title: Increasing tuberculosis case detection: lessons from the Republic of Moldova.
abstract: The Republic of Moldova undertook reforms in tuberculosis (TB) control and health care consistent with international recommendations and advanced towards the global target for case detection. The number of TB cases notified increased overall by 50% during 2001-2005. Expansion of the DOTS strategy and full coverage coincided with a greater role for primary health care (PHC) in TB control and the advent of national insurance for TB diagnosis and treatment. These developments and improvements in laboratories, surveillance, medical personnel skills, and public awareness contributed to increased case detection. The Republic of Moldova addressed both demand and supply sides in these efforts. It increased effective demand for TB services by dispersing diagnostic capability, instituting financing mechanisms and saturating the public with information on symptoms, transmission and treatment. It increased the supply of TB services by upgrading the laboratory network, revamping surveillance and training practitioners. The Republic of Moldova's experience offers lessons for other countries: TB-PHC integration allowed more suspect cases to be diagnosed at nearby PHC clinics, contributing to more cases being notified. Innovative TB communications reached the general public, vulnerable groups, practitioners and the media. TB control projects built on each other and national coordination mechanisms served to identify funding for the most pressing needs. There are challenges remaining for TB control in the Republic of Moldova, not least the stable treatment success rate, but the country can list valuable lessons and achievements.
authors.affiliation: American International Health Alliance, Chisinau, Republic of Moldova. viorel@aiha.moldnet.md
authors.forename: Viorel
authors.initials: V
authors.lastname: Soltan
authors.forename: Asma Khalid
authors.initials: AK
authors.lastname: Henry
authors.forename: Valeriu
authors.initials: V
authors.lastname: Crudu
authors.forename: Irina
authors.initials: I
authors.lastname: Zatusevski
mesh_terms: D003140:Communicable Disease Control; D019033:Delivery of Health Care, Integrated; D023801:Directly Observed Therapy / Q000706:statistics & numerical data; D018166:Health Care Reform; D006301:Health Services Needs and Demand; D006801:Humans; D008966:Moldova / Q000453:epidemiology; D009313:National Health Programs; D019982:Organizational Case Studies; D011320:Primary Health Care; D011322:Primary Prevention / Q000191:economics / Q000592:standards; D011635:Public Health Administration; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*