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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.

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The numbers of Multidrug Resistant Tuberculosis (MDR) in Norway are very small, between 2 and 10 cases each year. In 2014, the total numbers of TB, including sensitive and drug resistant TB, there were 324 new cases. In comparison, in the same year, in Romania were 15.353 new cases, of which 547 were MDR, according to World Health Organization (WHO). For further information about Tuberculosis in Norway, we invited Mona Drage, deputy director with LHL International, a Norwegian organization founded by TB pacients.

LHL International has been founded by an organization of patients. What is the mission of this foundation?

The origion of LHL was five TB patients getting together in 1943, starting an organisation that would work against prejudice and fear and for the right to work and social asistance for TB patients. LHL has later evolved to include lung and heart diseases, whilst LHL International continues the work on TB.

The vision of LHL international is a world free of TB, and we work towards this through ensuring the right to life and health for those affected by TB, ensuring patient involvement, and working to end discrimination of TB patients.

What is the history of TB cases in Norway?

Norway was very hard hit by TB previously. Around 1900, every 5th death in Norway was caused by TB. In this period, Norway was one of the poorest countries in Europe. From early 1900 to around 1950 there was a steep decline in TB prevalence and mortality in Norway.

What is the present situation of tuberculosis in Norway?

Today TB is a rare disease in Norway with between 300 and 400 new cases each year. In 2014 there were 324 new cases, resulting in an incidence of 6/100 000.

In Romania, many patients with MDR and XDR abandon treatment after a few months because they start to feel better and want to get rid of the side effects of antituberculosis drugs. Is this a behavior that is found among patients in Norway, too?

MDR and XDR treatment is very long and very though for many patients, and it is very understandable that some people fell tempted to stop the medication at some point. We have had examples of that happening in Norway also, but not very often. The numbers of MDR in Norway are very small, between 2 and 10 cases each year.

What are the psychosocial needs of patients with TB? Are there significant differences between patients from different countries of the world where it operates LHL?

The psychosocial needs of TB patients vary from individual to individual, but we have seen many commonalities in the countries we work. Patients need to understand what TB is and to believe that they can be cured. They must understand why it is important to continue their medication long after they feel well and they must be motivated to do so. Speaking with ex-TB patients/peer support is highly effective, both as a motivation and sharing of a common experience. There is a lot of shame and stigma (both spoken and unspoken) among patients, so not to feel alone, but to be supported by someone you trust, be it your doctor, neighbor, spouse, peer etc.

How can the doctor gain the trust of his patients so they remain adherent to treatment until the end of the treatment?

Trust is earned over time. The doctor showing interest in the patient , letting the patient feel you have a common goal, and that he/she will be supported all the way, helps building trust quicker. This includes for example how the doctor receives the patient, what kind of questions the doctor askes and the body language of the doctor.

What are the most effective ways that lead patients to maintain adherence to TB treatment?

Make sure that the patient has enough knowledge about TB, that they believe it is curable and that they are motivated to reach their goal. That is, ensure inner motivation. In addition, regular follow up of the patients and incentives that are appropriate to that particular patient is also effective.

How can the communication between health professionals and patients be improved in order to treat tuberculosis more effectively?

A lot can be done to improve communication between health professionals and patients in order to treat TB more effectively. The first and most important step is awareness; it is important to become aware of how our words and actions affect others and whether we affect others the way we wish to. We all have areas we can improve upon when it comes to communication, and small changes can have great impact in our lives, both professionally and personally. LHL International has developed a training concept that looks at how to achieve a good result even when time with each patient is limited. Together with ASPTMR, we have had four trainings in health communication through this project so far. And the unison feedback from the participants is that they find this training very useful!