The impact of the war in Ukraine on the prevalence of multidrug-resistant tuberculosis in Poland: an epidemiological overview and overview of countermeasures implemented.

Aim: The aim of this study was to evaluate the influence of the war in Ukraine on prevalence of tuberculosis (TB) and drug-resistant TB (DR -TB) in Poland. Background: Before 2022 Poland was on the way towards TB pre-elimination stage showing decreasing TB incidence from 18 to 10 per 100,000 between 2016-2021. Since beginning of war more than 8 million individual refugees, from Ukraine have been recorded across Europe, of which 1.5 million remained in Poland. Methods: Data recorded in national TB registry on MDR/RR-TB case notification was analyzed during January-September of 2020, 2021 and 2022. Results: In 2022 a total of 2,900 TB cases were notified, of which 72 had MDR/RR-TB, which is three times higher for MDR/RR-TB than in 2020 (21) and twice higher than in 2021 (35). Most of diagnosed MDR/RR-TB cases in 2022 had foreign origin with 75% from Ukraine. The National Institute of TB and Lung Diseases in cooperation with WHO and MSF had launched a joint comprehensive project “MDR-TB Emergency People-centered response in Poland” that is focused on ensuring of quality and free of charge diagnosis, treatment of MDR-TB at outpatient settings and introduction of digital adherence solutions (video-supported treatment), scaling up screening of TB among population at high risk for TB. Conclusion: Only due to war in Ukraine, neighboring countries including Poland may register higher number of cases with DR-TB. There is a need to ensure universal and free of charge and stigma prevention, diagnosis, treatment and care for TB and MDR/RR-TB using the outpatient and people-centered models of service delivery.