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RETROSPECTIVE ANALYSIS OF THE MAIN EPIDEMIOLOGICAL INDICATORS OF TUBERCULOSIS IN IVANO-FRANKIVSK REGION DURING 2011-2021

The diagnosis and treatment of tuberculosis have changed over the past few years. Tuberculosis remains the leading infectious cause of death worldwide, while drug-resistant tuberculosis poses a significant threat to the population. The epidemiological situation on tuberculosis in Ukraine has experienced stabilization of some indicators in recent decades. It remains, however, tense and predictably unfavorable as the indicators are continuously exceeding the epidemic threshold. 
The aim of the research: to analyze the epidemiological situation on tuberculosis in Ivano-Frankivsk region during 2011-2021. 
Materials and Methods. When writing this article, official sources, including the assessment of the indicators in Ukraine from the analytical and statistical reports of the Public Health Center of the Ministry of Health of Ukraine were analyzed and studied. We performed a retrospective cohort analysis. Data regarding the region were obtained from the annual reports of the Ivano-Frankivsk Regional Phthisiopulmonological Center of Ivano-Frankivsk Regional Council. 
Results. Despite the reduction in all key epidemiological indicators, the situation on tuberculosis in Ivano-Frankivsk region remains tense. During 2011-2021, the incidence of pulmonary tuberculosis (new cases + recurrent cases) gradually reduced by 59%. Tuberculosis mortality rate reduced from 10.9 cases per 100,000 population in 2011 to 3.3 cases per 100,000 population in 2021. We share the leading Ukrainian scientists’ opinion that the indicators of TB incidence exceed the epidemic threshold despite the reduced number of new cases. Considering the global Covid-19 pandemic and the martial law in Ukraine, one should not expect positive epidemiological changes in the next few years [3, 12, 13]. The identification of  destructive TB forms, indicating late diagnosis and more advanced disease stage, helps us to understand this situation. From 2016 to 2021, the incidence of destructive TB forms increased from 34.3% to 56.0% of all pulmonary TB cases, while the proportion of cavity formation was almost the same (24-27%) during 2011-2015. 
During 2011-2021, the incidence of tuberculosis among the rural population ranged from 2% to 20%, being higher as compared to urban residents. During 2011-2014, the incidence of tuberculosis and HIV/AIDS co-infection increased from 2.2 to 4.1 cases per 100,000 population, reducing to 1.0 case per 100,000 population by 2021. The incidence of extrapulmonary tuberculosis reduced from 5.4 to 2.7 cases per 100,000 population, possibly due to inadequate diagnosis, reforms, and the coronavirus infection. During 2014-2021, the incidence rate of tuberculosis among all the healthcare workers in Ukraine reduced from 6.7 to 1.47 cases per 10,000 healthcare workers. However, during 2014-2018, the indicators ranged from 6.7 to 5.6 cases per 10,000 healthcare workers. During 2013-2020, the incidence rate of newly diagnosed multidrug-resistant tuberculosis, including extensively drug-resistant tuberculosis, reduced by 177 cases, or from 260 to 49 patients. 
Conclusions. Over the past 10 years, there has been a slight reduction in the incidence of all active tuberculosis forms. However, they remain above the epidemic threshold, i.e., the tuberculosis epidemic has stabilized. Assessing the situation in our country, no positive changes in the tuberculosis epidemic in the coming years should be expected. The awareness of TB knowledge among all the population segments and control of TB situation during the period of healthcare reforms in Ukraine, according to which the anti-tuberculosis service is being reorganized, restructured, and reformed, are advisable.