Tuberculosis Control
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Program Overview
Moldova TB Program
Press-releases
Program Contacts
Participating AIHA Partnerships
Conferences and Workshops
A Glance at U.S. Laboratories
Public Awareness Campaign Materials
Program Overview
Worldwide, tuberculosis (TB) is the second largest contributor among infectious diseases to adult mortality. The World Health Organization (WHO) estimates that one third of the world’s population is infected with TB and that two million deaths occur each year from the disease. The WHO estimates that before dying the average multi-drug resistant TB (MDR TB) patient may infect an additional 15 to 20 people. The increase in MDR-TB combined with a population of people living with HIV/AIDS who are highly susceptible to TB has created a global crisis. The prevalence of MDR-TB is particularly high in Eurasia reaching 9-12% in the Baltic states and 10-14% in Central Asia. In some countries, such as Russia, MDR-TB is as high as 20% of all TB cases (2000 EuroTB Report).
With the goal of building sustainable capacity of institutions and health care professionals in Central and Eastern Europe and Eurasia to effectively respond to infectious diseases and the global TB crisis, AIHA and its twinning partnerships work with CDC, WHO, national and local ministries of health, health care administrations, and donor organizations to develop local and nationwide TB programs.
Strengthening Tuberculosis Control in Moldova Project
Problem Statement
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Program Goal
The goal of the four-year program (2003-2007), financed by the US Government under a USAID Cooperative Agreement, is to assist the Government of Moldova in preventing and controlling the TB epidemic by improving the overall TB case management capacity. The program contributes to achieving the objectives of the Moldovan National Strategy for Combating TB and complements the ongoing USAID-funded Tuberculosis Moldova/Romania Cross Border Initiative.
Program Objectives
The program comprises four components:
1) Improved laboratory network to diagnose TB and MDR-TB;
2) Enhanced skills of PHC physicians and nurses in detection, treatment, and follow-up of TB patients;
3) Improved surveillance system for tracking and managing TB and MDR-TB; and
4) Increased public awareness about symptoms and treatment to promote early detection and reach vulnerable groups.
Strategic Partners
AIHA is responsible for overall management and implementation of the project, with support and technical assistance from the University of Arkansas for Medical Sciences (UAMS) in the first program year. The State Centre of Tuberculosis and Lung Diseases of Latvia (SCTLD), the Ministry of Health, the Ministry of Justice, the Ministry of Internal Affairs, the NTP, the National Reference Laboratory (NRL), the TB Institute, and the State Medical and Pharmaceutical University “Nicolae Testemitanu” (SMPU) are participating extensively in the implementation of the project, contributing their expertise and ensuring sustainability.
Program Description
The four constituent parts of TB control are being enhanced and strengthened through training, technical assistance, equipment, materials, and renovation of facilities. The project encompasses a comprehensive approach to controlling TB and lays the groundwork for controlling MDR-TB. It addresses key elements of DOTS to support the DOTS-based NTP throughout Moldova. The project promotes collaboration among organizations and institutions combating TB, thus improving the overall case management of TB patients. As the management of TB is intensified through surveillance and diagnostic and treatment services, treatment outcomes are expected to improve. As more patients are cured and the population becomes more aware that TB is a treatable disease, more patients will present for diagnosis. With the combined effect of improved TB services and a larger percentage of infected patients accessing and receiving services, the burden of TB is expected to be reduced in Moldova.
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In support of the Moldova’s DOTS Plus Project, which was approved by the WHO’s Green Light Committee in 2005, AIHA renovated the ventilation system at the Moldovan Institute of Phthisiopneumology’s Multi-drug Resistant TB Department. The ventilation system now complies with international standards and allows for safe operation of the department.
PHC providers are often a patient’s first point of contact with the health system and therefore, play a particularly important role in TB control. AIHA trained two teams of trainers—family physicians and TB specialists who have in turn trained over 1000 primary health care providers to date. This is enabling family medicine physicians and nurses to decrease the burden of TB through early detection, referral for treatment, and community education and outreach—three elements critical to the success of Moldova’s NTP. The PHC Training Center at SMPU in Chisinau and the SCTLD in Riga are conducting the primary health care training and in cooperation with the World Bank’s primary care project. A PHC/TB module was added to the training conducted under the World Bank’s Health Investment Fund. Training materials and curriculum were adapted from existing manuals and course modules, including the instructional materials of the SMPU, UAMS, SCTLD, WHO, and CDC on TB diagnosis and treatment at the PHC level. The instruction emphasizes joint case management by physicians, nurses, and TB specialists and the coordinated management of TB in the hospital and ambulatory phases of treatment.
