Project status update by 31’st of July, 2015 (period 1.07 – 31.07.2015)

More and more patients with tuberculosis across the country are being screened for tuberculosis multidrug resistance, in the labs provided with modern equipment for rapid diagnosis of MDR-TB / XDR.

During July, it continued the rapid testing of TB patients in the laboratories of the PNPSCT network, equipped with modern diagnostic (national reference laboratories in Bucharest and Cluj and TB laboratories in Bacau, Brasov, Constanta, Craiova, Sibiu and Timisoara).
In total, in July, 1,327 people were tested within MGIT and LPA techniques; of these, 42 patients were found with resistant TB, including 15 patients with MDR TB.

The centralized data during March-July 2015 show that in 5 months only since eight laboratories in the country are carried out rapid testing for MDR TB using modern equipment procured under the project, 5428 people were tested. Of these, 333 patients were detected with resistant TB, including 122 patients with MDR TB.

Medicines for correct, complete and quality treatment of MDR TB, available for 200 patients

44 new patients with MDR TB were enrolled in the project in July, to receive correct, complete and quality treatment, adding to those already enrolled 138 patients by the end of June 2015. Currently, there are drugs available for the treatment of 200 patients. Medicines for the remaining 550 patients to be treated in the project will be available in approximately two months, after completion of quality controls and labeling exemption from approval by ANMDM.

Also in July, 27 of MDR project coordinators sent to the central team the databases updated with patients diagnosed with TB MDR / XDR and recorded during May – July 2015.

DOT and incentives for TB outpatients

In July, from 1723 patients considered eligible to be enrolled in the project, 409 patients were submitted signed consent forms, by 10th of June, and between June 11 to July 31, other 56 new patients were sent signed consent forms completed. Overall, the project enrolled 465 patients for receiving incentives (ie 31% of the 1,500 planned).
For patients eligible to receive social support adherence to anti-TB treatment administered according to the doctor’s recommendations throughout June, the project team has centralized the following information:
– 373 unique patients received social support so far in the project,
– cumulatively in July, June and May, vouchers were distributed to a number of 778 patients (172 in May, 249 in June, 357 in July). Of the 172 patients who received support in May, more than 91% (ie 158 patients) received vouchers for maintaining adherence in all three months.

By the end of July, 42 of MDR TB coordinators in Bucharest and the country received incentives for activities carried out in order to increase patient adherence to treatment, during April-June 2015.

Continue the training for the health professionals that are part of PNPSCT, in order to increase capacity to control the epidemic tubeculoza

Between 2nd – 4th of July, 2015 it was held a course for 25 health professionals in the field of respiratory medicine at Buzau. Lecturers were Dr. Luminita Palaghianu and dr. Emilia Tabacu. The course was attended by health professionals from Buzau and Vrancea counties.
In total, to date, 214 have been trained in the field of respiratory medicine by health professionals (109 nurses and 105 doctors), representing 36% of the proposed target of 600.
Also, on 2nd and 3rd of July was made a monitoring visit to Buzau, for the course held here.

Working on updating the national electronic database of PNPSCT

In July 2015, several working meetings were held with company representatives selected to provide services for updating and maintaining the national database of PNPSCT and were discussed the modules that require changes in line with the international recommendations in the field.

Steps to strengthen the capacity of preventing TB transmission in poor communities

On the 6th and 7th of July, the project team representatives attended the international seminar entitled „Services health for vulnerable communities”, along with representatives of Ministry of Health and five County Departments of Public Health of six Departments included in the project RO19.01.
The communication with experts appointed on completion of the course curriculum for community workers continued.
Also in July there were identified the two experts who will provide TOT course and the 12 representatives who will monitor the work of local officers and will prepare all community nurses in their communities.

The World Health Organization (WHO) will provide technical assistance to the PNPSCT

During July, the contract was drafted, for the World Health Organisation to provide technical assistance to the National Programme for Prevention, Surveillance and Control of Tuberculosis. The contract was sent to the office of the World Health Organizationin Copenhagen.

