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.
The provision of continuous, complete and quality treatment for 1 000 MDR/XDR TB patients
In October, the enrolment of patients continued in the two MDR TB centres in Bucharest and Bisericani and in the other TB facilities in the country involved in the project. As such, at the end of the month, a total of 744 patients were enrolled under complete, correct and continuous treatment.
As a result of the application submitted by the project team, the National Agency for Medicines and Medical Devices issued the special needs authorisation for the treatment scheme required for patients diagnosed with M/XDR TB. The medicines will arrive in the immediately following period.
The provision of integrated interventions for the prevention of TB transmission in poor communities and for the increase of treatment adherence
In October, a monitoring visit was conducted at the training session dedicated to community workers in Olt County, and 10 TB information, education and communication caravans were organized: 2 in Călărași County, 4 in Giurgiu County and 4 in Olt County. Through these caravans, 553 persons received information regarding tuberculosis, among them 133 Roma. So far, 8 795 persons, of whom 1 396 Roma, have received information throughout the project. The planning of the IEC caravans for November has been completed.
During this reporting period, 88 patients have been enrolled for the provision pf DOT, with a total of 739 patients enrolled at project level, of whom 97 Roma patients. The patients enrolled come from 212 localities in the country.
The establishment of a network of functional laboratories for the early detection of MDR/XDR TB
In October 2016, testing using rapid diagnostic techniques for MDR/XDR TB was conducted in 20 laboratories within the National Programme for Prevention, Surveillance and Control of Tuberculosis (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 activity carried out in the TB laboratories within the project in October 2016 show that, among the patients tested, 658 were detected with sensitive tuberculosis, 37 with MDR tuberculosis and none with XDR TB.
In total, since March 2015 and until the end of October 2016, of the 26 179 individual patients submitted to rapid diagnostic testing, 10 370 were detected with sensitive TB, 840 with MDR TB and 89 with XDR TB.
The procurement of two other Genexpert systems, one MGIT equipment and six centrifuges has been provided for, to take place in the following period. In October 2016, the summarized procurement procedure for the Genexpert and MGIT systems is underway, namely at the stage when the submitted tenders are being analysed. Technical specifications have been completed and the summarized procurement procedure will be launched the following month.
Also, the procurement of two IT servers required for the administration of the software for the national registration, monitoring and reporting of TB/MDR TB cases has been provided for. In October 2016, the legal procedure for the procurement of the 2 servers is underway.
The provision of directly observed treatment and of the incentives for TB patients treated in outpatient facilities in order to increase treatment adherence
At the end of October, the database comprising the patients enrolled in the project for social vouchers intended to increase treatment adherence included 1 685 individual patients, of whom 1 284 met the eligibility conditions to receive social vouchers. Of them, 411 patients have been enrolled and have been provided with support under the project for approximately one year, while 223 patients have completed the treatment.
Other activities carried out in October
Five TB Infection Control training sessions were organized in the counties of Dâmbovița, Sălaj 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.
Work has been undertaken to nail down the patient brochure and the organization of peer-support volunteer network.
A health communication workshop was organized in Sinaia (12-15 October), with 24 participants.
The provision of integrated services for the prevention of tuberculosis (TB) transmission in poor communities and for the increase of treatment adherence
During September, two information (IEC) caravans were organised in Dolj county, where 100 people participated, out of which 3 were Roma. Until now, from the beginning of the project, 8 242 persons out of which 1 263 Roma received information in the caravans.
Until the end of this month, in 2016 a total number of 1 500 vouchers were distributed to the community nurses and Roma mediators, who organised IEC caravans during January – August 2016. To ensure the directly observed treatment (DOT), in the project were enrolled until September 654 unique patients, and during September 91 patients were enrolled.
Until the end of September, 12 008 social tickets were distributed and another 132 tickets were about to be distributed, and for the DOT supporters who monitored the patients in the 6 counties were distributes 10 400 vouchers.
