BREATHE

The Department of Clinical Infectious Diseases at the Research Center Borstel, in collaboration with V.N. Karazin Kharkiv National University, Danylo Halytsky Lviv National Medical University, Ivano-Frankivsk Medical University, and the National TB Program of the Public Health Center of the Ministry of Health, aims to strengthen graduate and postgraduate medical education and patient management in infectious diseases and respiratory medicine in Ukraine, with the option for additional Ukrainian institutions to join by mutual agreement.

This initiative responds to the urgent need for increased clinical expertise in Ukraine in the context of the ongoing public health crisis. By supporting the training of healthcare professionals on-site, it will make a lasting contribution to sustainable educational and clinical structures and improve quality of care. To ensure long-term impact, a Training of Trainers approach will be applied, enabling local experts to further disseminate knowledge within their institutions and beyond.

The project is structured into four work packages within the Hospital Partnership Programme. The first focuses on the continuation and expansion of an online lecture series to support the training of medical students and postgraduate professionals in infectious diseases and pulmonology, featuring international experts. The lecture series will be divided into two semesters, with 18 lectures on infectious diseases in the fall and 17 on respiratory medicine in the winter.

The second involves the establishment of a weekly international multidisciplinary videoconference consilium for the discussion of complex tuberculosis (TB) and non-tuberculous mycobacteria (NTM) cases from Ukraine. This will include experts from all institutions as well as the University Medical Center Hamburg-Eppendorf and the German Reference Centre for Mycobacterial Diseases in Borstel. These sessions will provide a platform for in-depth case discussions, including joint review of radiological and microbiological findings and the development of treatment recommendations. Telemedicine as a tool for exchange strengthens accessibility to expertise, improves patient outcomes, and extends consultation services to hospitals with lower capacities, enhancing regional healthcare coverage.

The third consists of an annual advanced clinical course in Ukraine for students and young physicians, combining theoretical instruction with interactive hands-on training. The course will be taught by colleagues from Ukraine and Germany, with the first year focusing on infectious diseases and the second on respiratory medicine.

Finally, five doctors from Ukraine will attend an international clinical TB course in Borstel each year, ensuring sustainable knowledge transfer and capacity building.

Through this collaboration, we aim to sustainably increase medical expertise, improve patient outcomes, and strengthen long-term cooperation between our institutions, ultimately contributing to the development and resilience of the Ukrainian healthcare system.

Brief description of the partner organization(s) in Germany

The Research Center Borstel, Leibniz Lung Center, is a leading biomedical research institution dedicated to the prevention, diagnosis, and treatment of infectious and non-infectious lung diseases. As a member of the Leibniz Association, the center integrates basic, translational, and clinical research with the aim of advancing innovation in respiratory medicine and improving public health. It combines research laboratories, preclinical facilities, and clinical units, creating a strong translational environment where discoveries can be rapidly transferred into clinical application.

The center employs about 500 staff members, including physicians, scientists, technicians, and administrative personnel, working in interdisciplinary teams across microbiology, immunology, epidemiology, and clinical medicine. This structure enables close collaboration between basic researchers and clinicians. The clinical division includes specialized outpatient clinics and inpatient units, ensuring high-level patient care and access to well-characterized patient cohorts for research.

Within this framework, the Department of Clinical Infectious Diseases plays a central role in linking patient care with translational research. The department specializes in TB and NTM infections but also covers a broad spectrum of infectious diseases relevant to respiratory medicine. Its expertise includes the management of drug-resistant and complex cases, research on novel drugs and diagnostics, treatment monitoring, and biomarker discovery. In addition, it conducts epidemiological studies and health systems research and is actively involved in the training of medical students, residents, and international fellows. Multidisciplinary teams of physicians, microbiologists, epidemiologists, and data scientists ensure a comprehensive approach, while collaborations with national reference centers, German university hospitals, and international partners further enhance impact.

