TB Care in Ukraine: Understanding Access Barriers at the Primary Healthcare Level

Abstract Background In the WHO European Region, Ukraine is a high-priority country for TB control, being one of nine globally with high rates of multidrug-resistant TB. The WHO emphasizes patient-centered TB care, prioritizing patients as key figures in the care continuum. Thus, our aim was to explore barriers impacting the accessibility of TB services for patients at the primary healthcare level (PHC) in Ukraine. Methods During December 2022-June 2023, a qualitative study was conducted across eight PHC facilities in the Kyiv, Odesa, Mykolayiv, and Volyn regions. The study comprised: 4 focus groups involving 27 family doctors, 16 in-depth interviews with managers and health authorities from regional and national levels, as well as 25 interviews with TB patients. All data was transcribed, manually coded and deductively analyzed. Results All participants highlighted the benefits for patients of providing TB care continuum at the PHC level, yet the program lacks clear requirements for training of family doctors and nurses. Overall family doctors perceived positively various TB training they received; but despite this, they expressed doubts and reported a lack of practical skills, affecting the quality of care provided. Patients highlighted several barriers in interacting with healthcare providers, including stigma and cases of dismissive behavior of healthcare workers, communication challenges, and breaches of patientś data confidentiality. Patients also mentioned self-stigma, and perceptions of family doctors as poorly trained in TB. Still, patients who received healthcare services from the same family doctor “during long time” positively described their experience with TB services too. Conclusions Establishing robust patient-provider interaction at the PHC level can help overcome persistent barriers to TB care continuum in Ukraine. To achieve this, a comprehensive TB training program tailored for PHC family doctors and nurses should be developed and implemented. Key messages • Expanding TB healthcare services to primary healthcare levels in Ukraine can be beneficial for patients. Training primary healthcare staff can enhance TB care quality. • Establishing robust patient-provider interaction at the PHC level can help overcome persistent barriers to TB care continuum in Ukraine.