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Description
Tuberculosis is a top killer worldwide, ranking alongside HIV/AIDS, and places its heaviest burden on the world’s poorest and most vulnerable. Romania reported 10,404 new tuberculosis (TB) cases and 2637 retreatment cases, in 2017, having the highest TB incidence in the European Union/European Economic Area region.
The goal of the project is to strengthen tuberculosis control in Romania through the implementation of the WHO END Tuberculosis Strategy. The project contributes to the prevention and control of tuberculosis, aiming to improve access to health care for patients with tuberculosis, to strengthen primary care health services by purchasing laboratory equipment and training psychosocial staff, and participate in health care system development and information by specific activities such as awareness campaigns, training in advocacy, communication and social mobilization, health rights literacy programs promotion and health communication training. The main project results are: decreasing to 4% the Tuberculosis mortality rate (per 100,000 population), 15300 persons tested for tuberculosis, 600 multi-drugs resistant tuberculosis patients receiving adequate treatment.
The project will be implemented in partnership with a Norwegian entity (LHL International Tuberculosis Foundation). The role of the donor project partner is to enable the professionals and NGO activists to work with decision-makers at all levels to identify and overcome barriers to funding and providing tuberculosis prevention and care services, including universal access for health education and provision of services by NGOs. The Norwegian partner added value resides in its experience and capacity to ensure tuberculosis control in the population and the ability in the field of advocacy, information, and communication, a valuable experience clearly made to have a input in the framework of all the other activities of the project.
Summary of project results
Tuberculosis is a leading global killer, ranking alongside HIV/AIDS, and places the heaviest burden on the world''s poorest and most vulnerable. Each year there is a funding gap of US$1.4 billion for the implementation of existing TB interventions, meaning 3.6 million people with TB are lost to health systems each year and therefore may not receive care appropriate that they need. MDR-TB remains a public health crisis, as only one in four MDR-TB cases is detected and one in two cured. In 2015, 1 million children were affected by TB and 170,000 died from TB.
Romania reported 10,404 new cases of tuberculosis (TB) and 2,637 cases of treatment resumption in 2017 *, having the highest incidence of TB in the European Union / European Economic Area Region, and according to the Final Report of the National Resistance Study to drugs carried out in the period 2013-2014, the measured percentage of TB cases with MDR/RR-TB was 2.5% among new cases and 10.8% in cases of resumption of treatment from the total number of notified cases. (Daniela Homorodean 30.06.2016).
In the country-specific recommendations, the European Union recommends that Romania take steps to switch to ambulatory care, and this is covered in the project by developing, implementing and delivering the methodology for an ambulatory care model.
In 2015, the Government of Romania approved by Government Decision no. 121/2015 National Strategy for Tuberculosis Control 2015-2020, making TB one of the most important public health priorities.
In accordance with the National TB Control Strategy, the implementation of this project highlighted the need for interventions aimed at strengthening tuberculosis control in Romania through the accelerated implementation of the END TB Strategy, in accordance with the main gaps/differences identified in terms of the successful implementation of the Strategy National TB Control for TB control in Romania, supported by the 2015 government decision.
Thus, the project aimed at improving access to health care for tuberculosis patients, reducing social inequalities by targeting vulnerable groups, strengthening primary health services by purchasing laboratory equipment and training psychosocial staff, and participating in the development and information system of healthcare through specific activities such as awareness campaigns, advocacy training, communication and social mobilization, promotion of health rights literacy programs and health communication courses.
Also, this project wanted to achieve the objectives of the National Reform Plan for 2017, by increasing the quality of social services and moving them from an institutionalization to community-centered services, targeting children affected by tuberculosis and their families.
The project was part of the National Strategy for Social Inclusion and Poverty Reduction for the period 2015-2020, by providing health care services in relevant areas, such as tuberculosis, to poor and vulnerable groups in disadvantaged communities.
In the National Health Strategy 2014-2020 it was envisaged to improve the training of health care specialists and to provide them with opportunities to contribute to the organization and provision of health care services, fields that made the objectives of this project, respectively of the general objective of strengthening tuberculosis control in Romania by implementing the WHO END TB Strategy and specific objectives:
1. Ensuring universal access to early diagnosis of TB, including latent tuberculosis;
2. Increasing the involvement of communities, civil society organizations and all public and private care providers through IEC and advocacy activities;
3. Increasing TB infection control by implementing CI measures at the level of TB dispensaries/hospitals;
4. Increasing awareness of TB in Romania among patients, vulnerable groups and the general population;
5. Implementation of a patient-centered approach in ambulatory care, in accordance with WHO recommendations, by implementing effective TB control in Romania; ;
6. Increasing political engagement through advocacy and lobbying activities (including the necessary changes in legislation);
The main results were achieved through the following activities:
Activity 1: Project management, monitoring and evaluation, publicity:
Project management was ensured by constant monitoring of progress and result indicators in relation to the project objective. 8 interim technical and financial reports were submitted.
During the course of the project, its visibility and the funding obtained were ensured through: the development of the web page and the Facebook account, the use of visual identity elements on all the materials developed and on the equipment purchased, the organization of final closing conferences of the project.
Contact was maintained with the Norwegian partner, LHL International Tuberculosis Foundation.