The Research Center Borstel has extensive experience in acquiring and managing third-party funding from national and international donors. It has successfully coordinated and implemented projects funded by the German Federal Ministry of Education and Research (BMBF), the European Union (EU), the German Research Foundation (DFG), and the Leibniz Association. These range from large-scale clinical and translational consortia to investigator-driven projects. The Department of Clinical Infectious Diseases has coordinated and participated in numerous international collaborations and has previously received funding from the Hospital Partnerships programme. Projects with partners in Moldova and Namibia have focused on capacity-building in infectious diseases and respiratory medicine, strengthening local expertise and healthcare delivery. This track record demonstrates the department’s ability to manage complex, multi-partner initiatives, ensure accountability, and achieve sustainable impact.

Brief description of the partner organization(s) in Ukraine

The School of Medicine at V.N. Karazin Kharkiv National University is one of the oldest medical schools in Eastern Europe. It employs over 500 staff, including more than 300 doctoral-level scientists, and maintains an International Office, Grant Office, and agreements with regional hospitals to conduct clinical research. The Department of Infectious Diseases and Clinical Immunology hosts a specialized Phthisiatric (TB) Branch, where physician-scientists focus on molecular genetics, immune responses, novel diagnostics, and innovative management strategies.

Clinical and research activities are closely linked to the Communal Non-Profit Enterprise of the Kharkiv Regional Council “Regional Phthisiopulmonological Center”, a tertiary referral facility with 200 inpatient beds and two outpatient units. The Center manages the full spectrum of TB - including CNS, osteoarticular, pediatric, and palliative care - and collaborates with the National Health Service of Ukraine to provide multidisciplinary services.

The Danylo Halytsky Lviv National Medical University, founded in 1784, is one of the leading institutions in Western Ukraine, with strong expertise in medical education, clinical research, and translational science.

The Ivano-Frankivsk National Medical University is a major academic hub in the Carpathian region, with a focus on infectious diseases, public health, and integrating evidence-based approaches into training and practice. Their inclusion ensures national coordination of academic priorities and the representation of regional expertise.

The National TB Program of the Public Health Center of the Ministry of Health of Ukraine is also a key partner, providing leadership in TB control, alignment with national strategies, and contributing to dissemination and communication activities.

While we include leading medical universities as partners in the consortium, the structure remains deliberately flexible: other Ukrainian universities and research institutions are explicitly welcome to join the project, further strengthening reach, collaboration, and sustainability.

Brief description of the partnership

Since the beginning of the war, the Research Center Borstel has supported colleagues in Kharkiv and across Ukraine through educational, clinical, and humanitarian initiatives. Two online lecture series on infectious diseases and respiratory medicine were successfully implemented, featuring international experts and reaching a wide audience of students and healthcare professionals (PMID: 39557051). In 2024, a faculty member from V.N. Karazin Kharkiv National University participated as visiting professor at the DZIF clinical tuberculosis course in Borstel, demonstrating strong commitment to bilateral academic exchange. Beyond training, Borstel has donated medications, generators, and equipment to the Kharkiv Regional Phthisiopulmonological Center and Karazin University to stabilize patient care under crisis conditions. These efforts build on a longstanding scientific partnership, documented in numerous joint publications (e.g. PMID: 39959402, 38048026, 36853139, 33823271, 33762071, 37334103, 40023819, 40945720).

The partnership is structured as a collaborative network. Borstel provides expertise in infectious diseases, TB, NTM, and respiratory medicine as well as experience in coordinating international projects. V.N. Karazin Kharkiv National University and the Kharkiv Regional Phthisiopulmonological Center contribute knowledge of the local healthcare system, access to patients, and established teaching structures. Additional partners, including Danylo Halytsky Lviv National Medical University, Ivano-Frankivsk Medical University, and the National TB Program of the Public Health Center of the Ministry of Health, extend geographic and institutional reach, ensuring national dissemination and integration with health strategies. The consortium remains open, and further Ukrainian universities or research institutions are welcome to join by mutual agreement.

Responsibilities are shared: Borstel coordinates the lecture series and training in Germany, while Ukrainian partners lead on-site education, identify priority needs, and organize participation. The weekly case consilium and annual academies are joint efforts, with faculty from both sides co-teaching and co-moderating. Decision-making is transparent and participatory, with planning meetings held regularly via videoconference and work plans adjusted based on joint assessments.

