annual progress report-ro

8/8/2019 Annual Progress Report-RO

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Institutia publica Unitatea de Coordonare, Implementare si Monitorizare

a Proiectului de Restructurare a sistemului Sanatatii

36/1 Ciuflea Str., of. 23-25, MD2001, Chisinau, Republic of Moldova, Tel.: (373 22) 271113, 500941, Fax: (373 22) 500840

PROGRAMUL TB/SIDA

RAPORTUL ANUAL DE PROGRES ANUL

2


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2

ANNUAL (YEAR 2) PROGRESS REPORT ROUND 6 HIV GRANT MOL-607-G03-H

31 martie, 2010

Chiinu

INFORMATII GENERALE CU PRIVIRE LA GRANT

Titlul programului: Sporirea Accessului la Prevenire, Tratament si Ingrijire in cadrulProgramului National de Prevenire si Control al HIV/SIDA/IST2006-2010

Donator: Fondul Global pentru Combaterea SIDA, Tuberculozei iMalariei (GFATM)

Runda: 6

Numarul grantului. MOL-607-G03-HAmplasarea Proiectului: Republica Moldova

Recipient Principal (RP): Institutia Publica Unitatea de Coordonare, Implementare siMonitorizare a Proiectului de Restructurare a SistemuluiSanatatii

Acord l de grant semnat: 01 i 2007


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ACRONIME SI ABREVIERI

AFEW Fundatia SIDA Este Vest

SCS Studiul Comportamental de Santinela

CNC Consiliul National de Coordonare

GFATM Fondul Global pentru Combaterea SIDA, Tuberculozei i Malariei

KAP Cunostinte, Atitudini si Practic (abrevierea de la denumirea in engleza)

M&E Monitorizare si Evaluare

MS Ministerul Sntii

CNTS Centrul National de Transfuzie a Sangelui

CNMS Centrul Naional de Management in Sntate

ONG O i i N l


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CUPRINS

PROFILUL SARII........................................................................................................................................... 5

INTRODUCERE ............................................................................................................................................6

DESCRIEREA PROIECTULUI .......................................................................................................................7

SITUATIA EPIDEMIEI HIV/SIDA LA FINELE ANULUI 2009 ...........................................................................9

PROGRESUL MASURAT IN BAZA INDICATORILOR REZULTATELOR .................................................12

PROGRESUL MASURAT PRIN INDICATORII PROGRAMATICI .................................................................15

PROJECT ACCOMPLISHMENTS AND RESULTS .......................................................................................24

PROJECT MANAGEMENT 42


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PROFILUL SARII

Populatia*: 3567.5 mii, fara regiuneaTransnistreana (la 1 ianuarie 2009, BiroulNational de Statistica)

Stuctura de vrst a populaiei*: 0-14ani: 17.1% (la 1 ianuarie, 2009, BNS)

15-56/61 ani: 67,9 % (la 1 ianuarie, 2009,BNS)57/62+ ani : 15,0% (la 1 ianuarie, 2009,BNS)

Vrsta median*: total: 32.4 anibrbai: 30,8 anifemei: 34.3 ani (la 1 ianuarie, 2009, BNS)

Rata de cretere a populaiei*: - 0.15%(2007, Biroul Naional de Statistic)

Rata natalitii *: 10.9 nateri/1.000populaie (2008, Biroul Naional de

Statistic)

Rata mortalitii *: 11.8 decese/1,000

l i (2008 Bi l N i l d


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INTRODUCERE

Moldova a beneficiat de grantul GFATM directionat pentru suportul Programelor Nationale de Prevenire si Control alHIV/SIDA/IST ncepnd cu prima Rund din 2003. La moment ara gestioneaz dou granturi (Runda 6 i Runda 8)pentru a susine iniiativa in controlul si prevenirea HIV..

