Trainings for doctors and nurses in the area of tuberculosis

165 doctors and nurses from the pulmonology wards countrywide have attended training courses on tuberculosis epidemiology, rapid diagnostic methods for multidrug-resistant tuberculosis and the correct treatment, by the end of June 2015. Seven courses were organised in Timişoara, Sibiu, Ploieşti, Constanţa, Piteşti and Cluj, and 20 more training sessions shall be organized in other cities of the country by the end of the project.

The trainees had the chance to learn new things about the disease incidence and modern diagnosis, “information they don’t have access to in day to day medical activity”, as Dr Florin Sologiuc says, consultant at the Centre for Health Policies and Services Foundation, one of the organizations in charge with the training. One of the trainers, Doctor Marilena Crişan, specialized in paediatric tuberculosis, also stated that the added value of the trainings is given by the fact that they provide the doctors and nurses the opportunity to thoroughly discuss the news in the area of tuberculosis. “Although tuberculosis seems like a simple disease, it has been constantly surprising for more than 200 years. The trainings are very interesting because they are interactive, and the participants have access to the new technologies. We intend to discuss with the doctors about the cases and none of the training participants is marginalized; we want them to be engaged.”

The pulmonology network in Romania is made of more than 700 doctors and over 2000 nurses. A series of training courses on tuberculosis was organized during 2004 – 2014, especially within the projects funded by the Global Fund to Fight against HIV/AIDS, Tuberculosis and Malaria, but now, due to the increase of multidrug-resistant tuberculosis cases at global level and following the revision of the World Health Organization (WHO) guidelines on treatment and patient management, the training of the pulmonology doctors became a priority.

Project for the control of tuberculosis in Romania

On 8 August 2014, the “Marius Nasta” Institute of Pulmonology in Bucharest, in partnership with the Romanian Angel Appeal Foundation, the Centre for Health Policies and Services Foundation and the LHL International Tuberculosis Foundation in Norway began the implementation of the project “Improving the health status of the Romanian population through increased tuberculosis control”. The aim of this project is to strengthen the control of tuberculosis in Romania, focusing especially on multidrug-resistant and extensively resistant tuberculosis (MDR/XDR TB) and on poor and vulnerable groups.

“The importance of the implementation of this programme speaks for itself. Romania has the highest tuberculosis and multidrug-resistant tuberculosis incidence in the European Union. Approximately 10,000 patients are to be tested and 1,000 patients will be treated thanks to the Norwegian support in the fight against tuberculosis in Romania. This is an important step in the eradication of tuberculosis, both in this country and in Europe.” Tove Bruvik Westberg, Ambassador of the Kingdom of Norway to Romania.

With a total budget of over EUR 10 million, the project is financed in a proportion of 85% by the Norwegian Financial Mechanism 2009 – 2014, within the Public Health Initiatives Programme, the Programme Operator being the Ministry of Health. 15% of the project’s budget represents co-financing from the state budget.

“Tuberculosis is a public health priority for the Ministry of Health and for the Romanian Government. This is why the Ministry of Health has approved a series of measures for the improvement of the National Tuberculosis Prevention, Surveillance and Control Programme, the most important of which being the increase by over 50% of this year’s budget of the National Tuberculosis Control Programme and the approval of the Strategic Plan for the Control of Tuberculosis in Romania 2015-2020.” Suzana Matei, the manager of the Public Health Initiatives Programme, from the Ministry of Health.

The main activities included in the project concern the endowment of 8 laboratories with modern equipment for the rapid diagnosis of tuberculosis and multidrug-resistant tuberculosis, the continuous treatment with quality medication of a number of 1,000 patients with multidrug-resistant tuberculosis, the support of 2,500 patients during outpatient treatment, the update of the national database of the National Tuberculosis Control Programme, the purchase of 2,000 UV lamps to be provided to the TB units, the training of 960 doctors, nurses and administrative staff in the control of TB infection.

“We are hoping that through this project we will increase the treatment success rate, because we have one of the highest success rates for drug-susceptible tuberculosis, i.e. 85%, but this rate is very poor for multidrug-resistant tuberculosis.” Dr. Gilda Popescu, Technical Coordinator of the National Tuberculosis Control Programme.

