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.
Ensuring the correct, complete and quality treatment for 1000 patients with multidrug resistant and extensively resistant tuberculosis (MDR / XDR TB)
In May 2016, the enrollment of patients continued in the two MDR TB centers in Bucharest and Bisericani, also in TB centers in the country. At the end of April, a total of 531 patients were enrolled in complete, accurate and continuous treatment.
Between May 25th and June 2nd, 2016, monitoring visits took place in Timis, Dolj, Arges, Calarasi and Constanta counties, to discuss cases of MDR TB, assessing the state of enrolled patients and the results of rapid diagnosis activities.
Providing integrated interventions to prevent transmission of TB in poor communities and to increase treatment adherence
From 13th to 14th of May, 2016, at the “Marius Nasta” Institute for Lung Diseases in Bucharest, training of trainers sessions were organized, attended by 12 TB specialists and community health workers. A monitoring visit was made during the training.
This month, 19 information caravans (IEC) took place in several counties: 9 in Calarasi, 3 in Neamt, 6 in Giurgiu and 3 in Dolj. These sessions have been attended by a total of 1,021 people, of which 259 Roma. So far, in the project, a total of 5,479 people were informed, including 495 Roma.
For the July to September 2016 period, were planned other 12 IEC sessions in Gorj counties, besides the 6 previously planned for this period.
By the end of May, 2016, a total of 3,494 food coupons worth 34 940 lei, were distributed to patients. Also, 1,574 food coupons, worth 15 740 lei, were about to be distributed to other patients.
Establishing a network of functional laboratories for early detection of MDR / XDR TB
Of all patients screened in May through rapid diagnosis methods in NPPSCT network of laboratories, 783 were diagnosed with sensitive tuberculosis, 85 with multidrug-resistant TB and one with TB drug resistance.
Overall, between March 2015 and May 2016, 17,671 unique patients were screened through rapid diagnosis methods in the project, of which 6,805 were diagnosed with sensitive TB, 603 with drug resistance (MDR TB) and 21 extremely drug resistant TB (XDR TB).
To ensure the continuity of rapid testing activity in the NPPSCT laboratories within the project 2,896 LPA tests and 5,600 MGIT tests will be purchased.
This month, all 300 desktop computers purchased in project were delivered to TB units in the country. TB dispensaries and laboratories from 165 TB Hospitals have been equipped with desktop computers in the project.
The purchase of two IT servers, necessary for national management software for registration, monitoring and reporting of TB / MDR TB cases was scheduled for the extension period of the project (April 1st, 2016 – March 31st, 2017).
Other activities carried out in May 2016
597 patients met the eligibility requirements to receive food coupons to increase adherence to treatment, of which 100 new patients. To date, a total of 781 patients were reached in the project.
TB units in the country received UV lamps procured under the project. Also, training courses were organized on TB infection control.
WHO Technical assistance missions to improve the NPPSCT management were prepared and will begin in June-July. Discussions were held in this matter with the stakeholders who will be involved in these missions.
Ensuring the correct, complete and quality treatment of the patients with multidrug resistant and extensively resistant tuberculosis (MDR / XDR TB)
In April 2016, the enrollment of patients for treatment continued in MDR centers in Bucharest and across the country. At the end of April, a total of 460 patients were enrolled in complete, accurate and continuous treatment.
Between 29th of March and 1st of April, four monitoring visits took place in the counties of Galati, Neamt, Iasi and Bacau in order to discuss cases of MDR TB, assessments of enrollment and verification of the laboratories equipment and supplies for rapid diagnostic.
Another monitoring visit was organized on April 26 at Leordeni to check the progress of rapid diagnostic testing equipment and discuss MDR TB cases in the county.
Providing integrated interventions to prevent transmission of TB in poor communities and to increase treatment adherence
The team continued the work on the gathering, verification and centralization of consents signed by patients who were already enrolled and those enrolled in April and updated lists of patients who are given treatment under direct observation (DOT) in the six counties involved in the project.
For the period July to September 2016, 55 information-education-communication (IEC) caravans were planned in counties of Botosani, Gorj, Calarasi, Neamt, Giurgiu and Dolj. In the caravans organized by the end of April, 4458 people in the communities were informed regarding TB.
