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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.

Rapid testing of patients for Multidrug Resistant and Extensively Resistant Tuberculosis (MDR TB and XDR TB)

This month, the activity of rapid testing techniques for diagnosing MDR and XDR TB took place in 11 laboratories of the National Programme for Prevention, Surveillance and Control of Tuberculosis to control the TB epidemic (NPPSCT) network: National Reference Laboratory (NRL) Bucharest, NRL Cluj-Napoca, and TB laboratories in Bacau, Brasov, Constanta, Craiova, Sibiu, Timisoara, Iasi, Baia Mare and Leordeni.

In January, 2231 people have undergone rapid diagnosis in these laboratories. Of these, 491 were diagnosed with sensitive tuberculosis (TB), 58 with MDR TB and 7 with XDR TB. The centralized data show that, in total, from March 2015 to January 2016, 15127 people were tested, of which 3769 were detected with TB, 345 with MDR TB and 13 with XDR TB.

Strengthening the capacity of the National Programme for TB Control to control the TB epidemic

Also in January, three courses for health professionals in the field of respiratory medicine were organized in Bucharest (at Marius Nasta Institute of Pneumology), Iasi and Suceava. These sessions were attended by 67 specialists, so the total number of health workers trained so far in the project comes up to 616 specialists. There have also been three monitoring visits to these courses.

The development of a network of functional laboratories for early detection of MDR / XDR TB

Having GeneXpert equipment purchased within the project and put into operation in the TB laboratories nominated by NPPSCT, this was the month when the testing activity by this method began in the laboratories in Cluj-Napoca, Iasi, Constanta, Craiova, Timisoara, Brasov, Leordeni and Baia Mare.

In the previous month, the first batch of GeneXpert kits had been delivered to the TB laboratories equipped with GeneXpert equipment. In January 2016, all eight laboratories equipped with GeneXpert kits and equipment have been operating tests in order to diagnose MDR TB. Regarding the acquisition of 44 safety cabinets for laboratories, the centralised procurement procedure is in the bid evaluation stage.

Of the 10 LED epifluorescence microscopes purchased and received in the previous month, two were installed and commissioned in the NRL Bucharest. The other eight LED epifluorescence microscopes will be installed in Cluj-Napoca, Iasi, Constanta, Timisoara, Bacau, Brasov, Craiova and Leordeni laboratories.

This month, it has been carried out the first order for the supply of Versatrek kits for the 14 TB laboratories nominated by NPPSCT: NRL Cluj-Napoca, NRL Bucharest, and TB laboratories from Hospital St. Stefan (Bucharest), Iasi, Craiova, Leamna, Bacau, Calarasi, Galati, Targoviste, Drajna, Deva, Targu Mures and Focsani. For IT equipment, the centralised procurement procedure is in the bid evaluation stage.

Ensuring the correct, complete and quality treatment of the patients with MDR / XDR TB

In January 2016, 12 patients with MDR TB requiring in emergency treatment were enrolled in the project. In total, since the beginning of the project, a number of 302 patients were enrolled in treatment, of whom 45 Roma people.

During January, 108 medical records were analyzed by the MDR TB commissions doctors, and 55 of the patients received the recommendation to be enrolled into treatment as soon as anti TB from UNIFARM warehouse will receive authorization for exemption from the labeling.

Providing integrated interventions to prevent transmission of TB in poor communities and to increase treatment adherence

Three training sessions with Community workers were organized in Gorj, Giurgiu and Calarasi counties, involving a total of 149 people. To this date, this course was attended by a total of 309 community workers. There were four monitoring visits to the trainings that took place in Craiova (Dolj county) Tg. Jiu (Gorj county), Giurgiu (Giurgiu county) and Calarasi (Calarasi county).

Providing directly observed treatment (DOT) and incentives for TB patients treated in ambulatory in order to increase adherence to treatment

Of the 1876 patients considered eligible to be enrolled in the project, 671 patients had consent sheets signed until 10th of December. Between 11th of December 2015-31st of January 2016, a total of 24 new patients have sighend consent sheets. In total, 668 patients are enrolled in the project.

For the patients who are eligible to receive social support for adherence to anti TB treatment, the project team has centralized the following information:

– 598 unique patients, of which 61 Roma, received social support in the project so far, to maintain adherence to treatment.

– Overall, between May 2015 and January 2016, a total of 3594 patients received vouchers.

Of the 172 patients enrolled in the first month of the project: 59 patients successfully completed the treatment (34.30%), 9 patients died (5.23%), 3 patients abandoned the treatment (1.74%) and 101 patients are still in treatment and are adherent since April 2015 (58.72%).

Providing information about TB to the patients, vulnerable groups and general population

The brochure for TB patients was finalized and resources have been identified for organizing the workshop for assessing the information needs of TB patients. Preparations for organizing the communication for health training have been undertaken, as well.

Other January activities:

The procurement of UV lamps was completed and the locations to be equipped with UV lamps had been reviewed.

Preparations for next year TA missions of WHO experts continued, by identifying the periods, NPPSCT priorities and the experts to carry out those missions.