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Around the world in the next 60 minutes, some 1,500 people will die from an infectious disease. More than half will be children under the age of five. Of the remaining 50 percent, most will be working-age adults—many of them parents and the primary source of income for their families, according to WHO.
On a global level, infectious diseases are the leading cause of death among children and adolescents; they are also one of the leading causes among adults. Low- and middle-income countries are particularly hard hit, with largely preventable or treatable diseases such as diarrhea, lower respiratory infections, HIV/AIDS, tuberculosis, and malaria being some of the top killers.
Public health threats stemming from newer infections such as Ebola and Zika coupled with ongoing threats such as HIV/AIDS transcend virtually all boundaries whether national, cultural, ethnic, religious, or socio-economic. The re-emergence of age-old diseases like TB and antibiotic resistant strains of infections further compound the threat to global public health.
Through many of our programs and initiatives, including the HIV/AIDS Twinning Center Program and Blood Safety Program, AIHA is working to address communicable diseases by training healthcare practitioners, spearheading patient education and outreach campaigns, and strengthening health system infrastructures.
Preventing HIV/AIDS and Hepatitis B and C in Moldova (PHH)
The overall objective of the USAID-funded PHH/Technical Assistance Support Contract (TASC II) was to decrease the transmission of HIV/AIDS, hepatitis B, and hepatitis C in Moldova through cost-effective preventive measures. By helping to reduce the public health risk of these diseases, the program complemented and strengthened other related activities in the country by modernizing and institutionalizing critical health services and systems.
The Preventing HIV/AIDS and Hepatitis B and C Project (PHHP) began in June 2006 and was planned as a four-year, US $6.2 million effort in Moldova. USAID contracted the Emerging Markets Group to implement PHHP with assistance from two subcontractors — AIHA and Pathfinder International. AIHA’s role was to spearhead efforts to ensure the safety of Moldova’s blood and blood products, as well as to facilitate the strengthening of laboratory capacity needed both to diagnose HBV and HCV and to improve epidemiological surveillance capabilities.
USAID/Moldova was forced to curtail funding in October of 2008 in response to a funds directive from USAID/Washington. Subsequently, the PHHP was reorganized into a two-and-a-half year program. Despite a shorter-than-anticipated implementation period, PHHP was successful in meeting most of its targets and in its efforts to support and strengthen ongoing programs of Moldova’s Ministry of Health, the National AIDS Center, the National Blood Transfusion Center, the Center for Preventive Medicine, and other key government agencies.
Project implementation was in line with government policies and strategies, and this contributed to immediate results and the establishment of solid frameworks for sustainability. Throughout implementation, PHHP cooperated closely with international organizations, including UNAIDS, the World Bank, WHO, and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
In Moldova, blood is collected at the national and regional centers and in the regional departments, but blood testing is only done at the national center and one regional center. In 2005, some 10 percent of blood screened at transfusion center tested positive for transfusion-transmitted infections (including HIV and Hepatitis B and C). Although the infected blood was discarded, there has been a need to improve the safety of all of Moldova’s blood and blood products. To achieve this objective, PHHP implemented the following activities:
- Developed national guidelines and quality assurance procedures;
- Developed and implemented training plan for improved blood safety;
- Established data collection and management information system; and
- Provided support for volunteer donor recruitment campaigns.
A major accomplishment was PHHP’s AIHA-led effort to provide comprehensive support to the government to draft a new law revising national standards for blood transfusions. The law includes two major initiatives to bring the blood service system up to international standards. One is the establishment of a new quality management program at the National Blood Transfusion Center, based on new SOPs for blood donations. This program is the first of its kind in a government agency. The second initiative relates to establishment of an all-volunteer blood donation program.
PHHP’s contribution to implemention of the quality management program for blood services, also led by AIHA, was substantial. It included the full design and implementation of 196 new SOPs. Sixty percent of all new process documents (PDs) required by the quality management program have also been developed with PHHP’s assistance. An internal monitoring unit for implementing the quality management system was also established and is now functioning at the National Blood Transfusion Center.