Partners openly reflect on asymmetries in resources and infrastructure. To counterbalance these, the project emphasizes capacity building, Training of Trainers approaches, and leadership roles for Ukrainian colleagues, ensuring equitable participation, sustainability, and local ownership. Communication is maintained through weekly videoconferences, structured email exchanges, and secure data-sharing platforms. In-person visits during courses and workshops further strengthen trust and collaboration.

Through this cooperative structure, the partnership combines complementary strengths, ensures inclusive decision-making, and provides a framework for sustainable improvements in education, clinical care, and institutional resilience.

The Department of Clinical Infectious Diseases at the Research Center Borstel and the partner institutions in Ukraine recognize the urgent need to strengthen medical training and patient management in infectious diseases and respiratory medicine in Ukraine. The ongoing war has disrupted the treatment of TB and other infections, damaged healthcare facilities, displaced personnel, and placed an additional burden on an already strained system. A critical shortage of infectious disease specialists and pulmonologists, particularly in war-affected regions, further exacerbates the situation.

This collaboration brings together Borstel’s expertise in TB, NTM infections, and respiratory medicine with the Ukrainian partner institutions’ knowledge of local healthcare challenges and direct access to students and professionals. The primary goal is to contribute to rebuilding Ukraine’s healthcare system by improving medical education, optimizing patient management, ensuring sustainable knowledge transfer, and fostering long-term institutional collaboration.

The project directly aligns with the National Strategy on HIV/AIDS, TB, and Viral Hepatitis Response until 2030, endorsed by the Ministry of Health, which emphasizes reducing morbidity, disability, and mortality and strengthening public health systems. By focusing on TB and respiratory infections, the project also addresses MoH priority areas highlighted in cooperation with WHO and the EU, including combating communicable diseases, antimicrobial resistance, and strengthening resilience of health services. In addition, it supports the Ukrainian Healthcare System Reform Strategy, which aims to establish a capable hospital network, integrate evidence-based medicine, and enhance postgraduate training.

A cornerstone of the project is the Training of Trainers approach, enabling Ukrainian professionals to become educators and multipliers within their institutions. This supports the creation of sustainable structures and helps partner universities develop into regional knowledge hubs. By collaborating with hospitals with lower capacities, especially in war-affected regions, the project strengthens equitable access to expertise and supports the Ministry of Health’s vision of reducing regional disparities.

Ethical, sociocultural, and legal aspects are integral to the design. All training follows internationally recognized Good Clinical Practice and national guidelines. The involvement of the National TB Program of the Public Health Center ensures compliance with standards and integration into ongoing reforms. Training is offered in English and Ukrainian, with translation to ensure accessibility. Gender balance and inclusivity will be emphasized, with targeted efforts to include women and younger professionals in leadership roles. Patient privacy and data protection are safeguarded, with anonymization in line with Ukrainian and EU legislation.

Telemedicine will be used for case discussions and remote consultations. These addresses barriers caused by conflict and displacement, enabling professionals in resource-limited areas to access expertise while supporting the Ministry of Health’s long-term strategy of digital health integration.

Several challenges may limit universal access. Continued attacks may disrupt services and reduce participation in on-site training; therefore, activities can be relocated to western Ukraine or delivered online. Unequal distribution of resources between urban and rural areas will be mitigated through the Training of Trainers model and regional dissemination of expertise. Language barriers are addressed through professional translation and bilingual materials. Shortages of personnel due to displacement or military service will be managed through flexible scheduling in close coordination with Ukrainian institutions.

The initiative primarily targets medical students, postgraduate trainees, and physicians in infectious diseases, pulmonology, and microbiology. Indirectly, it benefits vulnerable patient populations, including internally displaced persons, TB and NTM patients, and individuals with chronic respiratory diseases. By strengthening education, introducing diagnostic innovations, and supporting clinical expertise, the project reduces inequities and improves resilience in Ukraine’s healthcare system.

