Tackling TB in Moldova: Speranta Terrei and the importance of civil society organisations
The Republic of Moldova has a considerable TB problem. In 2011, out of a population of 3 million, 4,208 people were diagnosed with TB. Compare this to the 3,528 people diagnosed with TB in Germany, out of a population of 82 million, and the alarming rate of TB in Moldova really hits home. Moreover, Moldovan has a high burden of multi-drug resistant TB (MDR-TB) that makes tackling the problem significantly more difficult. 19 percent of all new cases of TB in Moldova are estimated to be MDR and 51 percent of all retreated cases.
To add to the problem, Moldova is also a predominantly rural country. This not only makes carrying out national TB prevention programmes much harder, but it also increases the chances of patients not being able to complete treatment as a result of having to travel much longer distances to reach treatment than those who live in cities. Some patients are also too weak to walk far or even lack money for a bus fare to take a trip to a dispensary. If treatment isn’t completed or stopped early drug-resistant strains can emerge, thus further compounding the problem of MDR-TB.
There are, however, civil society organisations that are playing a vital role in the fight against TB, reaching patients and areas that may not have direct access to treatment, who have not been reached by national TB programmes or who are too weak or do not have access to funds to be able to make a trip to a dispensary.
One such organisation carrying out such critical work is Speranta Terrei. Speranta Terrei is a community organisation providing patient-centred care established by Dr Feodora Rodiucova. Her organisation manages a group of treatment support workers called moderators who carry TB drugs from dispensaries to patients’ homes and explain and observe the treatment. As our 2011 Voices report on TB in Europe states:
Directly observing a patient swallowing their TB medications contributed to higher completion rates and a reduced risk of drug resistance.
Without the moderators of Speranta Terrei offering to take on this role, many patients would undoubtedly be unable to complete a course of treatment either causing them to go on to develop drug resistant strains or even lose their fight against the disease.
Irina Gribeniuc is one such moderator. She gives treatment support to 8 patients altogether. One of these patients, Anton, has a relapse case of TB and is co-infected with MDR-TB and HIV. Prior to the support from Speranta Terrei Anton was abusing drugs and alcohol and his TB treatment was ineffective. He was also too weak to walk far. Having built up a relationship of trust, Irina now takes TB drugs to Anton 5 time per week and he follows the regimen, though complicated and long. This is just one of many stories of the vital work that Speranta Terrei carries out in ensuring patients can overcome TB.
Among its various projects, Speranta Terrei also carries out a project to reintegrate former prisoners who had TB. The organisation reaches out to ex-prisoners and encourages them to participate in psychological counselling and job training, thereby giving them the strength to complete treatment and learn a trade, earn a living and once again belong to society.
Civil society organisations, whether it be through this type of project or the support provided by Irina, for example, offer not only important medical support but also the moral and psychological support that can be so critical in the fight against TB. It is crucial that Speranta Terrei and organisations like it are recognised for the important role they play in tackling TB. Europe must strengthen engagement with these organisations as a means of tackling TB and, in particular, drug-resistant strains of TB in the Eastern Europe and Central Asian region more effectively. You can read more about the incredible work Speranta Terrei does here.
TB Europe Coalition