Establishing a functional laboratory network for the early detection of the multi drug resistant/extensively resistant TB at drugs (MDR/XDR TB)
During this month, the MDR/XDR TB testing activity with rapid diagnostic tests took place in 20 laboratories in the National Programme for Prevention, Surveillance and Control of Tuberculosis (NPPSCT) network: NRL Bucuresti, NRL Cluj-Napoca, TB laboratories in Bacău, Brașov, Constanța, Sibiu, Timișoara, Iași, Baia Mare, Leordeni, Sf. Ștefan Hospital in Bucharest, Leamna, Călărași, Galați, Târgoviște, Drajna, Deva, Tg. Mureș and Focșani. With the rapid diagnostic techniques – Genexpert, LPA, MGIT and Versatrek, in September were tested 2641 patients. After the tests, 614 were detected with TB and 27 with MDR TB. In September, none of the tested patients was detected with XDR TB.
From the beginning of the activities, in the TB laboratories equipped with modern equipment within the project there were done 40 846 tests for rapid diagnostic. Out of the total 24 328 unique patients tested in the project (the period March 2015 – September 2016), 9 691 were detected with sensitive TB, 803 with MDR TB and 89 with XDR TB.
Ensuring a directly observed treatment and the incentives for the TB patients treated in ambulatory, to increase the treatment adherence
From the beginning of the project and until the beginning of September, 1060 unique patients meeting the eligibility conditions in order to receive social tickets to increase the treatment adherence were enrolled in the project and received social tickets. Out of these, 351 patients are enrolled and benefit of support within the project for about one year, and 195 finished the treatment.
Other activities developed in September
In September continued the enrolment of patients in the 2 MDR TB centres in Bucharest and Bisericani (Neamț county), as well as in the rest of the country. As such, at the end of the month, 710 patients were enrolled in the complete, correct and continuous treatment within the project.
In order to establish a basic infrastructure for TB infection control in specific facilities and training of staff, four sessions in the area of TB Infection Control were organized – one in Bucharest and 3 in the country.
Within the activity of providing technical assistance by the World Health Organization (WHO) for improving the NPTPSC management, the mission of revision of the national guide regarding the Practical Approach to Lung Diseases, through which the algorithm of TB suspects detection among the general population, referral to the specialist, involving the primary health care network regarding TB in Romania.
NPPSCT national database update
During the reporting period, the functional specifications regarding the update and maintenance of the National Programme for Prevention, Surveillance and Control of Tuberculosis (NPPSCT) national database have been reviewed and completed with respect to the modules that require modifications in accordance with the international requirements and recommendations in the field. Nomenclatures have been compiled, including the physicians serving the TB supervision network, updated drug lists, available genetic laboratory tests. By the end of August 2016, the national database had been updated in a proportion of 50%.
The provision of continuous, complete and quality treatment for 1,000 patients with MDR/XDR-TB
At the end of August, 662 patients had been enrolled to receive complete, correct and continuous treatment under the project. Monitoring and supervision visits have been conducted in the country, in Caraș-Severin, Hunedoara and Cluj counties.
The provision of integrated interventions for the prevention of TB transmission in poor communities and for increasing treatment adherence
Four caravans were organised in August – 3 in Călărași County and 1 in Giurgiu County – and were attended by a total of 213 persons, 118 of them Roma. So far, 8,142 persons have received information under the project, of whom 1,260 Roma people.
Patient enrolment continued, in order to ensure the provision of directly observed treatment (DOT), 93 patients being enrolled in August, with the total number thus reaching 568 individual patients, 67 of them Roma.
By the end of August 2016, 10,076 social vouchers had been distributed to patients.
The establishment of a network of functional laboratories for the early detection of drug-resistant/extremely drug-resistant tuberculosis (MDR/XDR-TB)
In August 2016, in the 20 laboratories of the nationwide PNPSCT network, fitted with modern equipment and rapid tests, 2,912 tests were carried out, as a result of which 742 patients were detected with simple tuberculosis, 67 with multidrug-resistant tuberculosis and 5 with extremely drug-resistant tuberculosis.
Since the start of rapid patient testing, 38,205 tests have been carried out, with 22,906 individual persons tested. Of these, 9,076 were diagnosed with simple tuberculosis, 776 with MDR-TB and 89 with XDR-TB.
In August 2016, the centralised procurement procedure for the Genexpert and MGIT equipment for the project extension period was ongoing, the deadline for the submission of the tenders being 19 September 2016. The specifications for the procurement of the centrifuges were drawn up in August, with the centralised procurement procedure to be launched the following month.
