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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.

Tuberculosis (TB) is a major public health threat in Romania, and this is unanimously recognised at international level as well.

The poor diagnosis infrastructure, the out-of-date registration/reporting system for new cases, the insufficient provision of comprehensive, quality and directly observed treatment (DOT), especially for multidrug-resistant tuberculosis, the inappropriate infection control measures in the TB units, the absence of social support that could help adherence to treatment and cure, all of these caused by the chronic underfinancing of the National Tuberculosis Prevention, Surveillance and Control Programme and by the lack of a clear mandate under this programme regarding medicine management, deepen the TB problem in Romania.

Moreover, in recent years, tuberculosis has stopped being just a “disease of poverty” and has also reached the middle class, which has higher potential for spreading.

The project entitled “The improvement of the health of the Romanian population through enhanced tuberculosis control” is based on the measures included in the National Tuberculosis Control Strategy 2013 – 2017, which was developed based on the WHO and ECDC (European Centre for Disease Prevention and Control) recommendations, but these measures risk not being able to be put into practice in the absence of adequate financing from the state budget.

The general objective of the project is to consolidate the control of tuberculosis in Romania, focusing on multidrug-resistant and extensively resistant tuberculosis (MDR/XDR TB) and on poor and vulnerable groups.

Specific objectives

  1. The institutional capacity-building of the National Tuberculosis Prevention, Surveillance and Control Programme (PNPSCT) with a view to controlling the TB epidemic in Romania
  2. The strengthening of the national capacity for early diagnosis of MDR/XDR TB
  3. Ensuring comprehensive, continuous and quality treatment using second-line medicines, for patients with MDR/XDR TB
  4. The development of an integrated community support model for TB treatment and prevention in poor and vulnerable groups
  5. The increase of adherence to treatment in TB patients
  6. The strengthening of TB infection control in specialised medical units
  7. The improvement of the management of the National Tuberculosis Control Programme (PNCT)
  8. Raising the awareness regarding TB in in Romania among patients, vulnerable groups and the general population.

Within the project:

  • 8 reference laboratories will be endowed with modern equipment for early MDR/XDR TB diagnosis. To this end, the following will be procured: 3 MGIT systems, 8 GeneXpert systems, 2 LPA systems, 3 Versatrek systems, together with the necessary consumables for genetic tests, cultures and antibiograms, 10 LED microscopes, 44 biosafety cabinets. The medical staff will be trained in the use of modern diagnostic techniques.
  • 2000 UV lamps will be purchased in order to equip the TB units, and 960 employees (doctors, nurses, administrative staff) will be trained in the control of tuberculosis infection
  • WHO-prequalified second-line medicines will be purchased through the Global Drug Facility (GDF)mechanism, for the correct and complete treatment of 1000 patients with MDR/XDR TB
  • 1000 patients with TB and MDR/XDR TB, including Roma, will be supported in outpatient care, through DOT and social support, and 10.000 persons will be informed with regard to the transmission, prevention and symptoms of TB, as well as to the access to primary medical care, in 50 poor rural communities to be selected
  • 70 sanitary mediators and community nurses from the 50 communities will attend DOT and education-prevention courses in the TB field
  • 1500 TB patients treated in outpatient care will receive treatment under direct observation, as well as incentives in order to avoid treatment interruptions or even abandonment
  • 600 persons from the national TB network will benefit from a specialised course relating to medicine management, TB infection control and surveillance, and 15 employees of the Technical Assistance and Management Unit of the PNSPCT will attend training courses
  • the national TB database will be updated, following a software upgrade, and 315 computers will be purchased for the endowment of TB units
  • 20,000 brochures and 100,000 leaflets will be distributed to patients, vulnerable groups and the population
  • at least 30 decision-makers will be informed regarding the results of the projects.

The project “The improvement of the health of the Romanian population through enhanced tuberculosis control” started on 1 August 2014, it has an implementing period of 20 months and is carried out by the Marius Nasta Institute of Pulmonology in Bucharest, in partnership with the Romanian Angel Appeal Foundation and the Centre for Health Policies and Services.

The total budget of the project is of EUR 10,748,280, i.e. RON 47,308,554.42.

The project is co-financed through the Norwegian Financial Mechanism 2009 – 2014, within the Public Health Initiatives Programmes, operated by the Ministry of Health.