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.
Project financed by the Norwegian Grants 2009 - 2014, within the RO 19 - Public Health Initiative.
Increase of the NPTPSC network capacity for TB control
Objective: ensuring the quality, effective, cost-efficient and evidence based management.
Results:
– Ensuring the procurement management
– Ensuring the financial management on interventions, activities and partners
– Ensuring risk analysis and the implementation of avoidance, counteracting and diminishing the risk
– Ensuring the programatic management, including M&E visits
– Ensuring monthly and periodical reportings
– Ensuring the sustainability of the protect through lobby and advocacy activities, in order to integrate and take forward the project’s activities and ensuring their funding from governmental resources
Measuring the project’s impact, as well as the aggregation of the information gathered in TB control from different funding sources, in order to avoid the duplication of the met targets
Increase the capacity of the Technical Assistance and Management Unit (TAMU) of NTPSCP
Objective: ensuring quality, effective, cost-efficient and evidence based management, through the training of the TAMU team
Results:
– 4 training sessions in the area of medicines procurement from the Global Drug Facility of the WHO/StopTB partnership and the management of the distribution chain, financial management, monitoring, evaluation and reporting to the TAMU
– Monthly meetings to analyse and plan the project activities
– Operational support for the TAMU team available
Updating the national electronic system for the TB data collection
Objective: updating the national electronic system for the TB data collection
Results:
– 100% of the national data base is updated
– Additionally to ensuring the activity sustainability were foreseen also maintenance activities for the national data collection system, as well as the development of a e-learning platform which contains training modules for the network (sustainability ensured also for WP 4)
Increase of the NTPSCP network capacity for TB control
Objective: increase the capacity of the National Tuberculosis Prevention, Surveillance and Control Programme (NTPSCP) network at national level in the area of TB and MDR TB case management as major step in gaining optimal control of the MDR TB threat.
Results:
– 687 doctor and nurses working the NTPSCPnetwork were trained in the management of TB and MDR TB case
Capacity consolidation for early diagnostic of the MDR TV cases and improvement of detection with quality methods. Establishment of a functional laboratory network for the early detection of MDR/XDR TB.
Objective: Implementation of the diagnostic techniques in Romania in order to ensure the access to rapid diagnostic methods, with positive impact on the success rate of the treatment and ensuring the decrease of the transmission pool.
Results:
– 52 936 persons benefitted of rapid testing for TB, MDR TB and XDR TB, out of which 12 233 were diagnosed with TB, respectively 1 043 at least with R resistance (950 with MDR TB, 148 pre-XDR and 45 with XDR TB)
– 10 regional laboratory and national reference laboratories are operation for the rapid diagnostic of TB/MDR-TB/XDR-TB. Additionally, 10 county laboratories are functional for rapid TB diagnostic.
Providing quality, complete and continuous treatment for 1 000 patients with MDR/XDR TB
Objective: enrolment of the patients with MDR/XDR TB in continuous, correct and correct treatment according to the recommendations of the World Health Organization
Results:
– 880 patients with MDR/XDR TB enrolled until 24.02.2017
Provision of integrated community support interventions for TB preventions in poor communities and the improvement of treatment adherence of the TB cases. Ensuring the directly observed treatment and the incentives for the TB patients treated in ambulatory, in order to increase the treatment adherence
Objective: ensuring treatment adherence for the patients with TB and MDR/XDR TB
Results:
– 2976 patients with TB and MDR/XDR TB received up to now interventions of increasing the treatment adherence
– 309 community nurses and Roma mediators trained in TB
– 10 899 persons received information regarding TB
Advertising and communication
Objective: promotion of the project results
Results:
– The visual identity of the project was developed
– Up to now, a press conference was organized
– Up to now, 9 newsletter were developed
-The brochure of the project was developed, printed and distributed
– Information about the stage of the project implementation were disseminated online
– Internet and Facebook pages of the project were developed and updated
Establishment of a basic infrastructure for the TB infection control in TB facilities and staff training
Objective: improvement of the TB infection control in the TB facilities in Romania
Results:
– 2 000 UV lamps were procured
– 1014 employees of the TB facilities (doctors, nurses, administrative staff) were trained in TB Infection Control (TBIC)
NPPSCT national database update
In December, the Services Agreement for the update and maintenance of the national database for the National Tuberculosis Prevention, Surveillance and Control Programme (NPPSCT) was monitored with regard to the modules that require amendments in accordance with the international requirements and recommendations in the field. The reviews covered the nomenclatures including physicians who provide services in the TB surveillance network, updated medicines lists, genetical laboratory tests available, user manuals, testing scenarios for the functionalities of each type of user. 80% of the national database has been updated.
