Optimising tuberculosis care for refugees affected by armed conflicts

Globally, tuberculosis remains a leading cause of death from an infectious disease. 1 2022's theme for World TB Day, on March 24, is “Invest to End TB. Save Lives”. Tuberculosis control requires a pragmatic, tailored, multipronged approach to diagnose and treat all people with tuberculosis disease (drug-susceptible, drug-resistant, multidrug-resistant, and extensively drug-resistant tuberculosis) and latent tuberculosis infection, to prevent transmission, and to mitigate the risk of drug resistance. The COVID-19 pandemic has disrupted health services and derailed already overburdened tuberculosis control programmes worldwide, including in eastern Europe, substantially setting back progress 1 towards achieving the UN Sustainable Development Goal (SDG) and End TB targets. 2 The invasion of Ukraine by Russia, and the ongoing armed conflict, is having hugely damaging effects on health services, health infrastructure, and personnel, and further diminishes hope of achieving End TB targets for eastern Europe—now a seemingly insurmountable task. Although incidence rates of tuberculosis in Ukraine have gradually decreased over the past decade, Ukraine features in the WHO list of 20 countries with the highest estimated number of people with incident drug-resistant tuberculosis and it has one of the highest rates of HIV–tuberculosis co-infection and latent multidrug-resistant tuberculosis infection in Europe. 1 Drug-resistant tuberculosis is difficult to diagnose, expensive to treat, requires long-term treatment, has high mortality, and requires careful follow-up to monitor adverse drug side-effects and ensure a cure.