In summary, the project directly responds to national strategies and Ministry of Health’s priorities. It aligns with healthcare reform goals, promotes ethical and inclusive practices, integrates telemedicine, and addresses barriers to universal access. Through its focus on education, sustainability, and equitable participation, the initiative makes a meaningful contribution to rebuilding and strengthening Ukraine’s healthcare system during and beyond the current crisis. 

Relevance of the project (Why?)

The needs addressed by this project have been jointly defined by the Department of Clinical Infectious Diseases at the Research Center Borstel and our Ukrainian partners at V.N. Karazin Kharkiv National University, the Kharkiv Regional Phthisiopulmonological Center, Danylo Halytsky Lviv National Medical University, Ivano-Frankivsk Medical University, and the National TB Program of the Public Health Center of the Ministry of Health. All partners agree that strengthening medical education and patient management in infectious diseases and respiratory medicine is an urgent and strategic priority in Ukraine.

Ukraine faces one of the highest TB burdens in the WHO European region, with an estimated incidence of 112 per 100,000 population in 2023. Approximately 31% of new TB cases and 46% of previously treated cases are multidrug- or rifampicin-resistant (MDR/RR-TB), among the highest proportions worldwide and. Ukraine is therefore included in the WHO global list of high-burden countries for MDR/RR-TB. Mortality remains high, with nearly 3,000 TB-related deaths annually. Beyond TB, respiratory diseases such as COPD and asthma are widespread, and respiratory infections remain a leading cause of morbidity. The war has further aggravated this situation by destroying healthcare facilities, displacing medical personnel, and disrupting supply chains for diagnostics and medications. In Ukraine and other conflict-affected regions, patient access to specialized care is severely limited.

The consequences of this high burden are severe: untreated or poorly managed TB contributes to prolonged transmission, treatment failure, disability due to post-TB lung disease, and premature death. Patients with MDR/RR-TB face especially poor outcomes, with treatment success rates below 60%. Vulnerable populations are disproportionately affected, including internally displaced persons, people living with HIV, individuals with low socio-economic status, and those residing in rural or conflict-affected areas with limited access to specialized care. Children and the elderly are at increased risk of severe disease and poor outcomes. Women often face delayed access to diagnosis and treatment due to sociocultural and caregiving responsibilities.

To address these challenges, Ukrainian partners have emphasized three main needs:

• Capacity building in medical education – There is a shortage of infectious disease specialists and pulmonologists, compounded by the displacement of healthcare workers. Structured pre- and postgraduate training is required to rebuild and expand expertise.
• Improved clinical decision-making capacity – Complex TB and NTM cases require multidisciplinary expertise that is not always available locally. Telemedicine-based consultations and joint case discussions have been identified as promising approaches.
• Sustainable knowledge transfer – Training of Trainers programs are needed to enable Ukrainian physicians to become multipliers of knowledge, creating local hubs of expertise and supporting hospitals with lower capacities.

These priorities build on the partners’ joint experiences with online lecture series, case-based consultations, and exchange visits, which have demonstrated feasibility and strong demand.

The project explicitly embodies the “Leave-no-one-behind” principle by addressing the needs of individuals facing multiple barriers to healthcare. Telemedicine ensures that physicians and patients in rural and conflict-affected areas can access expertise otherwise unavailable locally. Training activities are provided in both Ukrainian and English, with simultaneous interpretation to reduce language-related barriers. Gender equity is prioritized in the selection of participants, ensuring the inclusion of women and younger professionals in leadership roles. Special consideration will be given to clinicians serving vulnerable groups such as internally displaced persons, people living with HIV, and socio-economically disadvantaged patients. The intersectional approach acknowledges that individuals may face multiple overlapping forms of disadvantage - for example, a displaced elderly woman with chronic lung disease living in a rural area - and seeks to strengthen healthcare responses to these realities.

In summary, Ukraine faces an urgent need to strengthen infectious disease and respiratory care in the context of high TB incidence, widespread drug resistance, and severe war-related disruptions. This project addresses these needs by focusing on sustainable capacity building, improved clinical decision-making, and equitable access to expertise. By prioritizing vulnerable and marginalized populations and applying an intersectional lens, the initiative directly contributes to reducing health inequalities and strengthening resilience in Ukraine’s healthcare system.