A total of 320 patients were enrolled to receive DOT, of which 17 Roma.
By the end of April, social vouchers worthing 26.650 lei were distributed to a total of 2,665 patients and other 520 food coupons worthing 5,200 lei were being distributed.
Establishing a network of laboratories for early detection of MDR / XDR TB
In April, the testing by rapid techniques for diagnosing MDR / XDR TB took place in 20 laboratories in the NPPSCT network: NRL Bucharest, NRL Cluj-Napoca, TB laboratories in Bacau, Brasov, Constanta, Craiova, Sibiu, Timisoara, Iasi, Baia Mare, Leordeni, St. Stefan Hospital Bucharest, Leamna, Calarasi, Galati, Targoviste, Drajna, Deva, Tg. Mures and Focsani.
In April 2016, through the rapid testing methods, 3124 patients have been tested, of which 529 were detected with sensitive TB and 31 with MDR TB. In total, between March 2015 and April 2016 in the laboratories of network NPPSCT 24 726 rapid tests were carried out, with the following results: 5871 patients were diagnosed with TB, 522 with MDR TB and 23 with XDR TB.
Up to 31st of March, 2016 a total of eight laboratories were provided with the GeneXpert equipment within the project: Cluj-Napoca, Iasi, Constanta, Craiova, Timisoara, Brasov, Leordeni, and Baia Mare. For the extended period of the implementation of the project (April 1st, 2016 – March 31st, 2017) further equipment shall be purchased: 2 GeneXpert, 1 MGIT equipment and 6 centrifuges, for which centralized procurement procedure will be organized. Also, to ensure continuity of rapid testing in TB laboratories, another 2896 LPA tests and 5.600 MGIT tests will be purchased.
In the project, 28600 GeneXpert tests were procured for nine TB laboratories: Cluj-Napoca, Bucharest, Iasi, Constanta, Craiova, Timisoara, Brasov, Leordeni and Baia Mare and 44 safety cabinets will be delivered to the laboratories.
Versatrek supplies were purchased and necessary kits were delivered to those 14 TB laboratories nominated by NPPSCT: NRL Cluj-Napoca, NRL Bucharest, laboratories TB Hospital at St. Stefan Hospital Bucharest, Iasi, Craiova, Leamna, Bacau, Calarasi, Galati, Targoviste Drajna, Deva, Focsani and Targu Mures.
Providing directly observed treatment (DOT) and incentives for TB patients treated in ambulatory in order to increase adherence to treatment
One year after the start of granting social vouchers, the situation is as follows: 682 unique patients were enrolled in the project to increase adherence to treatment and approximately 50% of them receive food coupons since the first month of enrollment. About 18% of all patients enrolled, 120 patients, were declared cured or complete treatment.
Other activities carried out in April 2016
The project implementation team has organized weekly training in TB infection control with participants from Marius Nasta Institute.
Assessment mission of the National TB Control Program was prepared, as well as the mission for reviewing the strategic documents developed for the laboratories, and the reorganization plan for bacteriology laboratories in Romania.
In terms of providing information about TB to the patients, vulnerable groups and the general population, the main activities undertaken in April were the completion of the leaflet, organizing a workshop to pretest the brochure for patients (9 -10 of April, 2016) and training outreach workers (11-12 of April, 2016), attended by 32 participants.
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.
Strengthening the capacity of the National Programme for TB Control to control the TB epidemic
In February, three courses for health professionals in the field of respiratory medicine were organized in Bucharest, attended by a total of 71 students. In total, by the end of this month, 687 specialists were trained within the project. For these courses, monitoring visits took place.
Rapid testing of patients for Multidrug Resistant and Extensively Resistant Tuberculosis (MDR TB and XDR TB)
This month, no patient was found with XDR TB among patients tested in the laboratories of the National Programme for Prevention, Surveillance and Control of Tuberculosis to control the TB epidemic (NPPSCT) equipped through the project. Of the 2630 patients tested between February 1st to 29th in these laboratories, 524 were diagnosed with sensitive TB and 42 with MDR TB. In total, from March 2015 until the end of February 2016, a number of 17 943 patients were screened, of which 4301 were diagnosed with TB sensitive, 397 with MDR TB and 13 with XDR TB.