Also, the centralized procurement procedure for 2,896 LPA tests and 5,600 MGIT tests was underway, in order to ensure the continuity of the rapid testing activity within the TB laboratories. The deadline for the submission of the supplier tenders was 19 September 2016. In August, a new centralised order for Genexpert and Versatrek systems was sent to TB laboratories.
The delivery, installation and commissioning for the 29 size-A fume hoods were completed and the 15 size-B fume hoods were accepted. Bailment agreements have been signed with all the establishments that received laboratory fume hoods for use.
The legal procedure for the procurement of the 2 servers required for the administration of the national software for the registration, monitoring and reporting of TB/MDR-TB cases was launched.
Other activities conducted in August
The provision of directly observed treatment and of the incentives for TB patients treated in outpatient settings in order to increase treatment adherence – lists of declared relapses were retrieved from the PNPSCT national database and recommendations to enrol these patients were sent to the MDR coordinators, in order to ensure treatment adherence.
5 TB infection control (TBIC) training sessions were organised. In total, 281 persons in the specialised TB units received TBIC training.
The provision of continuous, complete and quality treatment for 1,000 patients with drug-resistant/extremely drug-resistant tuberculosis (MDR-TB/XDR-TB)
In July 2016, the enrolment of patients in the MDR-TB centres in the country continued, with the number of patients enrolled for complete, correct and continuous treatment under the project reaching a total of 628.
Also, the assessment of MDR-TB cases continued and recommendations were made for the referral of the cases to the MDR-TB committee with a view to their enrolment in the project.
The strengthening of the NPPSCT capacity to control the tuberculosis epidemics
By the end of July, 687 persons in the national tuberculosis network participated in the drug management, tuberculosis infection control and TB surveillance training sessions.
The provision of integrated interventions for the prevention of TB transmission in poor communities and for the increase of treatment adherence
In July, 14 tuberculosis information, education and communication (IEC) caravans were organized: 4 in Călărași County, 3 in Neamț County, 3 in Giurgiu County and 4 in Dolj County. A total of 783 persons participated in these caravans, of whom 209 Roma. So far, 7,929 persons have been informed about tuberculosis within the project, of whom 1,142 Roma;
A total of 495 individual patients were enrolled for directly observed treatment, of whom 56 Roma. In July, 68 patients in the counties of Botoșani, Neamț, Dolj, Gorj, Giurgiu and Călărași were enrolled, all of them being monitored and due to receive the social incentives during the month of August.
By the end of July, 8,295 social vouchers amounting to RON 82,950.00 had been distributed to patients. At the end of this month, 127 social vouchers amounting to RON 1,270.00 were pending distribution to patients.
By the end of July 2016, 7,050 gift vouchers, amounting to RON 70,500.00, had been distributed to DOT supporters who monitored the patients in the 6 counties in the period January-June 2016.
The establishment of a functional laboratory network for the early detection of MDR/XDR-TB
In July, MDR/XDR-TB early diagnostic testing took place in 20 laboratories in the National Programme for Prevention, Surveillance and Control of Tuberculosis (NPPSCT) network: Bucharest NRL, Cluj-Napoca NRL, TB laboratories in Bacău, Brașov, Constanța, Craiova, Sibiu, Timișoara, Iași, Baia Mare, Leordeni, Spitalul Sf. Ștefan București, Leamna, Călărași, Galați, Târgoviște, Drajna, Deva, Tg. Mureș and Focșani.
The centralised data concerning the rapid testing conducted in the TB laboratories within the project in July 2016 show that 3,124 rapid tests were conducted using the LPA, MGIT and Verstatrek techniques, 695 patients being detected with sensitive TB, 71 with MDR-TB and 23 with XDR-TB.
In total, from the beginning of the project and until the end of July 2016, 35,298 rapid tests were conducted, with 21,394 individual patients being tested. Of these, 8,334 were detected with sensitive tuberculosis, 709 with MDR-TB and 84 with XDR-TB.
Also this month, the summarizes procurement procedures were started for 2 Genexpert systems, 1 MGIT equipment and 6 centrifuges, as well as for 2,896 LPA and 5,600 MGIT tests required in order to ensure the continuity of the rapid testing activity in the TB laboratories. Also, new summarized orders for Genexpert and Versatrek tests were sent to the TB laboratories.