Expenditure for the period 1 to 31 July 2015 are shown in the table below:

Project status update by 30th of June (period 1.06 – 30.06.2015)

Courses for healthcare professionals, to increase skills in TB control

During June 2015, five courses for health professionals in the field of pneumonology were held in Ploiesti (05.06 – 06.07.2015 for doctors in Ploiesti), Constanta (05.06 – 06.07.2015 for doctors in Constanta), Timisoara (12.06 – 14.06.2015 for doctors from Timis county and in Caransebes), Pitesti (19.06 – 21.06.2015 for doctors Dambovita and Arges counties), Cluj-Napoca (26.06 – 06.28.2015, for doctors from Cluj and Bistrita in Nasaud).

165 health professionals were trained in the field of respiratory medicine until now, within the project, through 7 training sessions. 117 of the professionals were trained in June.

Also in June it was completed the process of collecting the documents necessary for the conclusion of contracts for trainers courses, for 600 doctors and nurses working in PNPSCT network.

TB patients testing across the country, for rapid MDR TB diagnose

The data corresponding to the testing activity in the 8 laboratories equipped by the project, shows a total of 1,722 patients tested during June 2015, with the LPA and MGIT equipment. 63 patiens were found with resistant TB, including 22 with MDR TB.

Since March to June 2015, 3937 patients were screened within the project; 282 patients were found to have resistant TB, of which 106 have MDR TB.

Complete, continuous and quality treatment for patients with MDR TB

In June 2015, 38 more patients were enrolled in order to receive treatment for resistant tuberculosis, in addition to the 101 included up to May 31, in total being enrolled 139 patients with MDR TB.

By the end of June, the MDR TB project experts completed analysis of databases of all 41 counties and 6 districts of Bucharest. Of all cases analyzed, 422 were considered eligible and proposed to be communicated to MDR TB coordinators whose role is to ovesee the filing and forwarding of the relevant cases towards the two MDR TB committees, for enrollment in treatment.

The project’s team together with the MDR TB experts continued tu provide the MDR coordinators and physicians, information and clarifications about the  of cases forwarded to the MDR TB commission and also useful information about medication orders and stock management of anti-TB drugs.

During the current month , the last batch of drugs was received , part of the initial order (for the first 200 patients). The project team continued the correspondence with GDF and IDA regarding the next medication delivery, and the expiration deadlines for the other drugs that still need to be delivered.

DOT and incentives for MDR TB outpatients, in order to increase treatment adherence

In June, the regional coordinators sent to the MDR TB coordinators the latest database of patients diagnosed with resistant TB (RR, MDR-TB, XDR-TB) or sensitive TB and with a high risk of mortality, failure or treatment abandonment. The data were analyzed by expert physicians who made recommendations for enrollment.

Of the 1706 patients considered eligible to be enrolled in the project, 401 records submitted signed consent by the end of the month.

For patients eligible to receive social support for adherence to TB treatment administered under medical observation, throughout May, the project team has centralized the following information:

– 246 unique patients received social support so far in the project, status confirmed by treating physicians and comunicated by the MDR TB coordinators.

– Cumulatively, in June and May, tickets have been distributed to a total of 405 patients (166 in May and 239 in June), of whom 161 patients received vouchers for maintaining adherence in both months.

Also in June:

– For the process of updating the national database to be in line with TB WHO recommendations, the project’s team asked for technical assistance from the ECDC (the appointment of an expert in epidemiological surveillance for a mission of at least 3 days). According to the ECDC Director’s answer, the appointed expert is Vahur Hollo and the mission will take place in the next period.

– Preparations were made to finalise the signing of the contract with the World Health Organization and an official address was sent to ANRMAP to ask the opinion of the Agency on the OUG 34/2006 except for direct contracting of the World Health Organization.

– The project’s presentation brochure was printed, both in Romanian and English.

Expenditures for the period 1 to 30 June 2015 are shown in the table below

Project status update by 31st of May (period 1.05 – 31.05.2015)

All counties were assigned for sending samples to the labs equiped through the project, for rapid diagnosis of TB MDR / XDR

In May 2015, the TB patients’s testing through rapid MDR / XDR TB diagnosis techniques continued in the PNPSCT’s network laboratories in Bucharest, Cluj, Bacau, Brasov, Constanta, Craiova, Sibiu and Timisoara – the labs were equipped with appropriate equipment and supplies. All counties were assigned for sending samples to these laboratories, thereby ensuring patients across the country access to rapid diagnosis. By the end of May 2015, 2,186 patients had been screened (of which 1341 patients only in May); 195 patients were found to have TB resistance, of which 78 have MDR TB.