Establishing a network of laboratories for early detection of MDR / XDR TB
Nine new labs began testing activity through rapid diagnostic methods (Versatrek), being equipped within the project with test kits for use of such equipment. The nine new TB laboratories are at the St. Stefan Hospital Bucharest, Leamna, Calarasi, Galati, Targoviste, Drajna, Deva, Tg. Mures and Focsani. Thus, since February 2016, the NPPSCT network has 20 laboratories carrying out testing activity by rapid techniques for diagnosing MDR / XDR TB: NRL Bucharest, NRL Cluj-Napoca, laboratories TB in Bacau, Brasov, Constanta, Craiova Sibiu, Timisoara, Iasi, Baia Mare, Leordeni and the nine new laboratories.
Other 8 GeneXpert equipments were purchased, installed and commissioned in TB laboratories nominated by NPPSCT.
To purchase 44 safety cabinets for laboratories, the centralized procurement procedure was finalized and the purchase contract with the selected firm was signed. The 10 LED epifluorescence microscopes were also purchased and received. Two of them were installed and commissioned in the NRL Bucharest, the other 8 were installed this month in the NRL Cluj Napoca, RL Iasi, RL Constanta, RL Timisoara, RL Bacau, RL Brasov, RL Craiova and RL Leordeni.
Versatrek supplies were purchased. The first orders were shipped to the 14 TB laboratories nominated by NPPSCT: NRL Cluj-Napoca, Bucharest NRL laboratories at TB Hospital St. Stephen Bucharest, Iasi, Craiova, Leamna, Bacau, Calarasi, Galati , Targoviste, Drajna, Deva, Tg. Mures and Focsani.
Ensuring the correct, complete and quality treatment of the patients with MDR / XDR TB
In February 2016, 4 more patients were enrolled, leading to a total of 309 patients under treatment in the project. Another 75 medical records were analyzed and discussed by the MDR TB commissions doctors, and 46 patients received the recommendation to be enrolled into treatment as soon as anti TB are in store UNIFARM warehouse will receive authorization for exemption from the labeling. According to consent sheets received by the end of January, the number of Roma patients rose to 48.
The work on centralizing databases of TB patients in the six counties involved in the project continued, in conjunction with community workers associated communities with TB cases. They were collected, verified and centralized signed consent by patients who are to receive DOT.
Enrollments to ensure DOT were made for 160 patients from Botosani, Neamt, Dolj, Gorj, Giurgiu and Calarasi. In January, DOT has been granted for 36 patients, and in February for 114 unique patients. In total, to date, 150 unique patients received DOT, of which five Roma patients, according tos the community workers who were monitoring those patients.
They were planned and prepared to be held in March 2016 a number of 18 IEC caravans: four in Botosani county, 4 in Gorj county, 3 in Calarasi county, 3 in Neamt county, 2 in Giurgiu county and 2 in Dolj county.
Providing directly observed treatment (DOT) and incentives for TB patients treated in ambulatory in order to increase adherence to treatment
In February 2016, of the 1,930 patients considered eligible to be enrolled in the project, 691 patients had signed consent sheets until January 10. Between 11 January and 29 February 2016, a total of 47 new patients have sent consent sheets. To date, of the 1930 eligible patients to be enrolled, 613 have received social support for adherence to anti TB administered, of which 76 declared themselves Roma. Cumulatively, in the period May 2015 – January 2016, vouchers were distributed to a total of 4036 patients.
Of the 172 patients enrolled in the first month of the project, 73 completed treatment successfully (42.44%), 10 died (5.8%), two patients were declared abandonment (2.77%), and 81 patients are still in treatment and are adherents of April (47 %%).
Other activities carried out in February 2016:
The documentation for service contracts for TB infection control trainers was prepared, the courses were scheduled and lists of participants in training courses at the Institute Marius Nasta were prepared.
In terms of technical assistance by the World Health Organization (WHO) to improve the NPPSCT management, the technical assistance missions plan was carried and the mission objectives were detailed. The plan is consistent with the one of the missions of technical assistance funded by the FG.
For providing information about TB to patients, vulnerable groups and general population, the project team is working on organizing the fourth communication training for health. The third workshop for health communication has been established that will be held in Baile Felix, March 9th to 12th. Also, the preparation for the brochure for TB patients were conducted.
