Integrated transportation modelfor uninterrupted access to TB and HIV diagnosis, treatment, and monitoring in Ukraine

BACKGROUND: In many regions of Ukraine, inefficient or nonexistent specimen transportation systems have caused delays in access TB and HIV diagnostics, treatment, and patient monitoring. The COVID-19 pandemic worsened this situation, as regions had to prioritize services to combat the COVID-19 pandemic, leaving TB and or HIV patients, particularly in remote areas, with limited access to services.
DESCRIPTION: To ensure regular and uninterrupted access to HIV and TB diagnosis, treatment, and monitoring, the USAID-funded Support TB Control Efforts in Ukraine Project (STBCEU) established a transportation model in project-supported regions in Ukraine. The transportation system delivers specimens for TB and HIV diagnosis and treatment monitoring, COVID-19 testing, and others, and also transports TB and ART drugs when required. Established mainly to improve TB diagnostics, the system has adapted to work across disease areas, including HIV. The model was first introduced in Cherkaska oblast in June 2020, and now is functional in ten project-supported regions.
LESSONS LEARNED: From June 2020 through December 2021, 12,273 smear samples were delivered for TB diagnosis and 15,934 samples for treatment monitoring. As a result, 2,117 patients were diagnosed with bacteriologically confirmed TB (17% of all bacteriologically confirmed cases in 12 regions during this period), including 655 patients with DR-TB. In addition to TB samples, the transportation system delivered 30,644 biological samples (15,936 HIV, 3,965 hepatitis B, C, and other opportunistic diseases) for diagnostics and monitoring. The system also delivered TB and ART drugs to 1,500 clients every month. Two regions established local funding to sustain transportation system activities based on positive implementation results.
CONCLUSIONS: The successful pilot of an integrated transportation system for biological samples and medications by STBCEU has helped maintain continuity of TB and HIV diagnosis and treatment services. Based on these outcomes, STBCEU presented the model to national partners, and the National TB Program (NTP) plans to adopt and replicate the integrated transportation system using a Global Fund grant starting in 2022, using guidance and SOPs developed by STBCEU for country-wide implementation. The next step will be a cost-effectiveness study of the system to advocate for more sustainable funding.

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