Stopping Tuberculosis in Romania

With an estimated 31,000 annual cases of tuberculosis, Romania has one of the highest incidence rates of tuberculosis in Europe and the highest incidence rate of tuberculosis among children in Europe.

While Romania has implemented a version of directly observed treatment, shortcourse (DOTS) for many years, its current budget covers only the basic activities for tuberculosis control, such as first-line drugs, hospitalization costs, examinations, salaries of staff involved in clinical care and the vaccination of children at birth.

Other important aspects of the National Tuberculosis Control Program—including case management, supervision and monitoring, human resource development, upgraded infrastructure, diagnosis and treatment of multidrug-resistant tuberculosis and special attention to high risk groups—remain severely under-funded.

With a grant of nearly US$17 million payable over of two years, the Global Fund will support the Romanian Ministry of Health as it expands its DOTS program. Specifically, the Ministry of Health will collaborate closely with specialists, general practitioners, community health and social workers and religious representatives to raise awareness of the National Tuberculosis Control Program. Funding will also support the development and distribution of guidelines for the diagnosis and treatment of tuberculosis in children.

In addition, the National Tuberculosis Control Program will expand to include specific strategies to target prisoners and other portions of the Romanian population who are considered at high-risk for the disease. Financing will also underwrite the procurement of drugs and laboratory equipment, including treatment for multidrug-resistant tuberculosis through the Green Light Committee.

The Romanian Ministry of Health will also engage in pilot activities to use incentives to encourage treatment compliance. Both patients and health-care providers will be offered incentives such as food supplies and hygiene kits to encourage compliance with the treatment regimen. As many health-care providers are not compensated for the additional responsibilities they assume, incentives may result in better case management. Similarly, patients will be provided incentives at the treatment sites if they continue with their treatment in full compliance with DOTS. This activity will be monitored regularly and evaluated after two years to determine its cost-effectiveness; if proven to be successful, it will be expanded to other parts of the country.