Implementation of DOTS strategy for tuberculosis control in the Republic of Moldova. From theory to practice: opinions of medical personnel

Abstract

Background. Tuberculosis (TB), an ancient disease once believed to have disappeared from the World Health Organization (WHO) European Region, affects more people today than two decades ago. Currently, more than three-quarters of the TB cases in the European Region occur in the Former Soviet States, where the TB rates more than doubled in the last 10 years. To combat TB, the WHO has recommended adoption of a strategy called Directly Observed Treatment Short Course (DOTS). TB is a significant public health problem in the Republic of Moldova with high prevalence and important social and economic consequences. According to the data provided by the Department of Statistics from the Public Health Center of the Ministry of Health, the incidence of TB in Moldova has increased in the last 12 years by 98%. In order to address this problem in 2001 the Government adopted the National Program of Tuberculosis Control in the Republic of Moldova for the years 2001-2005 based on DOTS strategy. The Program objectives are to achieve a rate of detection of at least 70% of smear positive patients and to cure 85% of new cases of pulmonary tuberculosis, microscopic positive at the moment of the diagnostic. This study assessed the opinions of the medical personnel about the performance of the DOTS strategy in the Republic of Moldova. Methodology. The qualitative research was conducted in the family doctors centers from three regions with different incidence of tuberculosis. In-depth interviews were conducted with family doctors and phtiziopulmonologysts. These were two main categories of specialists involved in the National Tuberculosis Program implementation: family doctors, who work at the initial stage of identification and continuation treatment and specialized medical doctors, engaged in TB diagnosis and specialized services for TB patients. A desk review of relevant documents and reports, the WHO reports, guides and recommendations regarding DOTS implementation at international and local level were identified and analyzed during this research. Results. After the content analysis of the in- depth interviews, it could be concluded that most of the respondents considered that the results obtained during 2003-2005 in the fulfillment of the DOTS strategy implementation in the Republic of Moldova were satisfactory at this moment, taking into account the economic situation of the state. Most of the respondents considered that lower achievements of DOTS program were due to economic crisis, massive migration, poverty of the population, insufficient financing of the health care system. Conclusions: In the opinions of participants in this study implementation of DOTS strategy in Moldova was a step forward in combating alarming proportions of TB in the Republic of Moldova. For further successful implementation of the National Tuberculosis Control program and improving the performance of the program in the Republic of Moldova several strategies should be elaborated: strengthen primary health care, especially at local level; motivate young TB specialist as well as experienced staff; provide pretreatment counseling trainings for medical personnel; and develop appropriate social system support for TB patients.