As regards the 44 biosafety cabinets (safety fume hoods) for the laboratories, in July, 29 size-A fume hoods were accepted under the supply contract, and delivery, installation and training of the staff for the use of size-A fume hoods were commenced (27 fume hoods were already installed and commissioned at the end of the month); the production of size-B fume hoods, which are to be accepted the following month, also began.
In July 2016, the tender specifications were drawn up for the procurement procedure concerning IT equipment: 2 IT servers required for the administration of the national software for the registration, monitoring and reporting of TB/MDR-TB cases.
The provision of directly observed treatment and of the incentives for TB patients treated in outpatient settings to increase treatment adherence
In July, 843 patients met the eligibility conditions to receive social vouchers for the increase of treatment adherence, of whom 160 patients are under complete treatment, have concluded their treatment or have been declared cured, while over 258 patients have been enrolled and have been benefitting from support under the project for approximately one year.
Other activities conducted in July:
In July 2016, the 15th TB infection control (TBIC) training session was organised. Also, the documentation related to the organisation of the training courses was drawn up. Results: 281 persons trained with regard to TBIC.
The provision of technical assistance by the World Health Organisation (WHO) for the improvement of NPPSCT management: the TB infection control and human resources missions were organised in July.
Ensuring the correct, complete and quality treatment for 1000 patients with multidrug resistant and extensively resistant tuberculosis (MDR / XDR TB)
By the end of June, a total of 562 patients were enrolled in a complete, accurate and continuous treatment in the project. This month, the evaluation of MDR TB cases continued and recommendations were made in order to submit cases to the MDR TB commission for patients enrollment in treatment.
Providing integrated interventions to prevent transmission of TB in poor communities and to increase treatment adherence
It was carried out a monitoring visit (10th of June, 2016) to the information-education-communication (IEC) session held in Rasvani village, Calarasi county.
In June, 30 caravans were organized as follows: 2 in Calarasi county, 6 in Neamt, 5 in Giurgiu 12 in Gorj and 5 in Dolj county. These sessions were attended by a total of 1,667 people, of which 438 Roma. So far, 7,146 people have been informed, of which 933 Roma. For the July to September 2016 period, 10 IEC caravans have been scheduled, in addition to those previously planned for this period: 4 in Dolj county, 4 in Giurgiu and 2 in Neamt.
190 gift vouchers, totaling 1,900 lei, were distributed to nurses and community health workers, who organized caravans IEC in May 2016. A total of 495 unique patients have been enrolled so far to receive directly observed treatment (DOT), of which 50 Roma patients.
By the end of June 2016, 6,374 patients were distributed food coupons worth 63,740 lei and other 346 food coupons worth 3.460 lei were about to be distributed.
Also, a total of 5485 gift vouchers worth all of 54 850 lei have been distributed to the DOT supporters who monitored patients in the 6 counties during January-May 2016 period.
Establishing a network of functional laboratories for early detection of MDR / XDR TB
The centralized data corresponding to the activity of TB rapid testing performed in laboratories in the project in June 2016 show that among those tested, 654 patients were diagnosed with sensitive TB, 50 with MDR TB and2 with XDR TB.
In total, following rapid testing activities undertaken within the project (March 2015 – June 2016), a total of 7,578 patients were diagnosed with TB, 632 with MDR TB and 61 with XDR TB.
For the period of extension of the project (April 1st, 2016 – March 31st, 2017) the purchase of other 2 GeneXpert and 1 MGIT equipment, together with 6 centrifuges is planned. This month the specifications were developed.
Also, to ensure continuity of the rapid testing activity in TB laboratories, 2,896 LPA tests and 5,600 MGIT tests will be purchased. The specifications were developed this month.
Ensuring directly observed treatment and incentives for patients with TB outpatients treated in order to increase adherence to treatment
In June, a total of 821 patients met the eligibility requirements to receive food coupons to increase adherence to treatment, of which 134 patients have completed the treatment or are declared cured, while over 200 patients are enrolled and they get support within the project for approximately one year.
Other activities carried out in June 2016
Three training sessions on TB infection control were organized this month.
A brochure for patients was completed, the team worked to prepare communication training in July 2016 and made preparations to organize the peer-supporters volunteer network.