A surveillance information system that links all Moldovan medical institutions responsible for TB control has been implemented (Sept 2005). The system creates a comprehensive national network of TB-related prevention, diagnostic, treatment, and monitoring programs. The new system is equipped with specially designed surveillance software, 90 computers, four servers, and other equipment that greatly improves Moldova’s capacity to collect, process and analyze data on TB cases as well as track TB drug supplies. Additional funding for the surveillance information system was provided by the Global Fund to Fight AIDS, TB, and Malaria. Training of staff of surveillance units is being provided and the trained staff will then be responsible for implementing the revised guidelines, procedures, and reporting formats. The surveillance system will enable the NTP to generate evidence-based reports to guide the development of TB control policies.
Increasing public awareness about TB is critical to increasing detection and to realizing the benefits of improved laboratories, diagnosis, treatment, and surveillance. A KAP survey conducted in 2003-2004 established baseline data on cultural norms and TB knowledge and attitudes. The results were used to design general public awareness campaigns and educational campaigns targeted at specific populations. The themes of the campaigns are TB prevention, symptoms, diagnosis, length of treatment, treatment adherence, and survivorship. The project adapted available materials from WHO’s StopTB campaign and created a public awareness campaign – “Tuberculosis Can be Treated! See the Doctor” implemented 2004-2005. The annual World TB Day is a focal point for campaigns, and media coverage of events is being promoted and tracked. A pre- and post-release program for prisoners is being designed and implemented to increase treatment continuation in this vulnerable and critical population.
Accomplishments and Plans
The project started in October 2003. An assessment workshop was conducted in Chisinau in February 2004, bringing together the AIHA project staff; technical experts from UAMS and SCTLD; Government of Moldova officials representing the Ministry of Health, the NTP, and the Country Coordinating Mechanism (CCM); and representatives of the World Bank, the Global Fund, and Caritas Luxembourg. The participants visited laboratories, primary health care clinics, surveillance units, and schools to assess the current state of TB control in Moldova. They reviewed the approach and prepared an assessment report to lay out the course of the project for the coming year. A press conference for local journalists was held during the assessment workshop.
Since then, the project has undertaken activities related to all four components. The accomplishments and plans are summarized here.
Laboratories
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Beginning on World TB Day 2005, March 24, three renovated laboratories were reopened after extensive renovation. Three days of ceremony and celebration marked the reopening of the National Reference Laboratory (NRL) in Chisinau, and the Regional Reference Laboratories (RRLs) in Vorniceni and Balti. A total of 2,000 square meters of laboratory and classroom space were renovated and furnished at a total cost of $1.2 million.
A third RRL in Moldova’s Transnistria Region was renovated and reopened on October 3, 2005. In December 2004, the Transnistrian authorities agreed to carry out TB control in the framework of the Moldovan NTP consistent with DOTS.
The Moldovan firm, Arhiconi-Grup, provided the design and construction services, keeping closely to the tight schedule. As a result of collaboration and joint planning with the project staff, the Global Fund equipped and supplied the labs. This additional support allowed for the more extensive renovation necessary to bring the labs to international standards than indicated in the original 2001 assessment.
A five-day training of laboratory trainers was conducted at the SCTLD in Latvia in September 2004. The training focused on evidence-based practices and international standards for a TB microbiology lab network, sputum smear microscopy (SSM), biosafety, culturing, and drug resistance surveillance. A working group comprised of the trainers and NTP developed a curriculum covering quality assurance and procedures for SSM, culture, drug susceptibility testing. In September 2004, the TB Institute’s Scientific Board approved the guidelines for SSM and quality control of SSM. Trainers began training laboratory physicians and technicians in September 2005 and in July 2005 AIHA and the World Health Organization/Euro agreed to conduct training on smear sputum microscopy, resistance surveillance, and TB diagnostics for an additional 120 TB specialists.