Target group (Who will benefit?)

The project directly addresses one of the most pressing public health challenges in Ukraine: the disruption of infectious disease and respiratory care in the context of war. TB, including drug-resistant forms, remains a major burden, and respiratory diseases are highly prevalent. The war has further strained the system by damaging hospitals, displacing healthcare professionals, and limiting access to specialized care. In this context, there is an acute shortage of infectious disease specialists and pulmonologists, particularly in conflict-affected regions such as Ukraine. The project therefore responds to a highly relevant and urgent problem of the local population by strengthening medical expertise, ensuring continuity of care, and contributing to the resilience of the healthcare system.

The direct target group of the project are medical students, postgraduate trainees, and physicians in infectious diseases, pulmonology, and microbiology. They will benefit from structured education through online lecture series, weekly case-based consilia, and in-person academy courses. By providing both theoretical knowledge and practical training, the project enhances their diagnostic and therapeutic competencies. Additionally, selected Ukrainian physicians will participate in international training courses in Germany, gaining exposure to advanced clinical and laboratory practices and bringing this knowledge back to their institutions. Through the Training of Trainers approach, participants are empowered to act as multipliers, disseminating knowledge within their own institutions and thereby amplifying the project’s impact.

The indirect target group consists of patients and the wider Ukrainian population. Improved clinical knowledge and decision-making among healthcare providers will lead to better diagnosis and management of TB, non-NTM infections, and other respiratory diseases. This directly improves patient outcomes, reduces transmission, and strengthens trust in the healthcare system. Vulnerable groups such as internally displaced persons, children, and individuals with chronic respiratory conditions stand to benefit in particular, as they are disproportionately affected by disrupted healthcare services and barriers to accessing specialized care.

The project also pays special attention to diverse and vulnerable populations. Training activities are designed to be inclusive and accessible: lectures and course materials are provided in Ukrainian, simultaneous interpretation is available during academies, and telemedicine platforms ensure that physicians in rural or conflict-affected regions can participate without leaving their workplaces. Gender balance and inclusivity are emphasized in participant selection, with efforts made to encourage the participation of women, young professionals, and underrepresented groups in leadership roles. By prioritizing equitable access and ensuring that knowledge reaches hospitals with lower capacities, the project helps to reduce structural inequalities in healthcare provision.

In summary, the project addresses a highly relevant local health challenge by targeting both the immediate needs of healthcare professionals and the long-term needs of patients. Through a focus on inclusivity, sustainability, and vulnerable groups, it ensures that the benefits extend well beyond the direct participants, strengthening the resilience of the Ukrainian healthcare system as a whole.

What shall the project achieve and how?

Overall Objective

The overall objective of this partnership is to strengthen medical education and clinical expertise in infectious diseases and respiratory medicine, with a particular focus on TB and NTM infections. Through a structured pre- and postgraduate educational framework, the project aims to expand the knowledge base of physicians and healthcare professionals, foster cross-border collaboration, and improve clinical decision-making capacity. A cornerstone is the Training of Trainers approach, enabling local experts to act as multipliers of knowledge within their institutions and beyond, thereby contributing to sustainable capacity building and resilience of the Ukrainian healthcare system.

This objective will be achieved through a combination of online lecture series, case-based clinical discussions, and in-person training programs, integrating both theoretical education and practical skills.

Reporting

Progress will be documented continuously through attendance records, case logs, surveys, and evaluation forms. Interim reports will be submitted biannually, and a final report will be provided within two months after project completion, in line with program requirements.

Project plan: Main activities

Long-term perspective & sustainability

The sustainability of the project is ensured through its strong focus on education, capacity building, and institutional development, which extend beyond the immediate funding period. By training both students and practicing physicians in infectious diseases and respiratory medicine, the project strengthens human resources for health at multiple levels. The Training of Trainers approach is central to securing long-term impact: Ukrainian physicians and faculty members are equipped not only with knowledge and skills but also with pedagogical tools to pass them on within their institutions. This creates a multiplier effect, embedding expertise in local structures and enabling continuous dissemination of knowledge beyond the project’s direct participants.