Results:
8 technical and financial reports submitted
Purchases made
1 Facebook account developed and updated
1 functional web page
1 project completion press conference
Activity 2: Implementation of TB infection control measures at the level of TB dispensaries/hospitals:
At the project level, 9 training workshops were supported in which 320 people participated, of which 181 were medical assistants and 139 were pulmonologists.
80 nebulization equipment, 30 nebulization efficiency test equipment and 1600 liters of disinfectant were distributed in the pneumophthisiology network in the country
Training materials for the online module have been centralized
Results:
9 supported training workshops
320 people trained
80 nebulization equipment for infection control distributed in the pneumophthisiology network in the country
30 infection control equipment distributed in the pneumophthisiology network in the country
1 online module
Activity 3: Procurement and supply chain management (PSM) of laboratory equipment and supplies for rapid diagnostic techniques:
As part of the project, 16 BK laboratories in the country were equipped with state-of-the-art Genexpert equipment, 9 hospitals were equipped with equipment for testing in the liquid medium, 8 hospitals benefited from equipment for latent tuberculosis testing.
Within the Marius Nasta Pneumophthisiology Institute, the WSG sequencing laboratory was set up, which was fully equipped with the latest generation equipment. Also, the National Reference Laboratory in Bucharest was equipped with Genexpert equipment with 16 modules.
During the project, Genexpert tests were distributed in BK laboratories, which benefited from equipment through the project and in other laboratories in the country in the TB network.
15300 Genexpert tests were used for the target group of the project.
Results:
16 Genexpert equipment 4 distributed modules
1 Genexpert equipment 16 modules distributed
9 distributed liquid medium equipment
8 distributed latent TB detection equipment
1 complete sequencing line
Test supplies distributed
Activity 4: Management of the procurement and supply chain of medicines for patients with M/XDR TB:
The procedure for enrolling patients for treatment was developed and during the project, drugs (bedaquline and delamanid) were purchased for patients with multi-drug resistant tuberculosis.
The medicines were transferred to the hospitals in the country based on the requests received from the treating doctors, and the treatment was done by each patient in the hospital where he was hospitalized.
Patient monitoring was carried out based on the monitoring sheets received from the attending physicians.
Where the patient died, or abandoned the treatment, the medication was directed to another patient, thus avoiding medication losses.
Result:
422 patients, who benefited from treatment for multidrug-resistant tuberculosis.
Activity 5: Measures to enable NGO professionals and activists to work with policymakers at all levels to identify and overcome barriers to funding and delivery of TB prevention and care services, including universal access to education in health and service delivery by NGOs:
This activity was carried out by the Marius Nasta Institute in partnership with the LHL Foundation, during which the following took place:
o 14 health communication courses attended by a total of 288 people, including: 160 medical staff, 128 former TB patients, social workers, vulnerable groups
o Public speaking sessions were organized for former TB patients: 3 public speaking workshops, 5 patients in each workshop
o 6 meetings with volunteers were organized
o A training session was organized for 20 journalists
o The activity was completed on 28.02.2024
Results:
- 20 trained journalists
- 3 training packages developed
- 14 health communication training sessions
- 15 patients included in public speeches
- 288 informed and trained people
The project had a major impact in strengthening the capacity of the pneumophthisiology network in Romania in the prevention and control of tuberculosis by equipping the hospitals that treat patients with tuberculosis. The results obtained following the implementation of the project made it possible to consolidate the infrastructure necessary for testing and diagnosing people from vulnerable groups as follows:
1. 71 hospitals were equipped with equipment to prevent TB infection
2. 17 Genexpert equipment distributed in pneumophthisiology hospitals in Romania
3. 9 equipment for testing in the liquid medium distributed in pneumophthisiology hospitals in Romania
4. 8 equipment for latent tuberculosis testing distributed in pneumophthisiology hospitals in Romania
5. 1 complete sequencing line
To ensure a good use of the equipment for the prevention of TB infection distributed over 320 doctors and nurses benefited from training courses, thus increasing the level of development of human resources in pneumophthisiology hospitals.
The endowments made within the project contributed to increasing the testing capacity of people from less developed regions of the country and reducing the rate of TB infection in the respective areas.
At the same time, the project ensured the necessary Genexpert tests for the diagnosis of 15,300 vulnerable people (people from rural areas, homeless people, people of Roma ethnicity, etc.) and who have limited access to healthcare services in Romania.
Also, by providing the latest generation treatment for MDR tuberculosis, 422 patients benefited from a treatment scheme recommended by the WHO that allows the patient to be treated on an outpatient basis and for a shorter period of time.
In addition to the above activities, a series of communication and advocacy activities were carried out which had as beneficiaries former tuberculosis patients, current patients, medical personnel, journalists and volunteers and which contributed to increasing the level of awareness regarding the TB issue among the target audience.
The project results were:
• 9 supported training workshops
• 320 people trained
• 80 nebulization equipment for infection control distributed in the pneumophthisiology network in the country
• 30 infection control equipment distributed in the pneumophthisiology network in the country
• 1 online module
• 16 Genexpert equipment 4 distributed modules
• 1 Genexpert equipment 16 modules distributed
• 9 distributed liquid medium equipment
• 8 distributed latent TB detection equipment
• 1 complete sequencing line
• Test supplies distributed
• 422 patients, who benefited from treatment for multidrug-resistant tuberculosis.
• 20 trained journalists
• 3 training packages developed
• 14 health communication training sessions
• 15 patients included in public speeches
• 288 informed and trained people