The Environmental Mitigation and Monitoring Plan was approved by USAID in January 2005. It covers construction norms and engineering practices and laboratory procedures.
The ventilation system for an MDR-TB treatment facility was successfully renovated at the TB Institute in Chisinau; renovation was completed in August 2005.
Primary Health Care
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The trainers are providing three days of TB training, which has been added to the ongoing four-week training program for PHC providers. The first training session for 50 primary healthcare providers was conducted at the University Clinic for Primary Health Care in Chisinau September 29-October 1. Over 950 PHC physicians and assistants have been trained as of September 2005; training is expected to continue until the end of 2005 and a total of 1,200 PHC practitioners are scheduled to complete the TB/PHC training.
AIHA is part of a working group and steering committee on follow-up of released prisoners who are in the continuation phase of TB treatment. The working group is coordinated by KNCV Tuberculosis Foundation, which has an active project on TB in prisons, and includes Caritas Luxembourg; the Ministries of Health, Justice, and Interior; and the TB Institute. A plan for pre- and post-release social and medical services and incentive mechanisms for seeking treatment after release was formulated. KNCV is conducting the post-release outreach to promote treatment adherence among former prisoners.
Surveillance
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QSystems and CPHM worked closely together and the system went live in September 2005. The central server is housed at Center for Public Health Management (CPHM), which is the system administrator. The old and new systems will operate in parallel until January 2006, when the new system will completely replace the old system. AIHA coordinated closely with the Global Fund to purchase 90 computers, four servers, and other equipment for the center and peripheral units. AIHA provided programmatic training for 65 specialists who will initially operate the system.
The new surveillance system links all Moldovan medical institutions responsible for TB control and allows for improved management and tracking of TB cases. The system includes HIV/AIDS and STDs information and also links the medical institutions responsible for treatment and management of these diseases.
Public Awareness
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Educational and informational materials and TV and radio messages have been adapted and distributed. An informational campaign, entitled, "TB can be eradicated! DOTS: TB cure for all!" was targeted at PHC providers and TB specialists and conducted in conjunction with the PHC/TB training. A general public awareness campaign, entitled, "TB can be treated! See the doctor!" was launched in January 2005. The campaign includes patient education materials and an audio track and a video clip on symptoms and the main message of the campaign. Thus far, the audio has been broadcast on radio stations and the video has been broadcast on TV stations throughout the Republic of Moldova. Already, PHC and TB providers indicate a greater number of patients seeking treatment.
The “TB can be Treated! See the Doctor!” campaign was launched in Moldova’s northern districts, focusing in particular on the nation’s second-largest city, Balti, in October and November 2005. During the two-month period Tele-Radio Balti and 10 local tv channels and six local radio stations broadcast video and audio tracks created specifically to reinforce the campaign’s message. AIHA collaborated with the Association of Electronic Press, Association of Independent Press, News Agency DECA-press, and Balti Medical College to organize a contest for the best coverage of TB-related news by a local journalist.
Staff
Dr. Viorel Soltan, Project Director
Dr. Soltan has been the Director of Public Health Programs at the Soros Foundation in Moldova, an advisor to the Ministry of Health during UNGASS, and a lecturer in public h?ealth. At the Soros Foundation, he was responsible for design and implementation of programs in harm reduction for HIV/AIDS prevention, mental disability advocacy, workforce development, and health information systems. He is experienced in promoting policy changes in close coordination with government institutions and donor organizations. Dr. Soltan participated in the development of policy on integrated health information systems and was a member of the Ministry of Health task force on health information systems.
Dr. Soltan earned a medical degree at the State Medical University in Chisinau and a Masters of Business Administration at Newport University in California.
Dr. Valeriu Crudu, Laboratory and Surveillance Specialist
Dr. Crudu is the former chief of the National Reference Laboratory of Moldova and has 20 years of experience in TB microbiology, diagnostics and drug resistance. He has been a key participant in the development and implementation of Ministry of Health decrees on TB control and standards for microbiological and TB services in Moldova. He also contributed to the development of a unified, computerized database for drug resistance surveillance. Dr. Crudu has authored or co-authored 120 publications and scientific presentations. His principal research interest is the pattern of drug resistance in Moldova and he presented his research results at the American Thoracic Conference in May 2004.