The provision of continuous, complete and quality treatment for 1 000 patients with multidrug-resistant or extensively drug-resistant tuberculosis (MDR/XDR TB)
In December, the enrolment of patients continued both in the 2 MDR TB centres in Bucharest and Bisericani, as well as in the rest of the country, which resulted in 809 patients enrolled under complete, correct and continuous treatment in the project at the end of the month.
Monitoring visits continued in the dispensaries, laboratories and hospitals in the counties of Arad, Prahova, Brăila, Timiș, Teleorman, Olt, Mureș and Constanța.
The provision of integrated interventions for the prevention of TB transmission in poor communities and for the increase of treatment adherence
In December, 14 caravans were organized for the information and education of the public with regard to tuberculosis: 8 in Bacău County and 6 in Olt County. These caravans were attended by 717 persons, of whom 97 Roma. So far, a total of 10 673 persons have received information under the project, among them 1 575 Roma. The IEC caravans for January were planned.
By the end of December, 1 820 gift vouchers had been distributed to community nurses and sanitary mediators who organized IEC caravans between January and November. Also, 17 235 social vouchers had been distributed to patients. At the end of this month, a remaining 266 social vouchers were still being distributed to patients.
For the provision of DOT, a total of 908 individual patients were enrolled, of whom 141 Roma. 58 patients were enrolled in December. The DOT provision activity involved 304 DOT supporters who monitored patients from 8 counties and to whom 15 960 gift vouchers were distributed in the period January-November.
The establishment of a network of functional laboratories for the early detection of MDR/XDR TB
In December, testing using rapid diagnostic techniques for MDR/XDR TB was conducted in 20 laboratories in the NPPSCT network: NRL Bucharest, NRL Cluj-Napoca, the TB laboratories in Bacău, Brașov, Constanța, Craiova, Sibiu, Timișoara, Iași, Baia Mare, Leordeni, Sf. Ștefan hospital in Bucharest, Leamna, Călărași, Galați, Târgoviște, Drajna, Deva, Tg. Mureș and Focșani.
The summarized data related to the rapid testing carried out in the TB laboratories under the project during this month show that, out of the tested patients, 446 were diagnosed with sensitive tuberculosis and 21 with multidrug-resistant tuberculosis.
The data summarized since the commencement of the project show that 29 233 patients were tested in the laboratories referred to above using rapid diagnostic techniques, and 11 530 of them were detected with TB, 899 with MDR TB and 91 with XDR TB. The centralised procurement for the two Genexpert systems, the MGIT equipment and the six laboratory centrifuges established to be procured during the project extension period was completed in December, and the equipment has been accepted and installed in the TB laboratories.
Also in December, the documents were drafted and the procurement procedure was launched for a LPA laboratory equipment. Also, in order to ensure the continuity of the rapid testing activity in the TB laboratories, another 5 500 MGIT tests (5 000 cultures, 500 first line ABG) were procured and distributed to the TB laboratories in December 2016.
The procurement of two IT servers required for the administration of the national registration, monitoring and reporting of TB/MDR-TB cases has been provided for, to take place in the project implementation extension period (1 April 2016 – 31 March 2017). In December, the procurement procedure for the two servers was concluded and the supply contract was signed.
The provision of directly observed treatment and of the incentives for the TB patients treated in outpatient facilities in order to increase treatment adherence
At the end of December, the database comprised 2 078 patients enrolled both for treatment adherence and for treatment, and 1 653 patients enrolled for treatment adherence. Of these, 1 331 met the eligibility conditions to receive social vouchers for the increase of treatment adherence. Of these, 396 patients have been enrolled and have been provided with support under the project for approximately one year, 783 patients continue the treatment, while 311 patients have completed the treatment.
Other activities carried out in December
Three TB Infection Control training sessions were organised in the country, in the counties of Călărași and Iași.
