About Project

Norwegian Financial Mechanism 2009 - 2014
Project RO 19.02:
Strengthening the prevention and control of HIV/AIDS, HVB, HVC in Romania

Project title:

Strengthening the prevention and control of HIV/AIDS, HVB, HVC in Romania

Programme Area:

Public Health Initiatives

Name of Project Promoter (PP):

National Institute of Infectious Diseases “Prof. Dr. Matei Bals” Bucharest

Short description of the Project:

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.

Project objectives:

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.

    Main activities:
  • The organization of the Project Management Unit at the level of the National Institute for Infectious Diseases “Prof. Dr. Matei Bals” Bucharest
  • The production and distribution of a manual/operation tool for harm reduction professionals
  • Provision of information/ education/ counselling on HIV/AIDS prevention in places where IDUs work and/or live
  • The provision of protection materials (needle exchange, etc), including the collection of the used syringes
  • Involving IDUs in advocacy activities
  • Testing for HIV/ HVB/ HVC targeted to the Most at Risk Populations
  • The development of a National Hepatitis Registry
  • The development of training programs for medical staff: with focus on family doctors, gynecologist, dermatologists, hematologists, psychologists and nurses
  • The development of an information, education, communication campaign against HIV, HVB, HVC

Relevance

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:

  • Discrimination from their community
  • A high rate of unemployment and lack of income
  • Problems in getting different needs and lack of access to the health services
  • The process of fatigability of the treatment, many of them quitting the treatment
  • The consequences of this process are the resistance to treatment that occur in these kinds of patients. This phenomena drive to the continuous increase of the cost of treatment

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. 

Project content:

Project outcomes:

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.

Specific objectives:

The project’s specific objectives correspond to the National Romanian HIV/AIDS strategy 2014-2019:

  1. To reduce HIV transmission among intravenous drug users who are in situations of vulnerability (women, commercial sex workers, homeless persons, HIV+)
  2. To improve the capacity of intervention of NGOs working in harm reduction in order to effectively implement preventive interventions addressing IDUs in situations of vulnerability (women, commercial sex workers, homeless, HIV+)
  3. To increase access to information and protection materials, counselling and basic medical care for IDU’s.
  4. To develop and promote supportive policies through advocacy and multi-sector cooperation.
  5. To upgrade the medical infrastructure so that to increase the capacity to effectively implement all the interventions addressed to the medical staff and target population at the level of the primary health care (family doctors and nurses), secondary health care (gynecologist, dermatologists, hematologist, psychologist) and also at the target population level, especially at the most of risk population.
  6. To implement an opt-out HIV, HCV, HBV screening program with the aim to extend testing opportunity for people belonging to high risk groups and to carry out a testing and treatment strategy.
  7. To ensure visibility, dissemination and promotion of the project to the most at risk population and also for the general population.

Expected outcomes/ outputs/results of the Project

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:

  • A population of 2,000 intravenous drug users receive high - quality integrated harm reduction services
  • 2,000 IDUs that are also HIV + or homeless, women, sex workers constantly participate in the needle exchange programs 
  • 2,000 HIV tests delivered, accompanied by counseling and primary medical assistance
  • 2,000 IDUs in situations of vulnerability receive primary social support, in order to reduce their vulnerability
  • 12,650 patients will be tested for HIV, 12,650 for HVB, 12,650 for HVC, in 2 years in 8 regional centers in Romania
  • 100 specialists trained as future trainers for other specialists involved in the medical services offer to the general population and also to the most of risk population 
  • 5,000 general practitioner formed and involved in the project thought the 8 regional centres
  • 10,000 teenagers receiving information about HIV, HVB and HVC infections

Upon implementing this project the results will be:

  • Addressing HIV, HVB, HVC and the needs of most at risk populations (i.e. focus on IDUs); preventing the 
  • Improving case detection via testing with pre and post counselling
  • Monitoring and evaluating the system and impact measurement
  • Strengthening of the primary health care system based on the actions of this project
  • Involving qualified NGOs as partners in all these actions. 

Project activities: 

  1. Capacity Building for the Project Management Unit – the definition to design the Project Management Unit of the project at the level of the National Institute of Infectious Diseases “Prof. Dr. Matei Bals, Bucharest and decide the job description for each member of the team. We need also the official documents signed by the Minister of Health in order to empower this unit to implement the project – the team components, the policies and legislation documents developed. The project Management Unit shall organize and implement all project activities; special attention shall be dedicated to monitoring and evaluation.
  2. To enforce a screening strategy based on their specific epidemiological context:
    - Individuals who test negative will be referred to a surveillance program;
    - The individuals who test positive will be referred to the hub to retain them in care. 
    - The test strategy will also include other sexually transmitted diseases and/or infectious diseases, depending on the ability and on the epidemiological context of each region. 
  3. To develop a training program for family doctors, gynecologist, dermatologists, hematologists, psychologists and nurses (4 modules for 25 people each)
  4. To design and implement a BCC media campaign and also two press conferences: one for the launch of the project and the other one at the closing of the project, where the project results will be presented.
  5. Producing and distribution of a manual and operation tools for harm reduction Professionals
  6. Information and education on HIV/AIDS prevention in places where IDU’s work and/or live; the activity shall actively involve the IDUs into the solving of their own problems
  7. HIV testing and counselling, basic medical services for IDU’s. 
  • Provision of protection materials (needle exchange, etc), including recuperation of used syringes
  • The project external audit. Statistical and report production
  • Publicity: Media information, education campaign oriented to the target population (IDU’s and general population between 15 and 49 years old) and for the visibility of the project there will be the press conference, for project launching and for project closing and final results presentation
  • Project Beneficiaries:

    • Injecting drug users communities including Rroma communities from Bucharest
    • General population focused on the most at risk population. 
    • Teenagers from primary and secondary schools
    • The medical staff with focus on family doctors, gynecologists, dermatologists, hematologists, psychologists and nurses

    Project feasibility

    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.