The number of patients enrolled in treatment in the project increases – 101 people, up to May 31, 2015

33 more patients with MDR TB were enrolled in the project in May, in addition to the 68 enrolled until the end of April to receive complete, continuous,  quality treatment. The total number of MDR TB patients enrolled for getting medication is 101.

The inclusion of patients in treatment is based on the MDR TB Commission’s decision as a result of eligible patient dossier and the patient’s signed consent sheet submission to the Commission. By the end of May the information was collected in Bucharest and in all counties. The MDR TB experts continued the analysis of the project database and identified 600 patients with resistant tuberculosis that could receive treatment through the project. In the next period, this information will be communicated to the MDR coordinators who will supervise the process of forwarding the patient files to the  two MDR TB committees, in order to enroll them in treatment.

During May, the dossier for authorization of special needs for medication has been deposited at the National Medicines Agency,   and the correspondence with GDF and IDA, concerning the next disbursements of drug deliveries in the country, and  the expiration deadlines for the  drugs that will be delivered, was continued.

The process of data centralizing and eligibility analysis for social support was completed and the incetivising program was initiated in order to increase the adherence to treatment

After centralizing the databases  that the MDR coordinators received from all over the country until the end of May, regarding patients with resistant tuberculosis or sensitive TB patients with high risk of mortality, treatment failure or abandonment, , 1746 patients were considered eligible to be enrolled in the project. According to the methodology, once considered eligible to benefit from social support, the patients must submit signed consent sheets. 363 patients from 1746 submitted their signed consent sheets by the end of May.

For patients eligible to receive social support for anti-TB treatment adherence administered according to medical recommendations throughout April, the project team has centralized the following information:

– 160 patients were eligible to receive social vouchers – meaning 160 patients who completed and signed consent records up to April 10, 2015 (those who signed after this date will receive the tickets the following month).

– The 160 patients received social support in May in order to keep treatment adherence, status confirmed by the patient’s treating physicians and communicated by the MDR TB coordinators –through  completing and signing the monthly centralizers which have been forwarded to the RAA Foundation’s regional coordinators during the month.

On 9th and 10th of May, the project team organized, in Bucharest, the first meeting of the national MDR TB coordinators. The event was attended by 35 MDR coordinators and the topics were presented by lecturers from the « Marius Nasta » Institute and Romanian Angel Appeal Foundation.

During the meeting, the mobile phones and HEPA masks for the voluntary activity performed by MDR coordinators in order to increase patient adherence to treatment, were also distributed.

For the MDR coordinators who could not be present at the first meeting, monitoring and evaluation visits were organized, in order to inform and train them. By the end of May, the RAA coordinators visited Neamt, Cluj, Salaj, Hunedoara, Satu Mare and the Ambulatory of Pneumology of District 1, Bucharest.

Providing the laboratories in the country with MDR rapid diagnosis and IT equipment  

During this period, the supply the laboratories with GeneXpert equipment (8 devices) and Versatrek equipment (3 devices) continued . For GeneXpert equipment procurement the contract was signed with the company declared the winner of the selection procedure, as for the Versatrek equipment and supplies, the documents necessary for the selection process were finalized and the procedure will be officially launched on specialized sites after approval  of the unit investment list for 2015, by the Ministry of Health.

Other TB laboratories in the country will be equipped with protective hoods (44 labs), LED microscopes (10 labs), IT equipment and vehicles.

For the purchase of 44 protective hoods and 10 LED microscopes the technical specifications were developed in order to launch the selection procedure of the supplying company and the supplier selection procedure will be launched when the necessary funds will be available.

For the purchase of IT equipment and vehicles, the technical specifications development was completed and also the lists of TB units that need to be equipped through project. The procedure for selecting suppliers will be released upon receipt and approval, by the Ministry of Health, of the list of investment funds.

