Epidemiological Situation Regarding Drug-Resistant Tuberculosis in the Ternopil Region of Ukraine

The WHO notes that Ukraine is among the ten countries that account for about 70 % of the global gap between the estimated global number of people developing drug-resistant tuberculosis (DR-TB) each year (cases of DR-TB) and the total number of people starting treatment in 2022. Accordingly, WHO recommends that significant progress be made in closing this gap by improving coverage of drug resistance testing and improving access to treatment. Objective — to analyse the epidemiological situation regarding DR-TB in the Ternopil region and in Ukraine and to compare the data obtained before the coronavirus disease-2019 (COVID-19) pandemic, during the lockdown, and during the full-scale military operations in Ukraine. Materials and methods. A retrospective analysis of statistical indicators on the epidemiological situation of DR-TB in the Ternopil region for 2015—2024 was conducted. The materials of the analytical and statistical reference books «Tuberculosis in Ukraine» (2015—2024) were used to compare the epidemiological indicators of DR-TB. The incidence of DR-TB in the Ternopil region and in Ukraine, both in newly diagnosed patients and patients with recurrent disease, was studied. The analysis conditionally compared the indicators before the COVID-19 pandemic, during the lockdown, and in 2022—2024, when military operations began in Ukraine. The dynamics of the incidence of DR-TB by gender and age were analysed. The social structure of patients with DR-TB was considered. Since 2022, groups of military personnel and internally displaced persons have been added. Results and discussion. A retrospective analysis of statistical indicators on the epidemiological situation of DR-TB in the Ternopil region in comparison with the indicators for Ukraine for 2015—2024 was carried out. In the Ternopil region, in particular during the COVID-19 epidemic, it was found that in 2020—2021 the number of patients diagnosed with DR-TB significantly decreased compared to 2018—1019 (from 7 and 5.7 per 100,000 people to 3.3 and 3.7 per 100,000 people). The largest number of destructive forms of pulmonary tuberculosis with drug resistance was recorded in 2021 (72.9 %), which is most likely due to COVID-19 quarantine restrictions and the inability to seek medical help in a timely manner. During the period of full-scale hostilities, the incidence of DR-TB in the Ternopil region increased from 3.7 per 100,000 population in 2021 to 4.6 per 100,000 population in 2022. Starting in 2022, due to the full-scale hostilities, military person­nel and internally displaced persons were registered with DR-TB in the Ternopil region. Their number increased during 2022—2024: military personnel — from 4.3 to 9.3 % and internally displaced persons — from 6.4 to 7.5 %. This situation was caused by overcrowding, deteriorating sanitary conditions, forced displace­ment, mental overload, stressful situations, and financial difficulties. The rates of deaths from DR-TB within the first year of follow-up were quite high in the Ternopil region. The highest percentage of deaths was observed in 2022 (47.5 %) and 2024 (57.1 %). Conclusions. The epidemiological situation regarding tuberculosis during the war remains tense. The COVID-19 pandemic and hostilities in Ukraine have significantly affected the dynamics of indicators. A significant number of patients with bacterial shedding and destructive forms indicate late detection of tuberculosis. In such circumstances, general practitioners, family doctors, and specialist physicians should pay special attention to the timely detection and prevention of tuberculosis.