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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.

Ensuring the correct, complete and quality treatment of the patients with multidrug resistant and extensively resistant tuberculosis (MDR / XDR TB)

In April 2016, the enrollment of patients for treatment continued in MDR centers in Bucharest and across the country. At the end of April, a total of 460 patients were enrolled in complete, accurate and continuous treatment.
Between 29th of March and 1st of April, four monitoring visits took place in the counties of Galati, Neamt, Iasi and Bacau in order to discuss cases of MDR TB, assessments of enrollment and verification of the laboratories equipment and supplies for rapid diagnostic.
Another monitoring visit was organized on April 26 at Leordeni to check the progress of rapid diagnostic testing equipment and discuss MDR TB cases in the county.

Providing integrated interventions to prevent transmission of TB in poor communities and to increase treatment adherence

The team continued the work on the gathering, verification and centralization of consents signed by patients who were already enrolled and those enrolled in April and updated lists of patients who are given treatment under direct observation (DOT) in the six counties involved in the project.
For the period July to September 2016, 55 information-education-communication (IEC) caravans were planned in counties of Botosani, Gorj, Calarasi, Neamt, Giurgiu and Dolj. In the caravans organized by the end of April, 4458 people in the communities were informed regarding TB.
A total of 320 patients were enrolled to receive DOT, of which 17 Roma.
By the end of April, social vouchers worthing 26.650 lei were distributed to a total of 2,665 patients and other 520 food coupons worthing 5,200 lei were being distributed.

Establishing a network of laboratories for early detection of MDR / XDR TB

In April, the testing by rapid techniques for diagnosing MDR / XDR TB took place in 20 laboratories in the NPPSCT network: NRL Bucharest, NRL Cluj-Napoca, TB laboratories in Bacau, Brasov, Constanta, Craiova, Sibiu, Timisoara, Iasi, Baia Mare, Leordeni, St. Stefan Hospital Bucharest, Leamna, Calarasi, Galati, Targoviste, Drajna, Deva, Tg. Mures and Focsani.
In April 2016, through the rapid testing methods, 3124 patients have been tested, of which 529 were detected with sensitive TB and 31 with MDR TB. In total, between March 2015 and April 2016 in the laboratories of network NPPSCT 24 726 rapid tests were carried out, with the following results: 5871 patients were diagnosed with TB, 522 with MDR TB and 23 with XDR TB.
Up to 31st of March, 2016 a total of eight laboratories were provided with the GeneXpert equipment within the project: Cluj-Napoca, Iasi, Constanta, Craiova, Timisoara, Brasov, Leordeni, and Baia Mare. For the extended period of the implementation of the project (April 1st, 2016 – March 31st, 2017) further equipment shall be purchased: 2 GeneXpert, 1 MGIT equipment and 6 centrifuges, for which centralized procurement procedure will be organized. Also, to ensure continuity of rapid testing in TB laboratories, another 2896 LPA tests and 5.600 MGIT tests will be purchased.
In the project, 28600 GeneXpert tests were procured for nine TB laboratories: Cluj-Napoca, Bucharest, Iasi, Constanta, Craiova, Timisoara, Brasov, Leordeni and Baia Mare and 44 safety cabinets will be delivered to the laboratories.
Versatrek supplies were purchased and necessary kits were delivered to those 14 TB laboratories nominated by NPPSCT: NRL Cluj-Napoca, NRL Bucharest, laboratories TB Hospital at St. Stefan Hospital Bucharest, Iasi, Craiova, Leamna, Bacau, Calarasi, Galati, Targoviste Drajna, Deva, Focsani and Targu Mures.

Providing directly observed treatment (DOT) and incentives for TB patients treated in ambulatory in order to increase adherence to treatment

One year after the start of granting social vouchers, the situation is as follows: 682 unique patients were enrolled in the project to increase adherence to treatment and approximately 50% of them receive food coupons since the first month of enrollment. About 18% of all patients enrolled, 120 patients, were declared cured or complete treatment.

Other activities carried out in April 2016

The project implementation team has organized weekly training in TB infection control with participants from Marius Nasta Institute.
Assessment mission of the National TB Control Program was prepared, as well as the mission for reviewing the strategic documents developed for the laboratories, and the reorganization plan for bacteriology laboratories in Romania.
In terms of providing information about TB to the patients, vulnerable groups and the general population, the main activities undertaken in April were the completion of the leaflet, organizing a workshop to pretest the brochure for patients (9 -10 of April, 2016) and training outreach workers (11-12 of April, 2016), attended by 32 participants.