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Improving the health of the population in Romania by increasing TB control

Project financed by the Norwegian Grants 2009 - 2014, within the RO 19 - Public Health Initiative.

Eight laboratories in Romania began in April the rapid testing of the multidrug-resistant TB .
All counties were assigned for sending samples.

This month has started the MDR TB rapid testing in two TB reference laboratories (Bucharest and Cluj) and in the TB laboratories in Bacau, Brasov, Constanta, Craiova, Sibiu, Timisoara, all part of the National Programme for Prevention, Surveillance and Control of Tuberculosis. All counties were assigned and send samples to these laboratories, in order to ensure the patients access to modern diagnosis techniques. The eight laboratories perform rapid diagnosis of MDR/XDR TB, after being equipped with LPA and MGIT equipment and test kits, within the project.
So far, 707 people received rapid testing in the project.

A series of 8 GeneXpert rapid testing equipment and GeneXpert test kits will be purchased and installed in these eight laboratories. Equipment procurement contract was signed. As for the GeneXpert test kits procurement, the ANRMAP views were requested on the organization of a new procedure for selecting the supplier, because offers of companies participating in the project overcome the budget provided.


44 TB units in the country, being equipped for effective control of tuberculosis

A total of 44 protective hoods for laboratories and TB units, 10 LED microscopes, 3 Versatrek equipment and consumables, IT equipment, and 9 vehicles will be purchased to increase the capacity for effective control of TB in TB laboratories and units in Romania.
Currently, the technical specifications were developed for all these items and were made necessary papers and lists TB units which will be provided by the project.
Procurement procedures will be initiated in the next period. To buy microscopes, legal procedure for selecting the supplier will be released when the necessary funds become available. For Versatrek equipment, procurement procedure will be officially launched on specialized sites after the approval, by the Ministry of Health, of the unit investment list for 2015, and for the purchase of IT equipment and vehicles, the selection of suppliers will be launched after the receipt of the necessary funds and after the investments checklist approval by the Ministry of Health.

The laboratory personnel will also be trained in the TB infection control, and in April was completed the course curricula for training sessions.

The number of patients who receive continuous, complete and quality treatment through the project, increase.
Another 400 cases of MDR TB identified as eligible.

During April, 21 patients with MDR TB were enrolled in treatment, in addition to the 47 patients enrolled in March. Thus, at the end of April, 68 multidrug resistant TB patients were enrolled to receive continuous, complete and quality treatment.
The enrollment of patients in treatment is based on MDR TB commission decision, after examining the file of the patient and after the patient signs his consent sheet.
County coordinators have been identified for MDR TB (with responsibilities related to MDR TB case management, patient records transmission, including supervision by committee, supervision of medication orders for patients in the treatment of outpatient phase) and with their help was initiated the mapping of drug resistant tuberculosis patients who would be eligible to receive treatment through the project.
By the end of April, they collected information from Bucharest and 26 counties. The rest of the counties will transmit data until mid-May. After analyzing the database, experts have identified over 400 MDR TB patients potentially eligible to receive treatment in the project.


DOT and incentives for TB patients treated outpatients. 50 poor communities identified for providing support to prevent illness and increase treatment adherence

By the end of April, we collected information on 1,377 patients from Bucharest and 26 counties, diagnosed with resistant tuberculosis or with sensitive tuberculosis but who are at increased risk of mortality, treatment failure or abandonment, in order to centralize eligible cases to receive directly observed treatment (DOT) and support to increase adherence to treatment. The process continues and data are expected from all counties.
Meanwhile, the finalized the criteria for inclusion of patients in the project, and criteria for prioritizing cases. A patient is eligible to be enrolled, if he/she meets the following conditions: a. he/she is diagnosed with TB resistance (RR, MDR-TB, XDR-TB) or TB sensitive but has an increased risk of mortality, treatment failure or abandonment; b. he/she takes his drugs following the doctor’s recommendations; c. he/she takes anti-TB treatment as outpatient OR, he/she is at least at his/her second hospitalization by the time of his/her inclusion in the project.
The priority criteria to be enrolled in the project:
a. TB patients with MDR / XDR
b. patients with other chemoresistance
c. patients ‘chronic’ with retreatment
d. patients with retreatment due to abandonment or failure.

At the end of April, following the centralization of records of consent, a total of 218 patients will receive social support, which will be awarded in May.

Also in April, it was completed the identification of 50 poor communities where there will be provided integrated interventions to prevent transmission of tuberculosis and to increase treatment adherence. There were also identified the community workers who will work effectively with patients, after receiving training.


The World Health Organization (WHO) will provide technical assistance to the National Programme for Prevention, Surveillance and Control of Tuberculosis

In April, representatives of the Ministry of Health (operator of program), the Pulmonology Institute “Marius Nasta” (project promoter) and of the World Health Organization attended a working meeting with President of ANRMAP in order to identify legal solution, according to the GEO 34/2006, for directly contracting the WHO services of technical assistance for TB control. The project’s team will send an address to ANRMAP, specifying the relevant aspects for meeting the criteria for exception to GEO 34/2006, pursuant to Articles 14.a and c.


The training of healthcare workers starts. They will be able to provide information about tuberculosis to TB patients, vulnerable groups and the general population

The first tranche of funding was disbursed to the Norwegian partner LHL International Tuberculosis Foundation which coordinates the action to inform patients, vulnerable populations and the general public about tuberculosis. First, healthcare workers will be trained in order to be able to implement information campaigns. Their first training session will take place in the second half of May.


Coming soon, the project brochure

The activities to inform policy makers and the general public about the activities in the project continue. No 3 of the bilingual Newsletter was sent at the end of April and the project’s presentation brochure could be printed in May.

For receiving information about the control of TB in Romania, please subscribe to our Newsletter by entering your e-mail in dedicated field clicking the Subscribe button (in the right column).


Expenditure for the period 1 to 30 April 2015 are shown in the table below:

BUDGET LINE

Value of expenses

in M9

Human Resources

374,388.00

Travel Costs for the staff and volunteers

0.00

Consumables

1,889,186.92

Investigation Costs (under the upper limit established for each project)

0.00

Other costs related to the services supply to the beneficiaries

498,061.47

Project Communication and Promotion

0.00

Bilateral activities

0.00

Other subcontracted activities

330.90

Indirect Costs

11,598.44

Unexpected Costs

0.00

Total

2,773,565.73