Rapid testing of patients for Multidrug Resistant and Extensively Resistant Tuberculosis (MDR TB and XDR TB)
This month, the activity of rapid testing techniques for diagnosing MDR and XDR TB took place in 11 laboratories of the National Programme for Prevention, Surveillance and Control of Tuberculosis to control the TB epidemic (NPPSCT) network: National Reference Laboratory (NRL) Bucharest, NRL Cluj-Napoca, and TB laboratories in Bacau, Brasov, Constanta, Craiova, Sibiu, Timisoara, Iasi, Baia Mare and Leordeni.
In January, 2231 people have undergone rapid diagnosis in these laboratories. Of these, 491 were diagnosed with sensitive tuberculosis (TB), 58 with MDR TB and 7 with XDR TB. The centralized data show that, in total, from March 2015 to January 2016, 15127 people were tested, of which 3769 were detected with TB, 345 with MDR TB and 13 with XDR TB.
Strengthening the capacity of the National Programme for TB Control to control the TB epidemic
Also in January, three courses for health professionals in the field of respiratory medicine were organized in Bucharest (at Marius Nasta Institute of Pneumology), Iasi and Suceava. These sessions were attended by 67 specialists, so the total number of health workers trained so far in the project comes up to 616 specialists. There have also been three monitoring visits to these courses.
The development of a network of functional laboratories for early detection of MDR / XDR TB
Having GeneXpert equipment purchased within the project and put into operation in the TB laboratories nominated by NPPSCT, this was the month when the testing activity by this method began in the laboratories in Cluj-Napoca, Iasi, Constanta, Craiova, Timisoara, Brasov, Leordeni and Baia Mare.
In the previous month, the first batch of GeneXpert kits had been delivered to the TB laboratories equipped with GeneXpert equipment. In January 2016, all eight laboratories equipped with GeneXpert kits and equipment have been operating tests in order to diagnose MDR TB. Regarding the acquisition of 44 safety cabinets for laboratories, the centralised procurement procedure is in the bid evaluation stage.
Of the 10 LED epifluorescence microscopes purchased and received in the previous month, two were installed and commissioned in the NRL Bucharest. The other eight LED epifluorescence microscopes will be installed in Cluj-Napoca, Iasi, Constanta, Timisoara, Bacau, Brasov, Craiova and Leordeni laboratories.
This month, it has been carried out the first order for the supply of Versatrek kits for the 14 TB laboratories nominated by NPPSCT: NRL Cluj-Napoca, NRL Bucharest, and TB laboratories from Hospital St. Stefan (Bucharest), Iasi, Craiova, Leamna, Bacau, Calarasi, Galati, Targoviste, Drajna, Deva, Targu Mures and Focsani. For IT equipment, the centralised procurement procedure is in the bid evaluation stage.
Ensuring the correct, complete and quality treatment of the patients with MDR / XDR TB
In January 2016, 12 patients with MDR TB requiring in emergency treatment were enrolled in the project. In total, since the beginning of the project, a number of 302 patients were enrolled in treatment, of whom 45 Roma people.
During January, 108 medical records were analyzed by the MDR TB commissions doctors, and 55 of the patients received the recommendation to be enrolled into treatment as soon as anti TB from UNIFARM warehouse will receive authorization for exemption from the labeling.
Providing integrated interventions to prevent transmission of TB in poor communities and to increase treatment adherence
Three training sessions with Community workers were organized in Gorj, Giurgiu and Calarasi counties, involving a total of 149 people. To this date, this course was attended by a total of 309 community workers. There were four monitoring visits to the trainings that took place in Craiova (Dolj county) Tg. Jiu (Gorj county), Giurgiu (Giurgiu county) and Calarasi (Calarasi county).
Providing directly observed treatment (DOT) and incentives for TB patients treated in ambulatory in order to increase adherence to treatment
Of the 1876 patients considered eligible to be enrolled in the project, 671 patients had consent sheets signed until 10th of December. Between 11th of December 2015-31st of January 2016, a total of 24 new patients have sighend consent sheets. In total, 668 patients are enrolled in the project.
