Project financed by the Norwegian Grants 2009 - 2014, within the RO 19 - Public Health Initiative.
One thousand patients detected with multidrug resistant tuberculosis receive quality treatment, starting with March. At the same time, once they go home, they, together with other 500 patients (who receive treatment through governmental financing) shall be monitored by the doctors from the local TB dispensaries, so that they don’t discontinue the therapy. In order to help them cope with the new situation which involves many costs (from those related to healthy nutrition, to support the body, to those related to regular checks which imply travelling to the doctor), all the 1500 patients shall receive, starting with May 2015, monthly social tickets of 80 lei, the main goal being to help them follow the correct administration of anti-TB treatment.
Last year in Romania there have been diagnosed 14,938 TB cases; 12,562 new patients, and 2,376 patients were relapse cases. 449 were cases of multidrug resistant TB (MDR – when two anti-TB drugs cannot generate a response from the illness) and 36 extensive resistant (XDR – when more than 4 anti-TB drugs cannot fight the disease).
One of the biggest challenges of the multidrug resistant TB, either MDR or XDR, is the treatment, taken continuously and consistently. Some of the sensitive tuberculosis relapses can turn into multidrug resistant TB, if the patient didn’t take the drugs according to the treatment regimen and on the duration prescribed by the doctor. The treatment side-effects can be various: from vomiting, bone aches and headaches, up to hearing impairment. There are days, towards the end of the treatment, when some patients feel good and decide on their own to give up the medicines or start taking them irregularly. Thus, the few months of treatment become useless and the risks to relapse or to turn into a more aggressive form increase.
Cristina Popa, pulmonology doctor at the “Marius Nasta” Pulmonology Institute in Bucharest says that “the patients should know that they must continue the treatment, if not for them, then for those around them, to prevent spreading the disease to others”.
This time, the treatment is associated with a control system. In each county there will be one coordinator who shall collaborate with the doctors in all TB dispensaries in the county who are responsible for the MDR patients. “The DOT supporters are the medical staff or any other person trained in the administration under direct observation of the complete and correct anti-TB treatment. These can be nurses, community nurses or even the legal representatives of the patients”, says Iuliana Sîrbu, Romanian Angel Appeal Foundation, coordinator of one of the work packages within the project “Improving the Health Status of the Romanian Population through the Increase of the TB Control Capacity”.
In the MDR ward of the “Marius Nasta” Pulmonology Institute in Bucharest, about 30 patients have been enrolled since the beginning of March, while in Bisericani MDR Centre another 20 patients who receive treatment and who shall be monitored once they are discharged. This activity can be considered the most important of the project because, beside the TB treatment provided, there was a need to supervise its administration, but also for social incentives for the patients, support without which there is a risk to decrease the adherence to this difficult and long-term treatment.
The activities of the project are developed in line with the international TB control strategies, of which we mention: addressing the multidrug resistant tuberculosis in poor and vulnerable groups and ensuring standardized treatment, with the monitoring and support for the patients during the treatment.”
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