Also in May:

– Two courses for health professionals in the field of pulmonology were held in Timisoara (15.05 – 17.05.2015) and in Sibiu (28.05 – 30.05.2015), in order to increase the  containment of TB in Romania

– A work meeting of  the representatives of the Project Promoter, the RAA Fondation and the World Health Organization was held for arranging the procedure of contracting the WHO  and the joint missions financed by the Global Fund and Norwegian Fund.

– The first training course on health communication was held, meant to create new trainers

– The projects’s presentation brochure’s layout was finalized.

Expenditures for the period 1 to 31 May 2015 are shown in the table below:

Project status update by 30th of April (period 1.04 – 30.04.2015)

Eight laboratories in Romania began in April the rapid testing of the multidrug-resistant TB .
All counties were assigned for sending samples.

This month has started the MDR TB rapid testing in two TB reference laboratories (Bucharest and Cluj) and in the TB laboratories in Bacau, Brasov, Constanta, Craiova, Sibiu, Timisoara, all part of the National Programme for Prevention, Surveillance and Control of Tuberculosis. All counties were assigned and send samples to these laboratories, in order to ensure the patients access to modern diagnosis techniques. The eight laboratories perform rapid diagnosis of MDR/XDR TB, after being equipped with LPA and MGIT equipment and test kits, within the project.
So far, 707 people received rapid testing in the project.

A series of 8 GeneXpert rapid testing equipment and GeneXpert test kits will be purchased and installed in these eight laboratories. Equipment procurement contract was signed. As for the GeneXpert test kits procurement, the ANRMAP views were requested on the organization of a new procedure for selecting the supplier, because offers of companies participating in the project overcome the budget provided.

44 TB units in the country, being equipped for effective control of tuberculosis

A total of 44 protective hoods for laboratories and TB units, 10 LED microscopes, 3 Versatrek equipment and consumables, IT equipment, and 9 vehicles will be purchased to increase the capacity for effective control of TB in TB laboratories and units in Romania.
Currently, the technical specifications were developed for all these items and were made necessary papers and lists TB units which will be provided by the project.
Procurement procedures will be initiated in the next period. To buy microscopes, legal procedure for selecting the supplier will be released when the necessary funds become available. For Versatrek equipment, procurement procedure will be officially launched on specialized sites after the approval, by the Ministry of Health, of the unit investment list for 2015, and for the purchase of IT equipment and vehicles, the selection of suppliers will be launched after the receipt of the necessary funds and after the investments checklist approval by the Ministry of Health.

The laboratory personnel will also be trained in the TB infection control, and in April was completed the course curricula for training sessions.

The number of patients who receive continuous, complete and quality treatment through the project, increase.
Another 400 cases of MDR TB identified as eligible.

During April, 21 patients with MDR TB were enrolled in treatment, in addition to the 47 patients enrolled in March. Thus, at the end of April, 68 multidrug resistant TB patients were enrolled to receive continuous, complete and quality treatment.
The enrollment of patients in treatment is based on MDR TB commission decision, after examining the file of the patient and after the patient signs his consent sheet.
County coordinators have been identified for MDR TB (with responsibilities related to MDR TB case management, patient records transmission, including supervision by committee, supervision of medication orders for patients in the treatment of outpatient phase) and with their help was initiated the mapping of drug resistant tuberculosis patients who would be eligible to receive treatment through the project.
By the end of April, they collected information from Bucharest and 26 counties. The rest of the counties will transmit data until mid-May. After analyzing the database, experts have identified over 400 MDR TB patients potentially eligible to receive treatment in the project.

DOT and incentives for TB patients treated outpatients. 50 poor communities identified for providing support to prevent illness and increase treatment adherence

By the end of April, we collected information on 1,377 patients from Bucharest and 26 counties, diagnosed with resistant tuberculosis or with sensitive tuberculosis but who are at increased risk of mortality, treatment failure or abandonment, in order to centralize eligible cases to receive directly observed treatment (DOT) and support to increase adherence to treatment. The process continues and data are expected from all counties.
Meanwhile, the finalized the criteria for inclusion of patients in the project, and criteria for prioritizing cases. A patient is eligible to be enrolled, if he/she meets the following conditions: a. he/she is diagnosed with TB resistance (RR, MDR-TB, XDR-TB) or TB sensitive but has an increased risk of mortality, treatment failure or abandonment; b. he/she takes his drugs following the doctor’s recommendations; c. he/she takes anti-TB treatment as outpatient OR, he/she is at least at his/her second hospitalization by the time of his/her inclusion in the project.
The priority criteria to be enrolled in the project:
a. TB patients with MDR / XDR
b. patients with other chemoresistance
c. patients ‘chronic’ with retreatment
d. patients with retreatment due to abandonment or failure.