For the patients who are eligible to receive social support for adherence to anti TB treatment, the project team has centralized the following information:
– 598 unique patients, of which 61 Roma, received social support in the project so far, to maintain adherence to treatment.
– Overall, between May 2015 and January 2016, a total of 3594 patients received vouchers.
Of the 172 patients enrolled in the first month of the project: 59 patients successfully completed the treatment (34.30%), 9 patients died (5.23%), 3 patients abandoned the treatment (1.74%) and 101 patients are still in treatment and are adherent since April 2015 (58.72%).
Providing information about TB to the patients, vulnerable groups and general population
The brochure for TB patients was finalized and resources have been identified for organizing the workshop for assessing the information needs of TB patients. Preparations for organizing the communication for health training have been undertaken, as well.
Other January activities:
The procurement of UV lamps was completed and the locations to be equipped with UV lamps had been reviewed.
Preparations for next year TA missions of WHO experts continued, by identifying the periods, NPPSCT priorities and the experts to carry out those missions.
Rapid testing of patients for Multidrug Resistant and Extensively Resistant Tuberculosis (MDR TB and XDR TB)
A total of 1,398 people across the country have been tested in the National Programme for Prevention, Surveillance and Control of Tuberculosis to control the TB epidemic (NPPSCT) laboratories network which were equipped within the project with the latest equipment for rapid diagnosis of Multidrug-resistant (MDR TB) and the extremely drug resistant tuberculosis (XDR TB). A number of 295 of them were diagnosed with sensitive tuberculosis, 16 were detected with MDR TB and one person with XDR TB.
From March 2015 to December 2016, a total of 12 815 people have undergone rapid diagnosis, of which 3,160 were diagnosed with TB, 272 with MDR TB and XDR TB 5.
The development of a national laboratories network for early detection of TB MDR / XDR
GeneXpert equipment was purchased and installed in the designated laboratories within the project: Iasi, Timisoara, Leordeni, Craiova, Constanta, Cluj-Napoca, Brasov and Baia Mare. After commissioning of the equipment, laboratory staff has been trained in using the equipment. Also in December, the first batch of kits GeneXpert was delivered to TB laboratories equipped with GeneXpert.
Regarding the acquisition of 44 safety cabinets for laboratories, the centralised procurement procedure is in the bid evaluation stage.
The 10 LED epifluorescence microscopes were purchased this month. The procedure for selecting the supplier was completed, the supply contract was signed and products reception was made and two of the microscopes have been installed in the National Reference Laboratory (NRL) Bucharest. The two microscopes were put into operation and staff of the NRL Bucharest has been trained in their use. The remaining 8 LED microscopes will be installed in the following laboratories: Cluj Napoca, Iasi, Constanta, Timisoara, Bacau, Brasov, Craiova, Leordeni.
Three laboratories from the NPPSCT network – Bucharest, Cluj-Napoca and Galati – were equipped with Versatrek equipment, which were put into operation, and the staff has been trained in their use. The Versatrek supplies were purchased in December: the provider selection procedure was completed, the contract for delivery has been signed and reception of the products was made. For the purchase of IT equipment, the centralised procurement procedure is in the bid evaluation stage.
Strengthening the Capacity of the National Programme for Prevention, Surveillance and Control of Tuberculosis to control the TB epidemic
In December two training courses for staff were organized in Constanta and Baia Mare in order to strengthen the capacity of the NPPSCT. 41 people attended these trainings, and the total number of health professionals trained in the field of respiratory medicine through project has reached 549. Earlier this month, the direct purchase of services assessment ended and the training calendar has been updated for the month of January 2016.
Providing integrated interventions to prevent transmission of TB in poor communities and to increase treatment adherence
In December, three training sessions with the participation of Local Health Assistance services and Health Ministry were organized in Neamt, Botosani and Dolj, attended by a total of 160 people. There were three monitoring visits to these three training sessions.
It has also been prepared the documentation for the purchase of gift vouchers necessary to stimulate community workers who will ensure the support in providing integrated interventions to prevent TB transmission in poor communities and to increase treatment adherence. The procedure is in the stage of bid evaluation.
