Dear Colleague Letters
Uniting for Ukraine Program
June 21, 2022
The Uniting for Ukraine Program
This letter provides an overview of the tuberculosis screening requirements for Ukrainian parolees entering the United States through the Department of Homeland Security (DHS) Uniting for Ukraine Program (the Program), Uniting for Ukraine | Homeland Security (dhs.gov). The Program is a pathway for Ukrainian citizens and their immediate family members who are outside the United States to come to the United States and stay temporarily in a two-year period of parole. Ukrainians participating in the Program must meet specific requirements, including a health attestation for tuberculosis screening.
Vaccination and Tuberculosis Requirements under the Program
The Ukrainian parolees must meet health requirements under DHS rules that were developed in consultation with the Centers for Disease Control and Prevention (CDC). The applicants for parole are instructed to seek medical care and to record the completion of health requirements for vaccinations and tuberculosis testing by submitting a Uniting for Ukraine Vaccine Attestation Form, Uniting for Ukraine Vaccine Attestation | USCIS. The requirement for tuberculosis testing with an interferon-gamma release assay (IGRA) must be met within 2 weeks of entry.
Ukrainian parolees may be referred to health departments for an IGRA test. If the health department cannot provide this test, please refer them to other resources. A tuberculin skin test will not be accepted in place of an IGRA. DHS is collecting attestations online but is not requesting IGRA reports or other health records; the applicants are instructed to retain these records. CDC’s Electronic Disease Notification System, EDN, does not have information about the Ukrainian parolees because they have not undergone the overseas immigration medical examination. The health requirements under the Program are not the same as the Civil Surgeons Medical History and Physical Examination for the adjustment of status, Civil Surgeons Instructions.
Funding for Tuberculosis Testing and Other Health Services
CDC will be receiving funding for addressing some of the costs stemming from the Program, and part of those funds are specifically for tuberculosis needs including laboratory services. CDC’s Division of Tuberculosis Elimination (DTBE) and the Office of Grant Services (OGS) are determining the fastest, most flexible funding mechanisms for helping to meet the needs at state and big city health departments. We will send you further information and instructions when the mechanisms have been made final.
Ukrainian parolees may be eligible for federally funded health coverage programs such as Medicaid and Refugee Medical Assistance (RMA), Benefits for Ukrainian Humanitarian Parolees. The Office of Refugee Resettlement (ORR) in the Administration for Children and Families funds State Refugee Health Coordinators to oversee the domestic medical screening recommended by CDC, Domestic Medical Examination. This screening program varies in services, funding, and structure across states; however, tuberculosis testing may be a component of the domestic medical screenings. Valid documentation of IGRA tuberculosis testing completed to meet the DHS 2-week attestation requirement can be used for the domestic medical screening and prevent unnecessary retesting. We encourage you to reach out to the State Refugee Health Coordinator in your state, ORR Key State Contacts, to collaborate on tuberculosis screening services.
CDC is not collecting data from the attestations or the IGRA results. We encourage you to collect information about tuberculosis testing and screening, consistent with your routine systems for refugee health, surveillance, and program management.
Ukrainians who Entered the United States Before the Uniting for Ukraine Program
Ukrainians who were paroled into the United States before the Program or who were in the United States already under various visas presently do not have to meet health requirements such as TB testing. However, some may be eligible for federally funded health benefits and services.
Tuberculosis in Ukraine
Ukraine has a high incidence of tuberculosis compared to the United States, and multidrug resistance has been highlighted by the World Health Organization, WHO information note. The European Centre for Disease Prevention and Control has alerted its member nations about infectious diseases including tuberculosis in Ukraine, ecdc TECHNICAL REPORT.
Information About Tuberculosis for Ukrainians
Patient educational materials that have been translated into Ukrainian can be found on a CDC website, Uniting for Ukraine: Information for TB Programs. The materials are free and can be downloaded.
CDC will share additional information based on future developments. Please check frequently with your refugee health colleagues for their updates. Contact your CDC DTBE Tuberculosis Cooperative Agreement Project Officer with questions.
Terence Chorba, MD, DSc, LLM, MPH, MPA, FACP, FIDSA
Chief, Field Services Branch, Division of Tuberculosis Elimination
National Center for HIV, Viral Hepatitis, STD, and TB Prevention