosis patients are expected to arrive in the Republic of Moldova from Ukraine in the first month alone, according to preliminary WHO estimates. Dr Vilc says the national TB program has sufficient buffer stocks of drugs to treat both TB and drug-resistant TB patients. In addition, information on TB and HIV symptoms, as well as contact details for local institutions and organizations, are placed in visible places in the refugee centres.

“TB is a treatable disease,” emphasizes Dr. Vilc. “You can heal completely, but you have to take the opportunity to do so. If you give up, you won’t feel better, and everyone you know will suffer with you. The treatment is long, difficult and not always pleasant, but difficult does not mean impossible.

For Hanna, the important thing now is to finish her treatment and go home. She misses her family in Ukraine, but she understands how crucial it is not to interrupt her TB treatment under any circumstances.

“I thank everyone for their help and support. The main thing for me is that everyone is alive. Above all, I want this whole nightmare to end quickly and to return home to my family and friends.