Launching of the project “Improving the health status of the Romanian population through increased tuberculosis control”

On 12 February 2015 it took place the press conference for launching the project “Improving the health status of the Romanian population through increased tuberculosis control”.

The event took place in Bucharest, at Minerva Hotel.

The speakers were representatives of the Ministry of Health, the Embassy of the Kingdom of Norway and “Marius Nasta” Institute of Pulmonology, which highlighted the need of strengthening the TB control in Romania and the relevance of the project in the context of national and European efforts to fight this disease.

At the conference participated also representatives of the World Health Organization – the Romania Office, the Ministry of Public Finances, the Embassy of the United States of America, several institutions and non-governmental organizations active in the health area, as well as representatives of the mass media.

Modern MDR/XDR TB diagnosis equipment and second-line anti-TB drugs

The funds necessary for the implementation of the project “Îmbunătățirea stării de sănătate a populației din România, prin creșterea controlului tuberculozei” (The Improvement of the health of the Romanian population through enhanced tuberculosis control) for the period August-December 2014 have been transferred to the Romanian partners in November 2014, and, by the end of December 2014, 91% of these funds had already been spent for the purchase of medicines.

The implementation pace of this project is very rapid. The medicines for the treatment of patients with multidrug-resistant and extensively resistant tuberculosis are essential and we cannot cut any corners in terms of quality when the lives of patients are in our hands. We make efforts every day to find the best solutions to deliver the results promised in this project.” Silvia Asandi, Director of the Romanian Angel Appeal Foundation, project partner, in charge with medicine procurement.

In December 2014, the first batch of medicines for 200 of the 1000 patients who will be treated within the project had already been delivered, in parallel with the payment for a new batch of medicines that will ensure the treatment of 550 MDR/XDR TB patients.

Also in December, as a result of the fruitful collaboration between the Marius Nasta Institute and the RAA Foundation, the procurement procedures were launched for rapid diagnosis equipment and consumables (GeneXpert, MGIT and LPA).

So far, the assessment of the national database of the National Tuberculosis Control Programme has also been completed, and priorities have been established for the necessary changes, in line with the World Health Organisation recommendations.

An equally important step for the progress of the project is the identification by the Centre for Health Policies and Services (CPSS) of the vulnerable communities where activities are to be conducted for information-education-communication and for the detection of TB cases among the poor populations with limited access to health services. For these communities, the next step is to develop information programmes and materials concerning the transmission, prevention, TB symptoms and access to primary medical care.

The project is moving forward and – which is very reassuring – the rapid diagnosis and support services for the patients and affected community have already begun to be materialized, as a result of a successful partnership between the government sector and the civil society.

Tuberculosis in Romania

Each year, tuberculosis (TB) makes million of victims in the world, out of which a few tens of thousands only in Romania. And this in the context in which the general population only heard about the illness and tends to consider it an eradicated problem, an illness of the past century.

“Is still there tuberculosis in the 21^st century?”

Yes, there is, and at present it became a universal public health priority. The data of the World Health Organization of October 2014 shows that more than one third of the total world population is carrier of TB bacilli, and one in 10 carrier persons becomes sick. 9 million persons became sick only in 2013, while 1.5 million died, meaning almost 4109 deaths daily. At global level, it is estimated that in 2013, 480,000 people developed drug resistant tuberculosis (MDR TB).

Nonetheless, due to the sustained efforts for the rapid diagnostic and proper and directly observed treatment, at global level, the death rate caused by TB decreased with 45% between 1993 and 2013. About 37 million lives were saved between 2000 and 2013, due to early diagnostic and correct treatment. 86% of the people who developed TB and were under treatment in 2012 were successfully treated.

In Romania, the desease kills 1100 persons each year and affects other 16,000 yearly, most of them among the young and active population. Romania is the country of the European Union with the highest number of TB cases (about 20% of the TB patients in the EU are from Romania). Although the treatment success rate is about 86% at new cases, Romania has one of the lowest multidrug resistant TB curing rate in world, having an annual increase of the infectious patients pool.

Still, Romania is not an isolated case. The World Health Organization mentions, among the challenges in the area of tuberculosis control in the European Union, the need of reform in the health sector, which to include a higher engagement of the primary health care in TB control and a still limited political and financial engagement of the governments in TB control.