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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.

Training on multiple levels for strengthening the capacity of TB control

During September, trainings for the members of the Technical Assistance and Management Unit of the National Programme for Prevention, Surveillance and Control of Tuberculosis as well as for the pulmonologists, local trainers and other healthcare professionals in the country, have been organized in order to strengthen the capacity of Tuberculosis control.
The training for the Technical Assistance and Management Unit of the PNSPCT included sessions such as: introduction to project management and project planning, financial management principles, principles of financial management and procurement through GDF mechanism, monitoring and evaluation. The training was attended by 10 members of the Technical Assistance Unit and Management of the PNPSCT.

Three specialized courses for pulmonologists were organized, as follows: from 18 to 20 September, in Arad and Deva, and from 22 to 27 September, in Oradea. The course organized in Deva was performed including a monitoring visit.
The courses were attended by 75 doctors, so that total number of trained physicians trained so far in the project is 289.

Also during September, Training of Trainers (TOT) for local trainers and workshops for health communication for healthcare professionals in 4 counties (Neamt, Iasi and Botosani Braila) were organized. The training was attended by 23 people.

The work for the organization of the second National Meeting of the MDR Coordinators also started in September.

Preparation of poor communities to prevent TB transmission and to increase adherence to treatment of patients with tuberculosis

In September, the training courses for the trainers who will deliver training on education and prevention in poor communities in Romania have been prepared.
Two experts were employed to provide Training of Trainers (TOT) sessions; documents where collected for 12 local officers (six community nurses and six TB experts) of 6 counties (Botosani, Neamt, Gorj, Dolj, Calarasi and Giurgiu) who will attend the course.
The TOT course will take place on 2 and 3 October in Bucharest.

Testing of TB patients in order to detect MDR TB rapid, continued in September

1430 new patients across the country were screened for resistant TB during September, in the following laboratories of PNPSCT network equipped with appropriate equipment and supplies: NRL Bucharest, NRL Cluj, TB laboratories from Bacau, Brasov, Constanta, Craiova, Sibiu and Timisoara. Out of the tested patients, 60 were found TB resistant, while 21 of them were diagnosed with MDR TB.

From March to September, since the rapid testing activity actually started, 8093 patients across the country were screened free of charge. 504 patients were detected with resistance to TB drugs, of which 192 with MDR TB and 4 with XDR TB.

New MDR TB patients enrolled for correct, complete and quality treatment

In September, 50 more patients with MDR TB were enrolled in treatment, and in total, since the beginning of the project, 259 patients with MDR TB have been enrolled.
During September, 7 of MDR coordinators who have responsibility to identify new patients, sent to the project team updated databases of patients diagnosed with MDR-TB / XDR, registered in the period May to September 2015.
In parallel, the project team continued to follow-up correspondence with GDF and IDA in order to fill the information dossier submitted by UNIFARM to NMA, for issuing the authorization of special needs for the next batches of drugs. Also the samples for testing the quality of medicines (received in July) have been finalized by the National Institute of Pharmaceutical Chemistry Research and Development.
At the end of the month, the Bedaquilin (one of the anti-tuberculosis drugs necessary for treating patients with XDR TB) was delivered to UNIFARM.

Incentives for maintaining treatment adherence of patients treated in ambulatory

In September, out of the total of 1761 patients considered eligible to be enrolled in the project, 558 signed consent forms until 10th of August, and between August 11 to September 30, 15 new patients sumitted the consent sheets. Currently, 572 patients are enrolled in the project in order to receive incentives, meaning 38% of the 1500 planned.

Regarding the patients eligible to receive social support for anti-TB treatment adherence throughout the month of August, the following information has been centralized: 514 patients received so far social support in order to maintain adherence to treatment; cumulatively, from May to September, social vouchers were distributed to a total of 1678 patients (172 in April, 250 in May, 362 in June, 426 in July and 468 in August). Out of the 172 patients who received support for April, 80% (138 patients) received social vouchers for maintaining adherence during all five mentioned months.

Developing a functional network of laboratories in the country, for better TB control – in progress

In September, the acquisition contract was signed with the company declared the winner of the selection procedure for the procurement of 8 GeneXpert equipment. The procedure regarding the procurement of laboratory testing kits, is in progress through the GDF mechanism.
In order to purchase the 44 safety cabinets for laboratories, in September the legal procedure for centralized procurement has been launched; the date for opening of tenders is 16 October 2015.
Regarding the procurement of 10 LED laboratory microscopes, the supplier selection procedure is in the phase of evaluation of tenders; the winning company will be named in the near future.
The legal procedure for selecting the supplier of vehicles was completed. The vehicles will be delivered by 20th of October.

Regarding the procurement of 3 Versatrek equipment and necessary laboratory supplies, the legal procedures for the selection of suppliers are underway, the time for opening bids is October 3 (for Versatrek equipment) and November 12 (for testing kits).
Regarding the procurement of IT equipment, the documents relating to the selection procedure of suppliers is in the evaluation phase at ANRMAP.

Also during September:
It was signed by the World Health Organization, the contract concerning the provision of technical assistance from WHO to the National Programme for Tuberculosis Prevention, Surveillance and Control. The contract was sent for review and signing to Marius Nasta Pulmonology Institute.

Expenditures for the period 1 to 30 September 2015 are shown in the table below: