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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.

Strengthening the capacity of the National Programme for TB Control to control the TB epidemic

In March 2016, the testing activity using rapid techniques for diagnosing TB MDR / XDR took place in 20 laboratories of the NPPSCT network: Bucharest, Cluj-Napoca, Bacau, Brasov, Constanta, Craiova, Sibiu, Timisoara, Iasi, Baia Mare, Leordeni, St. Stefan Hospital Bucharest, Leamna, Calarasi, Galati, Targoviste, Drajna, Deva, Focsani and Targu Mures.

This month, 3108 patients were tested in labs within the project. Of these, 700 were diagnosed with sensitive TB and 64 with MDR TB. In March no pacient was detected with extensively drug resistant TB patients (XDR TB).

In total, since the beginning of the project, 21 296 patients participated in rapid testing, of which 5163 were diagnosed with sensitive TB, 463 with MDR TB and 13 TB with extensive drug resistant TB (XDR).

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

GeneXpert equipment were purchased, installed and commissioned in TB laboratories nominated by NPPSCT. All 8 laboratories equipped in the project continued GeneXpert TB diagnostic work: Cluj-Napoca, Iasi, Constanta, Craiova, Timisoara, Brasov, Leordeni, and Baia Mare.

This month, another order for kits was submitted to the GeneXpert supplier contracted within the project, to be used in all 8 laboratories equipped with GeneXpert equipment to diagnose MDR TB.

Regarding the acquisition of the safety cabinets for laboratories, the centralized procurement procedure was finalized and the supply contract had been signed.

Versatrek supplies were purchased. The first orders were shipped to the 14 TB laboratories nominated by NPPSCT: Cluj-Napoca, Bucharest laboratories at St. Stephen TB Hospital Bucharest, Iasi, Craiova, Leamna, Bacau, Calarasi, Galati , Targoviste, Drajna, Deva, Focsani and Targu Mures.

Regarding the purchase of IT equipment, the centralized procurement procedure was completed. Supply contracts were signed for 15 laptop computers, 300 desktop computers, printer, scanner, copier. Of all, there were received 15 laptop computers and 25 desktop computers for PNF units in Bucharest. The reception and delivery of the remaining computers procured under the project has been scheduled for next month.

Ensuring the correct, complete and quality treatment of the patients with MDR / XDR TB

In March 2016, the enrollment in two MDR TB centers in Bucharest and Bisericani resumed, and it will be extended across the country starting from April 2016. At the end of March, a total of 336 patients were enrolled in the treatment completely, accurately and continuously.

Also in March, there were four monitoring visits in Galati, Neamt, Iasi and Bacau counties.

Regarding the provision of integrated interventions to prevent TB transmission in poor communities and to increase treatment adherence, three monitoring visits were organized in Botosani, Piatra Neamt and Giurgiu, during which food coupons were distributed for patients enrolled in treatment within the project.

The team continued the work on the gathering, verification and centralization of consents signed by patients who will receive treatment under direct observation (DOT). This month, 18 IEC caravans were organized in 6 counties: 4 in Botosani, 12 in Gorj, 16 in Calarasi, 9 in Neamt, 6 in Giurgiu and 6 in Dolj. A total of 879 people attended these sessions. Until now, within the project, 979 people were informed and other 53 IEC caravans were planned for April-June 2016 period: 4 in Botosani, 12 in Gorj, 16 in Calarasi, 9 in Neamt, 6 in Giurgiu and 6 in Dolj.

In total, at the end of this reporting period, 231 patients were enrolled for DOT, of which 10 Roma ethnics.

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

In March 2016, of the total number of 1946 patients considered eligible to be enrolled in the project, 732 had signed consent sheets up to February 10th. Between February 11th – March 31st, 2016, 11 patients sent their consent sheets.

In the project, a total of 642 unique patients received social support (vouchers) to maintain adherence to treatment, status confirmed by the treating doctors and MDR coordinators. Of all patients who received social support, 77 declared themselves Roma. Between May 2015 and February 2016, vouchers were distributed to 4513 patients. At the end of March, of the 172 patients enrolled in the first month of the project, 77 successfully completed the treatment (44.76%), 11 died (6.39%), 2 were declared to abandon the treatment (2.77% ) and 73 patients are still in treatment and are adherents since April (42.44%).

In March, a joint event has been organized by „Marius Nasta” Institute and it was attended by county TB coordinators, physicians working with laboratories, and 40 coordinating MDR TB doctors.

Other activities carried out in March 2016

Weekly training in TB infection control were organized, attended by participants from Marius Nasta Institute.
The documentation related to distribution of UV lamps in TB units and the documentation for the reception committee of the UV lamps were prepared.
The organization of technical assistance mission started, aiming to review strategic documents developed for the laboratories and the bacteriology laboratories in Romania reorganization plan. The mission is scheduled in early May 2016.
Between 9th and 12th of March, the fourth training for health communication was organized in Oradea.
The work on the draft of the brochure for patients with tuberculosis continued, and also the preparation training for outreach workers.
The second press conference of the project was organized.