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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.

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.