Ensuring the correct, complete and quality treatment of the patients enrolled and of those who receive incentives for maintaining adherence to treatment
60 medical records were analyzed by the MDR TB commissions doctors, and 25 of the patients received the recommendation to be enrolled in treatment. In December, no new patients were enrolled in treatment. The project team continued the steps to complete the dossier submitted to the National Agency for Medicines and Medical Devices in order to obtain the special needs authorization to import the anti TB drugs in Romania.
This month, from the total of 1837 patients considered eligible to be enrolled in the project, 654 had signed consent sheets until November 10th. Between November 11th and December 31st, 10 new patients sent full consent sheets. There are 647 patients enrolled in the project to receive incentives / social support. So far, 580 unique patients have received social support to maintain adherence to treatment.
Other December activities:
NPPSCT county technical coordinators were requested information about locations to place the UV lamps purchased within the project.
Preparations for next year TA missions of WHO experts continued, by identifying the periods, NPPSCT priorities and the experts to carry out those missions.
Data from interviews of the TB patients about their information needs were collected and centralized, in order to accomplish a booklet about TB who will address TB patients, vulnerable groups and the general population. Also, the procurement procedure of an audit firm was organized.
Strengthening the Capacity of the National Programme for Prevention, Surveillance and Control of Tuberculosis to control the TB epidemic
Four training courses were organized in November for the medical staff in order to strengthen the capacity of the National Programme for Prevention, Surveillance and Control of Tuberculosis (NPPSCT) epidemic. The courses were organized in Bacau, Tg. Mures, Galati and Bucharest, and were attended by 85 participants. Overall, by the end of November, 508 health professionals were trained within this project. There were two monitoring visits, with courses organized at Galati and Bucharest, and the course planning was updated for the November 2015 – January 2016 period.
Documents were drafted for the procurement of services for training program evaluation and the panel of experts who will be invited to send their bid was selected.
Rapid testing of patients for Multidrug Resistant and Extensively Resistant Tuberculosis (MDR TB and XRD TB)
Two new TB laboratories – in Iasi and Leordeni – have started their activity of rapid testing within the project, completing the NPPSCT network of laboratories that have rapid diagnostic techniques for MDR TB and XDR TB in Bucharest, Cluj, Bacau, Brasov, Constanta Craiova, Sibiu, Timisoara. In November, in these modern equipped laboratories, 1,760 people have been tested, of which 484 have been detected with sensitive TB and 52 people with MDR TB.
In total, from March until the end of November, 11,406 patients have been tested in NPPSCT labs. A quarter of them (2,853 people) were detected with TB, 258 with MDR TB, and 4 with XDR TB.
Continue the work for the development of a functional laboratory network for early detection of MDR / XDR TB
The contract for the GeneXpert equipment procurement was signed and the laboratories in the country where it will be put into use were designated: Iasi, Timisoara, Leordeni, Craiova, Constanta, Cluj-Napoca, Brasov, Baia Mare. The persons responsible to work with the new equipment will be trained in this regard in December, 14th to 21st.
Regarding the acquisition of the 44 safety cabinets for laboratories, the centralised procurement procedure is in the bid evaluation stage. For the procurement of the 10 LED laboratory microscopes, the supplier selection procedure was completed, and the winner company was named. Next, the supply contract will be signed.
This month, the 9 vehicles procured under the project for transporting samples to rapid diagnosis laboratories were registered and sent to the designated TB units: Timisoara, Craiova, Calarasi, Constanta , Iasi, Bacau, Cluj-Napoca and Leordeni. One vehicle was assigned to NRL Bucharest, at the “Marius Nasta” Institute for Lung Diseases.
Three laboratories – NRL Bucharest, NRL Cluj-Napoca and LRR Galati – will receive Versatrek equipment, as stipulated in the contract signed in November with the company that won the procurement procedure. The equipment was received and shall arrive in laboratories between 3rd and 10th of December, when it will be put into operation and the staff will be trained to use it.
Ensuring the correct, complete and quality treatment of the patients enrolled and of those who receive incentives for maintaining adherence to treatment
Three more MDR TB patients were enrolled in treatment in November, and the total number of MDR patients enrolled since the beginning of the project is 292. Other 63 patients received the recommendation to be enrolled in treatment, after doctors from MDR TB committees analysed and discussed 111 new medical records.