At the institutional level, the project supports partner universities and clinical centers in developing into knowledge hubs that can serve as reference institutions for hospitals with lower capacities. Through integration of modern teaching formats (online lectures, telemedicine case discussions, blended learning), the project optimizes existing educational processes and aligns them with international standards of evidence-based medicine and good clinical practice. These structural improvements strengthen Ukraine’s medical education system and healthcare delivery in a sustainable way, contributing to the Ministry of Health’s long-term reform agenda.

Social sustainability is fostered through inclusivity and equity. The project explicitly addresses structural inequalities by ensuring equal access to training for women, younger professionals, and healthcare workers from resource-limited or conflict-affected regions. Translation services, bilingual teaching, and telemedicine platforms reduce barriers related to language, geography, and security, ensuring that participants from diverse backgrounds can benefit equally. Economically, the use of digital platforms for lectures and consultations reduces costs per participant, enhances scalability, and allows continuation with modest resources after the funding period. Environmentally, reliance on virtual teaching formats and teleconsultations minimizes the need for frequent travel, reducing the ecological footprint of the collaboration.

Long-term sustainability is further supported by institutional partnerships. The integration of the Ukrainian National TB Program and regional medical universities ensures alignment with national strategies and facilitates institutional ownership. After the funding phase, core elements of the project—such as the online lecture series and weekly consilia—can be maintained at low cost through existing digital infrastructures and voluntary faculty contributions, supported by modest institutional budgets. For larger in-person training activities, co-funding from Ukrainian universities, professional societies, and international organizations (e.g. WHO, EU public health programs) will be sought.

In addition, partners will continue to work closely together in clinical care and research. Further academic and scientific collaborations are already being planned, and joint efforts to secure corresponding international funding will ensure continuity and expansion of activities.

In sum, the project secures sustainability by embedding expertise in local institutions, fostering inclusive structures, leveraging digital solutions, and ensuring institutional alignment with national healthcare reforms. By addressing structural inequalities, ensuring local ownership, and expanding clinical and academic cooperation, the partnership lays the groundwork for durable improvements in education, patient care, and healthcare resilience in Ukraine.

Possible risks and challenges

The implementation of the project may face several risks and challenges that require proactive strategies.

One limitation is the variability in prior knowledge among participants, which could affect the effectiveness of training activities. To mitigate this, the curriculum will be designed with both introductory and advanced components, ensuring that students and healthcare professionals with different levels of expertise benefit without feeling excluded or overburdened.

Political and infrastructural instability in Ukraine represents a major risk, potentially disrupting in-person activities and restricting travel. To address this, the project will remain flexible, with contingency plans for remote delivery. Should local conditions not allow on-site implementation, courses will be relocated to safer regions of Ukraine or neighboring countries. This approach minimizes interruptions while adhering to the “Do-no-Harm” principle by avoiding exposure of participants to unsafe environments.

Language barriers are another potential challenge, as not all participants have the same level of English proficiency. To ensure equitable access, all lecture slides will be translated into Ukrainian, simultaneous interpretation will be provided during academy courses, and bilingual physicians will facilitate smooth communication in weekly consilia. This safeguards inclusivity and prevents unequal participation. Resource limitations in crisis-affected settings could hinder sustainability once external support ends. To counter this, the project prioritizes capacity building through a Training of Trainers approach, enabling local faculty to independently continue teaching after the project period. This ensures long-term benefits while reducing dependency on external partners.

Finally, unintended effects, such as overburdening local staff during times of high clinical workload, will be carefully avoided by aligning training schedules with institutional priorities and ensuring flexibility in participation. Continuous feedback mechanisms with Ukrainian partners will help identify and address unintended negative consequences at an early stage.

By anticipating these challenges and integrating mitigation strategies, the project minimizes risks, ensures resilience, and upholds the “Do-no-Harm” principle, while striving for sustainable capacity building and equitable access to education.