As in South Africa, there is a shortage of diagnostic technology in Ukraine, Zignol explained, and the lack of testing makes accurate prevalence estimates of MDR-TB difficult. The TB burden is most likely underestimated in both countries.
After analyzing the data, Zignol's group found that 15.5 percent of new TB cases circulating in the community were MDR-TB, one of the highest rates ever reported in a population study.
They also found that HIV infection was a significant predictor of MDR-TB. A history of incarceration and previous TB treatment were also independent risk factors. The mortality rate was also much higher in HIV-infected patients.
A main implication of the study is the need to improve preventive procedures, especially in prisons and hospitals, he concluded.
Zignol and his colleagues plan to submit their report to the Ukraine government with recommendations for changes in public health policy to improve infection control. For example, TB patients tend to be hospitalized in Ukraine for a long time, which exposes them and others to additional infection.
Zignol is "quite optimistic" that the government will be making some changes.
