[Analysis] How Moldova is trying to control tuberculosis

Some 2,121 new cases of the disease were detected in Moldova in 2022, out of a population of just under 3.5 million people. About 30 percent of these cases are resistant to several types of drugs.

However, these are the identified cases. Moldova’s biggest challenge lies in identifying new patients.

In neighbouring Ukraine, where there were more than 18,000 cases identified in 2022, the WHO estimates that more than 50 percent of tuberculosis cases are missed. In Moldova, about 13 percent are missed.

Moldova & EU

Moldova’s goal is to be tuberculosis-free by 2030, when the country also hopes to join the EU.

Moldova has been a candidate member since June 2022 and since then the country has been fully committed to meeting the requirements of the European Union.

That may seem feasible, but fighting tuberculosis is a different story.

Identifying patients, and the long duration of treatment that must be completed to combat resistance and resurgences, requires a lot of effort, especially considering the groups that are especially vulnerable to tuberculosis: the poor, the homeless, addicts, prisoners, HIV patients, and sex workers.

In addition, there are (transiting) refugees from Ukraine and there are people in Moldova who return from neighbouring countries, where they worked temporarily.

“Migration is a major problem, many people travel in and out of the country. This group has the highest priority,” says Angela Paraschiv, spokesperson for the ministry of health in Moldova.

“We may want to eradicate the disease by 2030, but across the European region, we are at risk of not achieving that goal. It requires a lot of cooperation with other countries, we must coordinate so that it is clear in each country how many cases there are, and which forms of tuberculosis are involved. There is a major problem with multi-drug resistant tuberculosis in Moldova (and therefore also in Ukraine),” she added.

“In the 1990s, when Moldova was going through a severe economic recession, the resistant variant of the disease increased enormously,” says Valentina Vilc, coordinator of the national program against the disease.

Back then, Moldova had little medication available against the disease. To get the disease under control, a national tuberculosis program was set up by the government in 1995 in which the ministry of health and various NGOs work together to control the disease.

One of the most important donors to the program is the multilateral organization the Global Fund, which invested a combined $5.8m [€5.35m] in the fight against both HIV and tuberculosis in 2021 and 2022.

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Given that the disease is so intricately linked to poverty, there have been mixed opinions about joining the EU from a tuberculosis perspective — based on the fear that Moldova will then no longer be eligible for support from the Global Fund.

“In Romania, we have seen that accession to the EU led to an increase in the number of tuberculosis cases. So, we must ensure that we prepare very well for all the administration required to qualify for funds from the EU” Rucsineanu said. After joining the EU, Romania was no longer eligible for the Global Fund funds.

According to Paraschiv and her predecessor Svetlana Nicolaescu, secretary of the ministry of health, she does not have to worry about this. “We now pay for about 80 percent of the national control programme ourselves.”

She sees the positive side of joining the EU. “It gives us the opportunity to exchange more knowledge and thus strengthen our healthcare systems,” she said.

Rucsineanu agrees: “Accession is important for us to solve poverty and therefore one of the risk factors for tuberculosis. Without support or important trade relationships, we are only a small and poor country.”

The stigma of tuberculosis

The house of single mother Olga (41) is not far away from Vladimir’s house. She lives in an old neighbourhood of Balti. About three years ago, when Olga was working in a car wash, she started feeling sick. She coughed and lost a lot of weight. Her baby was only four months old. Olga went to the hospital, but because of the pandemic, she had to take her tuberculosis treatment at home.

She was unable to work for two years and had to undergo treatment. Now she only has a benefit for single mothers with young children, but because her youngest is now three, the government considers her able to go back to work and her benefit is stopped.

Although she no longer has tuberculosis, she is afraid of not being able to find work because of stigma. “I notice that people are avoiding me since I had tuberculosis.”

She is also afraid of becoming ill again, for example through a new infection or a resurgence. “Getting tuberculosis was traumatic,” she says. “I was terribly afraid of dying and having to leave my children alone.”

To fight against the disease, the government trains healthcare professionals, and tests, in collaboration with NGOs, high-risk populations such as prisoners, refugees, healthcare workers, and people living with HIV/AIDS.

Additionally, the government provides free diagnostic tests for TB. When someone is diagnosed he or she receives uninterrupted supervised treatment and the drugs are for free. Eight different NGOs are working together with the government to eradicate the disease.