Features of the BPaL triage routine practice algorithm in Bit-TB regions of Ukraine

<bold>Background:</bold> Currently, there is much information about the implementation of the BPaL triage algorithm under OR conditions and limited in routine practice. <bold>Design/Methods:</bold> BPaL implementation started in Ukraine in Feb 2023 in routine practice. Study analyzed the BPaL/M triage algorithm's application across Lvivska, Odeska, Kharkivska, and Cherkaska regions, supported by the Bit-TB Project (USAID), in 412 patients (80.6% male; 37.7% below 40 years). A majority were unemployed, with 17% having HIV, 41.4% experiencing severe immunosuppression (CD4 less than 200 cells), and 97.1% on ART. BMI categorization showed 22.8% under 16, 36.9% between 16.1-18.5, and 40.3% over 18.5. Extrapulmonary and generalized tuberculosis was identified in 4.8%, and 9.7% had prior treatment with first or second-line ATDs (linezolid, bedaquiline and delamanid - in 2.9, 2.7 and 0.2%). <bold>Results:</bold> Following the WHO's short-term regimen algorithm, BPaL/M were initiated in 55.4% and 28.4% of MDR-TB and pre-MDR-TB patients and additionally in 13.6% of RifTB patients without fDST and in 2.6% of patients with RiskMDR-TB. BPaL/M were changed to another treatment regimen in 28.1% of patients. The reasons for that were as follows: absence of pretomanid during treatment - in 25%, SAE - in 0.5%, resistance to linezolid/bedaquiline - in 0.2%, refusal of treatment - in 1.2%, other reasons - in 1.2% of patients. <bold>Conclusions:</bold> a large part of the cohort consisted of patients with a normal BMI, without HIV infection, and a significant part of patients did not have fDST. Some patients were not prescribed BРaL/M according to inclusion criteria and for a significant part of patients BPaL/M were changed to another regimen during treatment.