In November, out of the 1,799 patients considered eligible to be enrolled in the project to receive incentives, 614 had signed consent forms until October 10th. In addition, 23 new patients had signed consent forms between October 11th and November 30th. Overall, 628 patients are enrolled to receive incentives within the project.
By the end of November, 561 unique patients had received social support to maintain adherence to treatment, as confirmed by the treating doctors.
Providing integrated interventions to prevent transmission of TB in poor communities and to increase treatment adherence
In November, the centralizing of the databases of TB patients from the six counties involved in the project was finished. 680 patients were identified for enrollment, as follows: 206 in Botosani County, 115 in Giurgiu County, 112 in Calarasi County, 107 in Gorj County, 79 in Neamt County and 61 in Dolj County.
Also, work has been done to prepare three meetings with the participation of Local Health Assistance services and Health Ministry. They are about to take place during December in Botosani, Neamt and Dolj.
Other November activities
The procurement procedure of the UV lamps continued.
Educational materials for TB infection control course for TOT have been prepared and the training was organized.
In November, the discussions with the WHO for programming the technical assistance missions for next year started by identifying and prioritizing NPPSCT periods and experts to carry out those missions.
Between 18 and 21 November the communications training session for health workers was organized, attended by 21 health professionals from NPPSCT network.
Rapid testing of patients for Multidrug Resistant and Extensive Resistant Tuberculosis
During October, 1368 more patients with tuberculosis from all over the country have been tested in the newly equipped – with modern testing equipment and supplies – laboratories of the NTP network as follows: NRL Bucharest NRL Cluj, laboratories TB in Bacau, Brasov, Constanta, Craiova, Sibiu and Timisoara. Out of the total tested patients, 15 were diagnosed with resistant tuberculosis among which, 5 with multidrug resistance.
The centralized data for the period March-October 2015 show that 6597 patients were screened for free within the project. 514 were detected with resistances, out of which 194 with MDR TB and 4 with XDR TB.
Continue the work for the development of a functional laboratory network for early detection of MDR/XDR TB
In October, the contract was signed with the winner of the procurement procedure for the 8 GeneXpert equipment and the laboratories to be provided with such equipment have been nominated.
Also, the opening of bids for the procurement of 44 laboratory safety cabinets was made. The offers will be assessed and the supplier will be established.
To purchase the 10 LED microscopes for laboratories, the legal process for the selection of the supplier is in the stage of technical evaluation of bids; the winning company will be selected.
The legal procedure for selecting the supplier of vehicles was completed. The purchase contract was signed for 9 cars needed to transport laboratory samples from the country to the laboratories equipped within the project, and in October the vehicles were received. TB laboratories were designated to benefit from the the cars for transport of samples and also bailment contracts were developed in order to be signed with the hospitals in which the laboratories operates. The procedures for vehicles’ registration also started.
It was also concluded the acquisition procedure for 3 Versatrek equipment, and contract will be signed with the successful supplier. For related supplies, the deadline for opening the submitted tenders is November 12.
Regarding the IT equipment, the term for opening the submitted tenders is November 27.
Also in October, the UV lamps procurement procedure was monitored as the procedure undergoing.
Increase the number of patients enrolled in correct, complete and quality treatment and of those who receive incentives for maintaining adherence to treatment
In October there were enrolled 30 more MDR TB patients for correct, complete and quality treatment, and in total, since the beginning of the project, 289 patients with multidrug resistant tuberculosis have been enrolled.
Also in October, out of the total of 1779 patients considered eligible to be enrolled in the project to receive incentives, 584 patients had signed consent forms until 10 September. In addition, during September 11 to October 30, a total of 20 new patients were sent consent forms. Overall 600 patients are enrolled in the project to receive incentives in order to maintain adherence to treatment.
In order to improve the coordination of the work, the project team organized between October 31 – November 1, the second National Meeting of MDR TB coordinators, attended by 34 doctors from Bucharest and the country. The meeting agenda included presentation of project results after 6 months of implementation and participative working sessions focused on the analysis of the project results obtained in different.