At the end of April, following the centralization of records of consent, a total of 218 patients will receive social support, which will be awarded in May.

Also in April, it was completed the identification of 50 poor communities where there will be provided integrated interventions to prevent transmission of tuberculosis and to increase treatment adherence. There were also identified the community workers who will work effectively with patients, after receiving training.

The World Health Organization (WHO) will provide technical assistance to the National Programme for Prevention, Surveillance and Control of Tuberculosis

In April, representatives of the Ministry of Health (operator of program), the Pulmonology Institute “Marius Nasta” (project promoter) and of the World Health Organization attended a working meeting with President of ANRMAP in order to identify legal solution, according to the GEO 34/2006, for directly contracting the WHO services of technical assistance for TB control. The project’s team will send an address to ANRMAP, specifying the relevant aspects for meeting the criteria for exception to GEO 34/2006, pursuant to Articles 14.a and c.

The training of healthcare workers starts. They will be able to provide information about tuberculosis to TB patients, vulnerable groups and the general population

The first tranche of funding was disbursed to the Norwegian partner LHL International Tuberculosis Foundation which coordinates the action to inform patients, vulnerable populations and the general public about tuberculosis. First, healthcare workers will be trained in order to be able to implement information campaigns. Their first training session will take place in the second half of May.

Coming soon, the project brochure

The activities to inform policy makers and the general public about the activities in the project continue. No 3 of the bilingual Newsletter was sent at the end of April and the project’s presentation brochure could be printed in May.

For receiving information about the control of TB in Romania, please subscribe to our Newsletter by entering your e-mail in dedicated field clicking the Subscribe button (in the right column).

Expenditure for the period 1 to 30 April 2015 are shown in the table below:

Project status update by 31st of March (period 1.01 – 31.03.2015)

Equipment for the rapid diagnosis of MDR TB; the first patients enrolled in the project, for treatment 

The firsts months of 2015 have meant major progress in the project “Improving the health status of the population in Romania by increasing tuberculosis control”, conducive to achieving some of the objectives of the whole endeavor: strengthening national capacity for early diagnosis of TB MDR / XDR and providing complete, continuous and quality treatment with second-line drugs for patients with MDR TB / XDR.

In late February, it was completed the acquisition of LPA and MGIT equipment enabling rapid diagnosis of tuberculosis resistant to treatment. In the first part of March 3 MGIT equipment have already been installed in lung disease laboratories in Bucharest, Cluj and Bacau. Because it enables the diagnosis of MDR TB in a very short time, the high performance equipment purchased under the project offers patients the chance to receive appropriate treatment immediately form of tuberculosis sufferers.

In early March, the first 50 patients with MDR TB were enrolled in the project (35 at Marius Nasta Institute, in Bucharest and 15 at the Bisericani Pneumology Hospital, in Neamt county) for receivind correct, complete and quality treatment treatment.

Training for professionals and TB Technical Assistance Unit and Management of PNPSCT staff

During 19 – 22 March, at Ibis Parliament Hotel, in Bucharest, the first session of training of trainers on drug management, control and surveillance of tuberculosis infection was held. Further, the trainers will train 600 doctors and nurses from across the country. Training sessions for different groups of participants are set to run until March 2016. The courses are organized under the coordination of the Policy and Services Health Center Foundation.

Between 24 – 25 March, the first training session in methods for rapid diagnosis of tuberculosis was held for the Marius Nasta Institute laboratory personnel. The courses are coordinated by Marius Nasta Pneumology Institute team.

