Implement the project „Emergency People-centered MDR-TB Response-2” in the context of the emergency response to the Ukraine crisis in Poland (EPC-MDR-Response-2)
and produce the technical documents for strengthening TB care in Poland
Tuberculosis in Poland
Before COVID-19 (5 years = 2015 – 2019), Poland had a decline of TB incidence by an average of -6% per year and in 2019 reached a TB incidence of 15 / 100 000 population; this qualifies the country as a closed to [low burden country]. However, due to: (a) the absolute number of annually emerging new TB cases (5 700 cases in 2019) and (b) bordering with high MDR-TB burden countries (Belarus and Ukraine), WHO/Europe and Poland are considering including the country in the list of the [High Priority Countries to EndTB by 2030 in the WHO European Region] = [HPC@Europe]. As the COVID-19 pandemic disrupted the core health care service delivery continuity, in 2020 vs. 2019, TB detection decreased by 36% (3 388 vs. 5 321), which is high above the regional average (23% under detection). This is the equivalent of every third emerged new TB patient not being detected or about 1 800 newly emerged TB patients.
TB notification rate incidence in Poland in 2020 was 3,388 cases or 8.89 per 100,000 population. Patients aged 45-64 constituted the highest percentage of all tuberculosis patients (44.4%). The notification rate incidence of tuberculosis in men in Poland was three times higher than in women, while in 2020, non-national foreigners accounted for 3.4% of all tuberculosis patients in Poland (116 people).
The majority of Polish patients have drug-susceptible TB (DS-TB). In Poland, multidrug-resistant TB (MDR-TB) was diagnosed in 2020 in 38 patients, including 15 foreigners.
In 2020, as in the previous years, HIV/TB coinfection was rare in Poland. Tuberculosis was an AIDS indicator disease in 5 HIV-infected people.
The National Tuberculosis Register in Poland collects data on tuberculosis cases. Tuberculosis case notification is mandatory, and doctors must notify them within the first 24 hours of a suspected or confirmed TB case to the State Poviat Sanitary and Epidemiological Station. The National Health Fund (for people with insurance) or the state budget (for uninsured patients) finances the treatment of people with TB infection.
Tuberculosis in Ukraine
TB incidence in Ukraine is around 32,000 cases, or 73 per 100,000 populations (2020), significantly higher than in Poland. TB notification in Ukraine in 2020 was 19,521 cases, and a significant share of patients remain undiagnosed. 33% of patients with pulmonary TB in Ukraine had RR-TB, which is almost 30 times higher than in Poland.
On 24 February 2022, more than 6.9 million people fled Ukraine due to the military conflict seeking safety, protection, and assistance from other countries such as Poland. As of 12 September 2022, more than 1.37 million Ukrainian refugees officially registered in Poland, but the total number is around 2 million. Ukraine has one of the highest burdens in Europe of HIV and tuberculosis.
Actions undertaken by Polish MoH, WHO, and other partners
From the very beginning of the humanitarian crisis, the Ministry of Health of the Republic of Poland adopted an active attitude and undertook quick and efficient actions. MoH appointed the Institute of Tuberculosis and Lung Diseases in Warsaw to become a coordination entity for all the stakeholders involved in the country’s TB response. In addition, MoH issued Regulations „On the pilot program of an outpatient treatment of multi-drug resistant tuberculosis,” which is the legal basis and the main normative document for the introduction of WHO-recommended approaches of TB care for the Ukrainian refugees with TB in Poland, and in general. WHO supported MoH with the donation of TB drugs and equipment for active case finding, provided technical assistance for the development and introduction of video- supported TB treatment in outpatient mode, and for setting up the system for clinical decision-making in complex cases.
APW Project objectives
- Strengthening active case finding for TB with the use of modern digital technologies and artificial intelligence (AI) and developing national guidelines for active case finding (ACF)
- Establishing the National TB Concilium, carry out capacity building and regular meetings and ensuring its initialization and proper functioning to support Polish TB specialists
- Supporting and coordinating VST development and deployment in Poland and developing the National requirements on VST technical solution