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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.

The practice showed that some TB patients might abandon the treatment after the first month of administration, because they begin to feel better, or continue to take only a part of the compulsory medication, discarding those with unpleasant adverse reactions (nausea, vomiting, bone aches, etc.). The pneumologists say all the time: these moments favor the development of the Koch bacilli (Mycobacterium tuberculosis) resistant to the existing anti-TB drugs, and the patients become a source of resistant TB infection. In this context, the treatment under direct observation (DOT) by community nurses and community health workers (called DOT supporters) is extremely important. The project Coordinator, Florin Sologiuic, working with the Center for Health Policies and Services (CHPS), partner in the project ”Improving the health of the population in Romania by increasing TB control” explains the role of the Center in implementing the directly observed treatment (DOT) in communities.

In how many communities in Romania the TB directly observed treatment is implemented by DOT supporters?

In the project ”Improving the health of the population in Romania by increasing TB control”, we have 82 communities in 6 counties: Botoșani, Neamț, Gorj, Dolj, Călărași and Giurgiu. Those 50, as we initially began, were not enough, because we realized we have patients in several towns and we wanted to cover as much as possible.

How were the DOT supporters selected in these communities?

Based of the communities having TB patients. This was the selection criterion for the DOT supporters. In the communities with patients, the health mediators and community nurses of the local social care authorities were included in the project. Some of the employees leave, they go to work abroad or find another job, some take maternity leave. At present we have 89 DOT supporters, out of which 4 are Roma health mediators.

What has to do a DOT supporter in this project?

Initially, the worker contacts the patients following to be enrolled in the project, those who receive financial incentives which must ensure an additional support for the medication.

In each county we have also one coordinator of the DOT supporters and, based in the data he or she provides, the supporter gets in touch with the patients, explains them what is all about and give them a file explaining her rights and obligations. If the patients agree to enter the program, signs a consent form in order to receive the directly observed treatment. Afterwards, the supporter goes to the family doctor in the community or to the TB ambulatory in the catchment area of the community and administers them three times a week to each patient. The DOT supporters also encourage the villagers to participate at the medical caravans, information sessions about TB which are organized in these communities.

How do the directly observed treatment process is taking place?

So far, in this project, 150 patients receive directly observed treatment. In average, a DOT supporters has 1 up to 3 patients. It is not very simple, because the treatment implies travel in 3 different days to the patient, so one cannot have many patients, otherwise one wouldn’t have time to do all the work. In each of the 3 days in which the patient has to take the treatment, the worker watches the patient taking each pill in the list of treatment. Because the reactions are sometimes difficult for the patient, from vomiting to headaches or deafness, it is a good thing that the patient to be encouraged and monitored when taking the treatment, to avoid the relapse with aggravated form of multidrug resistant tuberculosis.

What else does the DOT supporter has to follow at the patients?

Being in close contact with the patient, in case he or she declares the change of the health status or tells the worker that something with impact on the disease or treatment happened, the DOT supporter communicates with the family doctor or the TB ambulatory that the status has worsened or the new situation the patient informed him about.  It is possible that, at some patients, other diseases appear, ant this fact should be notified.