The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Review of the National Iceland Ireland Israel Tuberculosis Programme Italy Kazakhstan Kyrgyzstan in the Republic of Moldova Latvia Lithuania Luxembourg Malta 4–15 February 2013 Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan World Health Organization Regional Office for Europe Marmorvej 51, DK-2100 Copenhagen Ø, Denmark WHOLIS number Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01 E-mail: [email protected] Original: English Web site: www.euro.who.int Review of the National Tuberculosis Programme in the Republic of Moldova, 4–15 February 2013 By: Pierpaolo de Colombani, Sevim Ahmedov, Kai Blondal, Silviu Ciobanu, Andrei Dadu, Smiljka de Lussigny, Nigorsulton Muzafarova, Pierre Yves Norval, Cristian Popa, Oriol Ramis, Sabine Ruesh-Gerdes, Jonathan Stillo and Erika Vitek Keywords0B EPIDEMIOLOGY HEALTHCARE ECONOMICS AND ORGANIZATIONS NATIONAL HEALTH PROGRAMS SURVEILLANCE TUBERCULOSIS, MULTI-DRUG RESISTANT TUBERCULOSIS, PULMONARY – prevention and control Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). © World Health Organization 2013 All rights reserved. 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Review of the National Tuberculosis Programme in the Republic of Moldova, 4–15 February 2013 page iii CONTENTS Page Acknowledgments ................................................................................................................ iv Abbreviations ....................................................................................................................... v Executive summary .............................................................................................................. vi Introduction ......................................................................................................................... 1 General information .............................................................................................................. 2 TB epidemiology ................................................................................................................... 3 NTP strategies, structure, budget and main achievements ....................................................... 4 Case finding and diagnosis .................................................................................................. 11 Treatment and case management ........................................................................................ 15 TB in children ..................................................................................................................... 21 Drug-resistant TB ............................................................................................................... 23 HIV-related TB.................................................................................................................... 26 TB control in prison ............................................................................................................. 29 Other vulnerable populations and social determinants ........................................................... 33 TB infection control ............................................................................................................. 36 Management of medicines and other commodities ................................................................ 40 Monitoring and evaluation ................................................................................................... 44 Human resources development ............................................................................................ 46 Operational research ........................................................................................................... 47 Ethics and human rights ...................................................................................................... 49 ACSM and community involvement ...................................................................................... 51 Health system and TB control .............................................................................................. 53 References ........................................................................................................................ 62 Annex 1. Roadmap for implementation of review recommendations ....................................... 67 Annex 2. Members of the review team ................................................................................. 72 Annex 3. Programme overview ............................................................................................ 73 Annex 4. Field team programme .......................................................................................... 75 Annex 5. Professionals interviewed ...................................................................................... 77 Annex 6. Profiles of patients interviewed .............................................................................. 83 Review of the National Tuberculosis Programme in the Republic of Moldova, 4–15 February 2013 page iv Acknowledgments The review team members would like to express their gratitude to the Ministry of Health, the National Tuberculosis Institute “Chiril Draganiuc”, the Project Coordination Implementation and Monitoring Unit, the Centre for Health Policies and Studies, the health authorities in the Transnistria region, the Global Fund to Fight AIDS, Tuberculosis and Malaria and Dr Jarno Habicht, WHO Representative in the Republic of Moldova and his office, for making this review possible. We would like to offer special thanks to all the doctors, nurses and patients at the sites visited for their assistance and collaboration. We also extend our appreciation to the Ministry of Justice, the Ministry of Labour, Family and Social Affairs and the National Health Insurance Company for their cooperation, as well as to key partners of the National Tuberculosis Programme, such as Act for Involvement and the Soros Foundation – Moldova. Finally, we acknowledge the support given by Dr Hans Kluge during his mission as Director of the Division Health Systems and Public Health of the WHO Regional Office for Europe and Special Representative of the WHO Regional Director to Prevent and Combat M/XDR-TB in the European Region. Review of the National Tuberculosis Programme in the Republic of Moldova, 4–15 February 2013 page v Abbreviations ACSM advocacy, communication and social mobilization AFI Act for Involvement ART antiretroviral therapy BCG Bacillus Calmette–Guérin (vaccine) DOT directly observed treatment DST drug susceptibility testing GDF Global TB Drug Facility GDP gross domestic product Global Fund Global Fund to Fight AIDS, Tuberculosis and Malaria GLC Green Light Committee HCT HIV counselling and testing IPT isoniazid preventive therapy MDR multidrug-resistant MGIT mycobacteria growth indicator tube NGO nongovernmental organization NHIC National Health Insurance Company NIPP National Tuberculosis Institute “Chiril Draganiuc” NTP National Tuberculosis