Activities continued for the review of the Practical Approach to Lung Diseases national guide, which will establish the algorithm for the identification of TB suspects in the general population, the specialist referrals, the involvement of the primary care network in tuberculosis care in Romania.
In December, the patient brochure was finalised and the organisation of the peer-support volunteer network continued.
The promoter organised a press conference on 21 December to launch the information material (the brochure) for TB patients.
The provision of continuous, complete and quality treatment for 1 000 patients with MDR/XDR TB
In November, the enrolment of patients continued in the two MDR TB centres in Bucharest and Bisericani, as well as in the other TB facilities in the country involved in the project. As such, a total number of 774 patients were enrolled under complete, correct and continuous project at the end of the month.
Also, monitoring visits continued at the dispensaries, laboratories and hospitals in the counties of Prahova, Brăila, Timiș, Mehedinți, Sibiu and Mureș. These visits included the verification of the rapid testing registers, of laboratory equipment and of patient treatment records, and recommendations were made concerning the submission of the cases to the MDR committees for analysis. Monitoring visits will continue.
In the first part of November, the medicines for MDR/XDR patients were imported. In accordance with the recommendations of the National Agency for Medicines and Medical Devices (ANMDM) included in the special needs authorisation, samples were collected for the quality testing of medicines originating from outside the EU.
The provision of integrated interventions for the prevention of TB transmission in poor communities and for the increase of treatment adherence
The lists of patients under DOT in the 6 counties where this project component is implemented have been updated, and the IEC caravans for the month of December 2016 have been planned. A monitoring visit was organised at the community worker training session in Bacău County.
20 caravans were organised in November: 2 in Călărași County, 4 in Giurgiu County, 5 in Bacău County and 9 in Olt County. 1 101 persons attended these caravans, of whom 82 Roma. So far, IEC caravans organised under the project provided information to 9 896 persons, among whom 1 478 Roma.
By the end of November, 1 620 gift vouchers had been distributed to community nurses and sanitary mediators who organised the IEC caravans between January and October 2016.
109 patients were enrolled in November 2016 for the provision of DOT. In total, since the commencement of the project, 825 patients have been enrolled for DOT, among them 116 Roma. This activity involved 281 DOT supporters, and patients were enrolled from 242 localities.
By the end of November 2016, 15 542 social vouchers had been distributed to patients, with 152 such vouchers still to be distributed. Also, 13 940 gift vouchers had been distributed to DOT supporters who monitored patients in the 7 counties between January and October 2016.
The establishment of a network of functional laboratories for the early detection of MDR/XDR TB
In November, testing using rapid diagnostic techniques for MDR/XDR TB was conducted in 20 laboratories in the National Programme for Prevention, Surveillance and Control of Tuberculosis (NPPSCT) network: NRL Bucharest, NRL Cluj-Napoca, TB laboratories in Bacău, Brașov, Constanța, Craiova, Sibiu, Timișoara, Iași, Baia Mare, Leordeni, Sf. Ștefan Hospital in Bucharest, Leamna, Călărași, Galați, Târgoviște, Drajna, Deva, Tg. Mureș and Focșani. As a result of the tests, 707 patients with sensitive TB, 40 patients with MDR TB and two patients with XDR TB were detected in November 2016.
In total, since the commencement of the rapid diagnostic activity (March 2015) and until the end of November 2016, out of 28 132 tested patients, 11 077 were detected with sensitive TB, 880 with MDR TB and 91 with XDR TB.
The provision of directly observed treatment and of incentives for TB patients treated in outpatient facilities in order to increase treatment adherence
At the end of November, the database comprising patients enrolled in the project for social vouchers intended to increase treatment adherence included 1 386 individual patients registered, of whom 1 208 met the eligibility conditions to receive social vouchers. Among these patients, 470 have been enrolled and have benefited from support under the project for approximately one year, while 270 patients have completed the treatment.
Other activities carried out in November
14 TB Infection Control training sessions were organised in the country, in the counties of Brașov, Satu Mare, Ialomița and Cluj.
Work has continued for the drawing up of the tuberculosis patient brochure.
Activities continued for the review of the Practical Approach to Lung Diseases national guide, which will establish the algorithm for the identification of TB suspects in the general population, the specialist referral, the involvement of the primary care network in tuberculosis care in Romania.
