Analysis of the impact of crises tuberculosis incidence in Ukraine amid pandemics and war.

Ukraine has a historically high burden of tuberculosis (TB). As a result of many years of the healthcare system's reformation, the epidemiological situation has improved. However, under the influence of the COVID-19 pandemic and the illegal invasion by Russia, fluctuations in incidence occur. Through a retrospective, observational analysis using data from the Public Health Center of the Ministry of Health of Ukraine, this study tracked the incidence of TB and multidrug-resistant tuberculosis (MDR TB) and highlights changes caused by crises. The region that maintained a consistently high level of TB and MDR TB throughout the entire study period was Southeastern Ukraine. Data analysis showed a significantly increased TB incidence in Central Ukraine in 2022-2023 (62.75 per 100,000 population) versus 36.55 per 100,000 population in the 2013-2019 period. In Eastern Ukraine, TB incidence decreased markedly (14.95 per 100,000 population) after the beginning of the war in 2022 compared with the pre-COVID-19 pandemic 2013-2019 period (50.36 per 100,000 population). These results indicate a changing pattern of TB incidence throughout Ukraine during the conflict, with lower rates in conflict-affected areas and higher rates in host regions. This reflects the importance of strengthening TB surveillance and control strategies adapted to areas experiencing population influx.