Public Health Initiatives
National Institute of Infectious Diseases “Prof. Dr. Matei Bals” Bucharest
Looking at a broader picture of historical data on HIV infection in Romania, the records show a cumulative of 17,819 unique cases of HIV/AIDS from 1985 to the end of June 2012. HIV infection is one of the most serious potential health risks for injecting drug users (IDUs), who had a low incidence among this at risk category until recently, as acknowledged by EMCDDA. The number of HIV cases in Romania increased dramatically from 3 to 5 cases annually from 2007 to 2009 to 131 cases in 2011 and to 231 confirmed HV/AIDS new cases among IDUs in 2012.
In order to prevent further spread of the HIV outbreak among IDUs, the project comes to complement the initiatives developed so far by the national authorities and will work directly with harm reduction professionals and with most at risk groups to monitor, prevent and inform on the HIV infection.
To increase the access of vulnerable (most at risk populations) groups to primary and secondary prevention programs for HIV, HVB, HVC The project aims to control HIV, HVB, HVC, by stopping the spread of HIV, HVB, HVC infections among injecting drug users and by increasing the effectiveness of screening for HIV/HVB/HVC to people belonging to high risk groups.
HIV, HVB and HVC infections represent not only a medical problem but also a very difficult economic and psycho-social issue. Social status, the high level of migration, quick urbanization, and discrimination are very important determinants for the most of risk populations and also for the population affected by these infections. The consequences are unequal distributions of key social determinants of HIV, HVB, HVC, including food insecurity and malnutrition, poor housing and environmental conditions, and financial, geographic and cultural barriers to health care access. Other impact issues for the public health are: exposure to infection, progression to disease, late or inappropriate diagnosis and treatment, poor treatment adherence and success. As it is recognized today, the treatment and the patient’s adherence to treatment represent the most important factors for disease prevention.
A real progress in HIV, HVB, HVC monitoring in Romania, or elsewhere in the European Economic Area requires, besides a serious investment in strengthening of the main components of the national HIV, HVB, HVC monitoring program and also to influence also the social determinants of this infections.
The Project has the potential to decrease the rate of HIV, HVB, HVC infections among IDU and also among the general population focused on teenagers. Strengthening HIV, HVB, HVC control has been elaborated based on the profound understanding of current social determinants of these infections and interventions from outside the health sector, specifically in the area of social support and prevention in vulnerable populations. The project is also based on the process of testing, diagnosing, treating and offering healthcare for this kind of patients.
HIV infection is one of the most serious infectious diseases with serious consequences both for the individual and for society. Bilateral efforts to curve this disease may result in more successful interventions. If Norway records a moderate decrease or stable levels of the diseases in specific target groups (e.g. amongst drug users), in Romania drug users show increasing trends of HIV/AIDS. The bilateral cooperation and exchange of best practices may not only result in improved outcomes of health interventions, but also result in enhanced bilateral relations between Romanian and Norwegian colleagues.
The HIV/AIDS, HVC and HVC patients are, in general, people with a low socio-economic status, living in poverty in unsafe and poor environmental conditions. Families are impoverished also due to the presence of the above mentioned diseases, their lower capacity to cope with increasing job stress, etc. There is also a frequent combination between all these infections and TB, different forms of cancer or other illnesses that are consequences of the low level of immunity.
The persons affected by these infections encounter a range of social problems such as:
The purpose of the project is to control HIV, HVB, HVC infections among most of risk populations with high risk of exposure by improving essential prevention services, screening/ diagnosis, contributing thus to enhanceing the health gain and the quality of life within this target population. Thus, the project contributes to the fulfilment of the objectives of the Operational Programme 2007-2013 on Employment, Human Capital and Social Cohesion but also to the emerging National strategy for Health 2014-2020.
The project outcome will be to isolate the epidemiological focal point represented by IDUs and also to improve diagnosis, treatment, health care, adherence, monitoring and evaluation of the target population and also to create and offer social support and prevention interventions for epidemiologically important and vulnerable populations. The final impact will be on economic and social disparities caused by HIV, HVB, HVC in Romania and European economic area.
One of the strategies designed by the project is to provide medical, health care and counselling services to the target population – IDUs.
On the other hand, the project addresses the general population with focus on teenagers, in order for them to be tested for HIV, HVB, HVC. Also, in the event of a diagnosis they will be early diagnosed, initiated with health care measures and monitored in terms of health evolution. Another key issue is to insure a high rate of diagnosis and increasing the success rate of treatment, in order to mitigate the possible migration of HIV, HVB, HVC cases from Romania into the European economic area.
On the other hand, the project emphasizes public interest issues, with special focus on the young population in order for it to be tested for HIV, HBV, HCV, should it be the case- early diagnosed and benefitting in due time from optimal care measures of their health and monitoring of their evolution. Another key issue is to increase the rate of diagnosis, the rate of treatment in order to reduce the migration of HIV, HBV, HCV case from Romania to EEA.
The project’s specific objectives correspond to the National Romanian HIV/AIDS strategy 2014-2019:
The results of this project will be reflected in the decrease of HIV, HVB, HVC infections, among injecting drug users. Another outcome will be to increase the effort to educate, to diagnose, to care and to monitor HIV, HVB and HVC infections to the general population and also to the most of risk population.
To underline some of these results it is important to mention:
Upon implementing this project the results will be:
The project addresses some key trigger areas requiring improvement in the area of control of HIV/AIDS, HVB, HVC: increasing the capacity for preventing the infection of most of risk populations (IDUs) through screening. Romania has now high expertise regarding HIV, HVB, HVC infections program management. The main HIV, HVB, HVC transmission is heterosexual and the current trend among most at risk population reveals an increasing rate of transmission among injecting drug users. As the project addresses one of the most pressing health issues in the context of the recent EMCDDA outspread recommendation, it also comes at a time when programmes such as Global Fund to Fight AIDS, Tuberculosis and Malaria and those of the EU in the health sectors have ceased. Having said this, the approach used for this project is based on the expansion of diagnosis interventions, adherence to treatment and increase of their efficiency and effectiveness demonstrated over the past six years, through projects implemented under the Global Fund grants
The innovative interventions focusing on developing community support network for poor and vulnerable populations follow Ministry of Health’s strategy to enhance the role and capacity of primary care medical services with the purpose of improving the health status of Romanian population.
The Project also aims to strengthen the managerial capacity of the NTP coordination unit. At this point, there is no dedicated specialised staff at the NTP coordination unit, able to ensure financial, procurement and programmatic management of strategic programmes and projects.
This approach will constitute a sustainability element in terms of project implementation based on the principle of quality, transparency, cost-efficiency and financial probity and successful achievement of the financial and programmatic targets of the project.