With PHHP’s assistance, the Center has developed a comprehensive plan to establish the voluntary blood donation system, which is an important step to ensure that there is sufficient national blood supply for those who need it. This Plan was kicked off at a successful public relations event on the World Blood Donor Day in June 2007, which was
televised nationally and supported with posters and informative leaflets. The Deputy Prime Minister, the Minister of Health, and the US Ambassador spoke, focusing on the importance of voluntary blood donations.
All targets in the revised PMEP were met or exceeded. For example, the target for reducing the percent of blood discarded due to infectious markers was met, and the target for the number of blood personnel trained was exceeded. Because the Project was shortened, workon the policy and the manual was not initiated, and a quality blood service system meeting international standards was not established though a great deal of progress was made. All required SOPs were designed and implemented, and so were 60 percent of the PDs. The real impact on target beneficiaries can be measured after the quality system has been fully implemented.
Strengthening Tuberculosis Control in Moldova Project
In December 2003, AIHA launched a four-year USAID-supported project to strengthen Moldova’s health system capacity to control and prevent TB. The project concluded in September 2007.
AIHA adopted a four-pronged approach to combat Moldova’s tuberculosis epidemic, working to:
- Improve the nation’s laboratory capacity to diagnose TB and multi-drug resistant TB (MDR-TB);
- Enhance the TB detection, treatment, and follow-up skills of primary care physicians and nurses;
- Improve the national surveillance system for tracking and managing TB and MDR-TB; and
- Increase public awareness about symptoms and treatment to promote early detection, especially among vulnerable groups.
Strategic partners working in conjunction with AIHA included:
- University of Arkansas for Medical Sciences;
- State Centre of Tuberculosis and Lung Diseases of Latvia;
- Moldova’s Ministry of Health, Ministry of Justice, and Ministry of Internal Affairs;
- Moldovan National Reference Laboratory and TB Institute; and
- State Medical and Pharmaceutical University “Nicolae Testemitanu.”
Hundreds of Moldovan health practitioners, educators, students, policymakers, journalists, broadcasters, NGOs, TB patients, and the general population contributed to the success of this project, as did active collaboration with other international efforts, particularly the Global Fund.
During the four-year project period, the four planned components were carried out comprehensively and complemented one another. The national TB laboratory network was strengthened, primary level capacity for TB control was strengthened, surveillance and monitoring of TB was improved, and public awareness of TB was increased.
For all four components, AIHA surpassed its stated output targets within the project period. There were more extensive renovation of laboratories, more primary care and laboratory practitioners trained, a surveillance system designed with greater analytical and patient management functionality, and larger numbers of informational materials distributed.
For more detailed information about the impact of AIHA’s Strengthening Tuberculosis Control in Moldova Project, please click here to read the final closeout report.
Improvements in patient care and clinical outcomes are predicated on an effective infectious disease surveillance system. To facilitate advances in both these areas, AIHA developed a program for continuous quality improvement in hospital microbiology laboratories through our Infection Control Initiative, which was implemented in countries of the former Soviet Union with USAID support. This program included establishing internal quality control systems for media, reagents, and test performance; introducing current methods of antimicrobial susceptibility testing; and creating an antimicrobial surveillance network, using the World Health Organization’s WHONET information system.
The AIHA program began early in 1997 with a thorough evaluation of microbiology laboratories in three partnership hospitals and at three central reference laboratories in the Russian Federation and Ukraine. Based on needs assessments, each of these six pilot laboratories received equipment and supplies that allowed for quality testing of antimicrobial susceptibility and ongoing monitoring of test results. Since then, a total of 18 AIHA partnership hospitals throughout Armenia, Georgia, Kazakhstan, Kyrgyzstan, Russia, and Ukraine implemented the WHONET system; 13 of them were still actively participating in the program when AIHA’s projects in these countries concluded.