Dr. Crudu earned a medical degree at the State Medical University in Chisinau and a Ph.D at the Academy of Sciences in Moscow.
Dr. Irina Zatusevski, Senior Health Communications Specialist
Dr. Zatusevski has 30 years experience in publishing, journalism, and public relations. She taught at the Faculty of Journalism and Mass Communications at Moldova State University and has worked as an editor, researcher, and journalist. She was a co-founder of the first independent radio station in Moldova, “Unda Libera.” Dr. Zatusevski was the coordinator of the Moldova Health Communications Network, which is dedicated to improving the coverage of medical issues in the media. She has participated in social mobilization and advocacy campaigns related to iodine deficiency and immunization, and has led the efforts in Moldova on the WHO’s Framework Convention on Tobacco Control. She is the author of nearly 30 publications and is an International Policy Fellow at the Open Society Institute in Budapest.
Dr. Zatusevski earned a Masters of Arts in Journalism and Mass Media Editorship and a Ph.D. at the Faculty of Editing in Moscow.
Ms. Tatiana Dumbrava, Project Administrator
Ms. Dumbrava has worked as an office manager, executive assistant and interpreter/translator for English, Italian, Romanian and Russian. She has interpreted and translated at trade fairs and for international development projects. She was the Executive Assistant for the Chisinau Water Service Rehabilitation Project and the Operations Manager for the Low-Income Energy and Social Assistance Program. She is experienced in financial and reporting procedures for international projects.
Ms. Dumbrava earned a degree in Foreign Languages at Moldova State University, specializing in Italian and English Philology.
Mr. Sergiu Gherman, Procurement and Financial Assistant
Mr. Gherman has worked in banking supervision and regulation at the National Bank of Moldova, examining compliance and control systems of commercial banks and serving as an insolvency administrator. He developed recommendations on improving banking supervision and accounting policies and compliance with international standards. He has experience in marketing and accounting in private companies in Romania. Mr. Gherman earned a Management Degree at the Academy of Economic Studies in Chisinau.
Press-releases
- AIHA Launches Second Public Awareness Campaign on Tuberculosis in Moldova (October 3, 2005)
- AIHA Opens Newly Renovated Regional Reference Tuberculosis Laboratory to Improve Diagnostic Capacity in Moldova’s Transnistria Region (October 3, 2005)
- AIHA Launches New National TB Surveillance Information System in Moldova, Continues Making Crucial Improvements to the Nation’s Tuberculosis Prevention, Diagnosis, and Treatment Infrastructure (October 3, 2005)
- New National TB Information Surveillance System Being Developed through AIHA’s Strengthening Tuberculosis Control Project in Moldova (December 3, 2004)
- AIHA Initiates Tuberculosis Training for Primary Healthcare Providers in Moldova (September 24, 2004)
- Dr. Viorel Soltan Selected To Lead AIHA Tuberculosis Program in Moldova (May 26, 2004)
- American International Health Alliance Launches New Program to Strengthen Tuberculosis Control in Moldova (February 9, 2004)
- American International Health Alliance Receives USAID Award to Implement Comprehensive Tuberculosis Control Program in Moldova (October 29, 2003)
- Three Renovated Tuberculosis (TB) Reference Laboratories in Moldova Opened on March 25, 2005, as Part of Commemorations of World TB Day (article from USAID Programs in Moldova web site)
Program Contacts
Faulconer, Laura
Senior Program Officer, Twinning Center
1225 Eye Street, N.W.
Suite 1000
Washington , DC 20005
Phone 1: (202) 789-1136
Fax: (202) 789-1277
LFaulconer@aiha.com
Soltan, Viorel
Moldova Project Director
29/1 Armeneasca St.
Chisinau , 2012
Phone 1: (373-22) 27-93-81
Fax: (373-22) 22-67-37
viorel@aiha.moldnet.md
Participating Partnerships
Graduated Partnerships
Riga, Latvia / Little Rock, Arkansas
Volgograd, Russia / Little Rock, Arkansas
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