Information activities

• The press conference to launch the project was held on February 12, 2015, at Hotel Minerva. The speakers were the Ambassador of Norway in Bucharest, Mrs Suzana Matei, RO 19 Program Manager from the Ministry of Health and Mrs. Dr. Gilda Popescu, Project Manager, from the Marius Nasta Pneumology Institute. The event enjoyed broad participation from the World Health Organization – Romania Office, Romanian Ministry of Finance, the US Embassy, ​​numerous institutions and NGOs active in health, media.
• It was completed the first draft of the project’s presentation brochure.
• In early March, the first two issues of the electronic bilingual Newsletter (Romanian and English) of the project were sent to over 450 recipients – Romanian decision makers, public authorities, media, NGOs in Romania, but also to embassies and international organizations such as Finnancial Mechanism Office, World Health Organization (WHO Europe and WHO), Global Fund, Stop TB Partnership, TB Europe Coalition, GD Advocates, Results UK, TB Alert, UK Parliament, The Union etc.

Project status update by 31st of December (period 7.08 – 31.12.2015)

The project “Improving the Health Status of the Romanian Population by Increasing Tuberculosis Control” began a 7 August 2014 and aims at strengthening the tuberculosis (TB) control in Romania, with focus on multidrug resistant tuberculosis (TB) in Romania, with focus on multidrug resistant tuberculosis and extensively resistant TB (MDR/XDR TB) and poor and vulnerable groups.

Following the additional, on 4 December 2014 the additional agreement was signed for the extension of the project, it value becoming 10 740 280 EURO.

Thus, the operational objectives of the project were also extended, from 4, the initial number, to 8 objectives at the time being:

1. Strengthening the institutional capacity of the National Tuberculosis Prevention, Surveillance and Control Program (NTPSCP) in order to control the TB epidemics in Romania
2. Strengthening the national capacity to early diagnostic of MDR/XDR TB
3. Ensuring complete, continuous and quality treatment, with 2^nd line drugs, for the patients with MDR/XDR TB
4. Development of an integrated community support model for the treatment and prevention of TB in poor and vulnerable groups
5. Increase of treatment adherence at the TB patients
6. Strengthening TB infection control in the specific health facilities
7. Improving the management of the National Tuberculosis Control Program (NTP)
8. Increase the awareness degree of TB in Romania, among patients, vulnerable groups and general population

At this moment, there are 13 work packages under development, comprising activities meant to increase the TB control level in Romania and the awareness degree of the public regarding this affection.

The funds necessary for the project implementation for August-December 2014 were transferred in November 2014, that is after 4 months after the beginning of the project. Nonetheless, at the end of December 2014, 91% of the funds were spent for ensuring drugs for 750 patients.

After almost 5 months after the beginning of the project, in 31 December 2014, all the activities are according o the established schedule, and the most important results obtained are the following:

1. The anti-TB drugs procurement for the patients with multidrug resistant and extensively resistant TB was finalized; in December, the first batch of drugs was delivered for 200 patients out of the 1000 to be treated within the project. The same time, also in December, the payment for a new batch of drugs was done, which shall ensure the treatment for 550 patients with MDR/XDR TB.
2. The procurement procedures for rapid diagnostic equipments and supplies (Genexpert, MGIT and LPA) were launched. The procurement shall be finalized in February 2015, and starting with March the reference laboratories in the TB network can be equipped with the new devices and the rapid testing shall begin, in order to diagnose the MDR/XDR TB.
3. The evaluation of the national data base of the National Tuberculosis Control Program was finalized and priorities for the necessary adjustments were established, according to the World Health Organization.
4. There were identified the vulnerable communities where information-education-communication activities and TB cases detection shall take place, among the poor groups with limited access to health services.
5. The identity book of the project was developed, as well as the communication rules and tools, the project site and the Facebook page.

The total budget of the project is 10 748 280 Euro, respectively 47 308 554.42 RON.

In November and December, the Ministry of Health transfer to the “Marius Nasta” Institute the amount representing the advance of 25%, respectively 11 827 137.50 lei. Until the end of December, 10 300 541.02 lei were spent, representing 87% of the transferred funds. Of the total funds spent, more than 91% were spent for ensuring the treatment of patients with MDR/XDR B.

 The spending for the period 1 August – 31 December 2014 are shown in the table below: