SCHEDULE 1. INTEGRATED GRANT DESCRIPTION

Country:

Republic of Moldova

Program Title:

Strengthening Tuberculosis control in the Republic of Moldova

Grant Name:

MDA-T-PAS

Grant Number:

TBC

Disease:

TB

Principal Recipients:Center for Health Policies and Studies( PAS )

A.PROGRAM DESCRIPTION

1.Background and Rationale for the Program

Tuberculosis re-emerged as a public health threat in early 1990s, after the breakdown of the Soviet Union, and its burden remains high in Moldova. According to the latest WHO estimates for 2013, TB incidence (new cases and relapses) was 159 per 100,000 population, which is the one of higher level among 53 countries of the WHO European Region.[footnoteRef:2] The WHO case detection rate (all cases) registered in Moldova was 81% in 2013. 1 [2: Source:Global Tuberculosis Report 2014, Key indicators for the WHO European Region( http://who.int/tb/publications/global_report/indicators_european_region.pdf?ua=1 ), pg. 33.]

According to the NTP notifications data, there were a total of 5,055 TB cases, all forms, in 2013 (124.2 per 100,000 population); out of these, 3,604 were new cases (88.5 per 100,000). TB mortality rate was 11.2 per 100,000 population in 2013 (456 deaths attributable to TB, all forms). The epidemiological situation is more difficult in Transnistria where the rates of indicators are higher than average per country. The burden of anti-TB drug resistance is one of the highest in the world representing the key challenge for the National TB Program (NTP) and the main obstacle for effective TB control in the country. WHO estimates that the number of MDR-TB cases among notified TB patients was 1,700 (1,600 1,700) in 2013.[footnoteRef:3]The NTP drug susceptibility testing data shows that over the recent years, MDR prevalence was between 24-26% in new cases and over 60% - in previously treated cases. [3: Source:Global Tuberculosis Report 2014, Key indicators for the WHO European Region( http://who.int/tb/publications/global_report/indicators_european_region.pdf?ua=1 ), pg. 74.]

Regarding TB/HIV co-infection, in 2013 4,821 TB patients (all forms) were tested to HIV, and 314 among them were HIV-positive (6.5%). While almost all TB patients on treatment are tested for HIV, the coverage by TB screening among PLHIV is low. Also, out of 314 TB/HIV cases detected in 2013, only 160 (50.9%) received antiretroviral treatment, according to the NTP data.Treatment success in 2012 countrywide cohort of new smear positive cases was 72.9%, death 13.2%, failure 3.5% and 8.8% of patients were lost to follow up (NTP data). The final outcomes of MDR-TB treatment are available for 2011 cohort, in which treatment success rate was low of 54.3%[footnoteRef:4] (but higher compared to previous three years cohorts, where treatment success was achieved in 48.7-52.4% of cases). [4: Source:Global Tuberculosis Report 2014, Key indicators for the WHO European Region( http://who.int/tb/publications/global_report/indicators_european_region.pdf?ua=1 ), pg. 100.]

In the light of the epidemiological profile and the programmatic challenges, the overall goal of the program is to reduce the burden of tuberculosis (including M/XDR-TB) in Moldova by ensuring universal access to quality diagnosis and treatment, implementing sustainable patient-centered approaches, addressing the needs of high-risk groups and strengthening NTP management capacity. The program covers the full spectrum of TB control issues including the overall performance of TB control services and intersectoral approaches for TB, DR-TB and TB/HIV control with special attention to the needs of vulnerable and at-risk populations.The program principles and priorities are consistent with the international policies and guidance, including those laid in the Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-Resistant Tuberculosis in the WHO European Region, 20112015, as well as with the principles of the Post-2015 Global Strategy and Targets For Tuberculosis Prevention, Care and Control, recently approved by World Health Assembly. The program is also an integral element of the National TB Control Program and involves relevant governmental stakeholders and non-governmental organizations.The program upholds and scales-up the interventions that have been previously supported by the Global Fund, as well as to support new activities such as rolling out rapid molecular diagnostic technologies at peripheral service delivery level. At the same time, the program activities are planned taking into account the increasing contribution of the Government in taking over key financial needs of the program, including increasing supply of second-line TB drugs.The program interventions cover both civilian and penitentiary sectors, as well as the separated region of Transnistria addressing, therefore, the problem of limited access to essential TB services for the population living in the area.

2.Goals, Strategies and Activities

Goal: To reduce the burden of tuberculosis (including M/XDR-TB) in Moldova by ensuring universal access to quality diagnosis and treatment, implementing sustainable patient-centered approaches, addressing the needs of high-risk groups and strengthening NTP management capacity.Strategies:

To ensure universal access to timely and quality diagnosis of all forms of TB including M/XDR-TB To ensure universal access to quality treatment of all forms of TB including M/XDR-TB To strengthen patient-centered approaches to M/XDR-TB treatment To improve management of HIV-associated tuberculosis To strengthen national TB control program management, coordination, monitoring and evaluation.Planned Activities: Comment by RePack by Diakov: Should be included all planned activities or only those that refer to each PR only ? I underline with yellow only PAS activities. I understood from the Tatiana V. message that the general overview including scope and objectives should be identical presented in the document, but activities to be specified by RP. I see that furher there is description ofacitivities by RP , but is there any need to write twice. May be is more relevant to start immediately to list the acitivities according to distribution between actors?

Implement Xpert MTB/RIF at district level, in the penitentiary system and AIDS Centers Support to WHO-recommended diagnostics (WRDs) at reference laboratories Procurement of anti-TB drugs for treatment of M/XDR patients Provision of adherence support for M/XDR patients Support to TB Community Centers NGO small grants program for high-risk and hard-to-reach populations affected by TB Strengthening ACSM / information and education for DR-TB prevention Strengthening national capacities for TB/HIV collaboration Strengthening NTP program management capacities Capacity building for improved TB care delivery Strengthening NTP supervision, monitoring and evaluation

Under the above defined strategies the PAS as Principal Recipient will be responsible for implementation of following activities, namely implementation of Xpert MTB/RIF at district level, in the penitentiary system and AIDS Centers; Provision of adherence support for M/XDR patients; Support to TB Community Centers; NGO small grants program for high-risk and hard-to-reach populations affected by TB; Strengthening ACSM / information and education for DR-TB prevention and strengthening of national capacities for TB/HIV collaboration.3.Target Group/Beneficiaries

TB Patients; MDR-TB patients; Prisoners; PLHIV; Helathcare providers involved in diagnosis, case management and treatment of TB including primary healthcare (PHC) providers; CommunityComment by RePack by Diakov: I included community since we have ACSM wich is oriented on the population , Communtiy Centers will worck with community