New training session for TB coordinators at county level

The second county coordinator training session within the WP7 component – “Provision of integrated community support interventions in order to prevent TB spread in poor communities and to improve treatment adherence in TB cases” – of the project RO 19.01 “The Improvement of the health of the Romanian population through enhanced tuberculosis control,” entitled “Tuberculosis – course for community nurses and sanitary mediators,” was organised on 13-14 May at the “Marius Nasta” Institute of Pulmonology in Bucharest and focused on the streamlining of the implementing methodology and working procedures used, in order to improve the services provided to TB patients, as well as on the finding of solutions to the problems identified in the 6 counties where this work package is being implemented, by the county TB coordinators and community nurses.

“My colleagues in the counties are of the opinion that family doctors should be more seriously involved in the relation with the patients undergoing TB treatment, that they should be stimulated to participate in the efforts to increase patient adherence to the treatment. Another aspect is the need to employ community nurses, particularly in the rural area and in those villages and communes where there are no family doctors. At present, In Romania there are around 1,350 community nurses and over 2,800 communes that have approximately 13,000 villages. The community medical assistance law is currently being drawn up, we will see how this field is regulated in the end,” explains Dr. Dana Fărcășanu, executive chairperson of the Centre for Health Policies and Services Foundation (CPPS) and coordinator of the WP7 work package, which is being implemented by the CPSS.

The 10 participants in the course evaluated the project implementation status and the degree of achievement of the indicators at the end of April 2016, and planned the activity for the following period in terms of directly observed treatment provision (DOT) and the organisation of the following information-education-communication (IEC) caravans.

“In general, the practice is as follows: patients come once a month to the TB dispensaries and they take their medicines for the month in question. Nobody monitors on a permanent basis whether each patient takes his or her medicines in accordance with the treatment chart. When directly observed treatment (DOT) is applied, the DOT supporter stays next to the patient when he or she actually swallows the drugs. As a result, we have correct patient monitoring and the certainty that they continue to be adherent to the treatment,” says Andreea Turcitu, project monitoring and evaluation assistant on behalf of the CPSS. “The provision of directly observed treatment (DOT) within this project component began in January, and the first evaluations relevant in terms of effectiveness compared to the usual practice will be obtainable within around six months of actual implementation of DOT provision.” By the end of April, approximately 320 patients have been enrolled and received directly observed treatment under the WP7 component in the 6 implementing counties: Botoșani, Neamț, Gorj, Dolj, Giurgiu and Călărași, with around 160 DOT supporters involved.

The projects conducted at present with funding from the Norway Grants 2009-2014 (RO 19.01) and from the Global Fund to Fight AIDS, Tuberculosis and Malaria “are pilot-projects that are able to validate effective DOT methods and may represent models for their possible nationwide extension, and this is one of the project’s added values,” Dr. Fărcășanu adds. “Another added value is the large amount of important information gathered in the field: what works, what does not work, what must be changed and how in order to have national DOT coverage. These types of courses and meetings are necessary and I would be very happy if they were organised more frequently, because they are a good opportunity to discuss and find solutions to the problems identified in the field.”