Improve the Capacity of the National Programme for Prevention, Surveillance and Control of Tuberculosis to control the TB epidemic
In October, six training courses were organized for medical staff in the PNPSCT as follows: October 9-11 in Alexandria, Brasov and Craiova, 22-24 October in Ramnicu Valcea, 23-25 October in Iasi and 28-30 October in Bucharest. The courses were attended by a total of 134 participants. So far 423 people have been trained.
Also in October:
A technical assistance contract was signed between the World Health Organization and the Pulmonology Institute Marius Nasta and related funds were transferred for the first contractual phase. The discussions started with the WHO for programming the technical assistance missions, which will start next year.
Preparations were made for the next training that will be held in Sinaia, during 18-21 November 2015, the training will target the staff who will be involved in communication activities in order to prevent the spread of TB at community level.
Expenditures for the period 1 to 31 October 2015 are shown in the table below
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:
6628 patients were screened from March until the end of August through modern methods of detecting TB bacillus drug resistance
Testing TB patients for detecting TB bacillus drug resistance continued during August. The laboratories in the PNPSCT network provided with modern equipment and appropriate supplies (NRL Bucharest NRL Cluj, TB laboratories from Bacau, Brasov, Constanta, Craiova, Sibiu and Timisoara) receive evidence from TB units across the country, in order to ensure patients access to rapid diagnosis techniques.
1103 new patients were tested only in August 2015. 39 of them were found with resistant TB, and 15 of whom were diagnosed with Multidrug resistant TB.
The project pooled data show that in March (when they started testing) by the end of August, 6628 patients across the country were tested with modern equipment. 434 patients were found with resistances and 171 of whom were diagnosed with MDR TB.
Medicines for correct, complete and quality treatment for all patients with MDR TB
In August, another 26 patients with MDR TB were enrolled to receive correct, complete and quality drug treatment, and in total, from the beginning of the project, 208 MDR TB patients were enrolled. Also in August, the project team has centralized state enrollment in treatment of patients in Bucharest and in each county. After this update, the Marius Nasta Institute, as promoter of the project, sent a letter to inform the MDR coordinators, announce the first monitoring visits to be carried out by MDR experts focused on case management of TB MDR / XDR and accelerate the enrollment of eligible patients to receive treatment for tuberculosis.
By the end of August, the MDR coordinators continued to send, to the project team, databases updated with patients diagnosed with resistant and extremely resistant to treatment tuberculosis and recorded in the period May to July 2015.
Incentives for outpatients treated TB patients in order to increase adherence to treatment
In August, form the total of 1740 patients considered eligible to be enrolled in the project, 487 patients sent (by the 10’th of July) signed consent records. In addition, during July 11 – August 31, 1 of 62 new patients were sent sheets consent. Overall, 549 patients were enrolled by the end of August 2015 (36.6% of the 1,500 planned for the entire implementation period). For patients eligible to receive social support for treatment adherence as medically administered throughout July, the project team has centralized the following information:
– 441 patients received single social support so far in the project to maintain adherence to treatment,
– Cumulatively in the period May to August, vouchers were distributed to a total of 1,193 patients (172 in May, 249 in June, 359 in July and 413 in August). Of the 172 patients who received support in May, more than 87% and 151 patients received vouchers for maintaining adherence in the 4 months mentioned.
Equipment for TB laboratories and TB units in the country
A contract was signed for the acquisition of 8 GeneXpert equipment and the procurement procedures for work kits were initiated with GDF mechanism.
For the acquisition of 3 Versatrek equipment and necessary supplies documents required have been completed the process for selecting the supplier, and the acquisition will be officially launched on specialized sites.
Legal procurement procedures were launched for the purchase of 44 protective hoods for laboratories (date set for the opening of tenders is 16 October 2015) and 10 LED microscopes for laboratories.
It was completed the legal procedure and signed the purchase contract for nine vehicles who will ensure the transport of samples from TB units in the country to laboratories with modern equipment diagnostics.
And last but not least, for the purchase of IT equipment provided there were completed: the technical specifications, the requirement reports and the lists of the TB units to be equipped (the criteria for selecting the units PNF, the lists of units to be first appointed, the PNPSCT management decision).
Also during August activities were conducted to organize the second training of trainers in health communication (participant’s identification, location identification).
Expenditures for the period 1 to 31 August 2015 are shown in the table below:
