Moldova

Moldova is one of the poorest countries in Europe. The TB case rate has nearly doubled since 1991 when Moldova gained independence from the former Soviet Union. Most TB cases affect young adults in their most productive years. Multidrug resistant TB (MDRTB) is high and a nationally-representative drug resistance survey is underway. TB and HIV epidemics overlap which exacerbates TB control, particularly in prison settings. Nonetheless, TB control efforts in prisons have improved over recent years. The treatment success rate for TB patients remains low in Moldova, partially due to TB patients not finishing their treatment.

Role KNCV Tuberculosis Foundation

KNCV TB Foundation has worked closely with Moldova over the last five years to improve their TB control program. Recently, KNCV assigned a senior consultant from the international unit to assist Moldova for up to 4 weeks per year with both field visits and desk support on the programmatic management of TB. This support includes general TB control as well as monitoring and evaluation, TB/HIV, MDRTB, laboratory strengthening and prison health.  In addition, from 2004 through 2007, KNCV has technically and financially supported a local physician to focus specifically on improving TB control in prisons in Moldova.

Achievements

Moldova has achieved, since 2004, complete national coverage of DOTS. The NTP is now integrating components of Stop TB strategy to improve capacity in laboratories, recording and reporting, drug management, MDRTB management, TB/HIV initiatives, ACSM, HRD and TB control among vulnerable groups.  Since 2002, the Global Drug Facility has supplied quality first-line anti-TB drugs which eliminated drug shortages that were common. The Green Light Committee has supported a rational and systematic approach to increase the capacity to manage MDRTB.  Further, since 2004, the NTP has engaged the entire country within the same TB control strategy including territories with disputed sovereignity. TB control staff training, recruitment and retention schemes have also been initiated. KNCV and partners have further supported TB control in prisons with health education and promotion. Such support lead to earlier detection, better supervision of treatment and quality care, and follow-up of prisoners who are released prior to their treatment completion.  Due to a current lack of resources, the government is not able to finance TB control without external funding—the Global Fund, USAID, KNCV and other partners have provided Moldova with funds to address the TB situation.

Next steps

In 2008, KNCV Tuberculosis Foundation will dedicate up to 8 weeks of full-time support to Moldova’s TB control activities. This assistance will include an in-country monitoring mission for the Global Drug Facility to ensure an adequate supply of quality drugs, training and technical support in TB laboratory infection control (particularly for biosafety cabinet maintenance), and other monitoring and supportive activities as requested by the NTP.  KNCV will work closely with the NTP to evaluate and potentially reduce the relatively high default rate among TB patients and to further scale-up TB infection control practices in coordination with other partners.