Recipientul Principal

Propunerea CNC ctre Fondul Global de Combatere SIDA, Tuberculozei i Malariei (GFATM), Runda 6 pentru

Componenta HIV a fost aprobat n decembrie 2006. Instituia public "Unitatea de Coordonare, Implementare iMonitorizare a Proiectului de Restructurare a Sistemului Sntii (n continuare IP UCIMP PRSS) a fost selectat ncalitate de Recipient Principal pentru implementarea grantului n sum total de USD$ 6.734.272,00 acordat pentrucinci ani.

Acordul de grant al programului MOL-607-G20-H a fost semnat la 1 mai 2007 la Chisinau de ctre Fondul Global i IPUCIMP PRSS. 01 ianuarie 2007 este data de lansare a implementrii Grantului n republica Moldova.Grantul GFATM, Runda 6, Componenta HIV sustine implementarea Programului National pentru Prevenirea siControlul HIV/SIDA/IST 2006-2010 prin extinderea prevenirii, tratamentului si ingrijirii HIV cu scopul de asiguraaccesul universal la terapia antiretrovirala inalt activa (HAART), de a creste utilizarea serviciilor de consiliere si testarein randul celor cu risc inalt si de a spori activitatile de prevenire pentru cei mai vulnerabili.Obiectivele propunerii sunt in conformitate cu Initiativa Global Comuna a OMS/UNSIDA pentru accesul

universal la tratament si ingrijire.

Subrecipieni

IP UCIMP PRSS a selectat si a subcontractat patru sub-recipienti pentru a implementa activitatile cu privire lacomunicarea pentru schimbarea comportamentala, tinerii implicati in prevenirea HIV, implicarea in comunitatea

il l bil d l i il i iji i i i b l ii i i i f il i


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DESCRIEREA PROIECTULUI

Programul se angajeaza sa asigure accesul universal la prevenire, ingrijire si tratament, pentru a

mentine Republica Moldova in categoria de tara cu prevalenta scazuta, cu mai putin de 1% dinpopulatie infectata cu HIV/SIDA.In special, Programul are drept scop reducerea transmiterii HIV/ISTpe cale sexuala si de la mama la fat, si transmiterea HIV prin intermediul utilizarii commune a

seringii prin sporirea accesului populatiei la servicii de consiliere si testare voluntara (CTV), siextinderea interventiilor de prevenire pentru grupurile vulnerabile. In plus, serviciile sociale simedicale pentru persoanele care traiesc cu HIV/SIDA (PTHS) vor fi extinse si vor fi intreprinseactivitati de combatere a stigmatizarii si discriminarii.Mai mult, programul va consolida capacitateacomunitatii si a guvernului de a face fata epidemiei HIV prin parteneriate si o mai buna coordonare.

Scop: Scopul programului este de a extinde prevenirea, tratamentul si ingrijirea HIV, de a asiguraaccesul universal la tratamentul antiretroviral (HAART), de a creste nivelul de consiliere si testarevoluntara in randul persoanelor celor mai expuse la risc, precum si sporirea prevenirii pentru

grupurile vulnerabile.

Pentru atingerea scopului, Programul urmrete sa atinga trei obiective:

Obiectivul 1: Reducerea transmiterii HIV/IST pe cale sexuala si de la mama la fat (TMF) si a transmiterii HIV

prin intermediul utilizarii comune a seringii, prin sporirea accesului populatiei la serviciile de prevenire sitestare; Acest obiectiv presupune extinderea serviciilor confidentiale de consiliere si testare voluntara a femeielorgravide si de distribuire a medicamentelor PMTCT. El urmareste extinderea retelei CTV in intreaga tara si consolidarea


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IP UCIMP PRSS n colaborare cu sub-beneficiarii i beneficiarii implementeaz Obiectivele programuluimenionat mai sus i raporteazn baza a 16 indicatori reprezentai n tabelul de mai jos.

Tabelul 1Nr. Obiectiv Indicator

1 Obiectivul 1: Reducerea transmiteriiHIV/IST de la mama la fat (TMF) si atransmiterii HIV prin intermediulutilizarii comune a seringii, prinsporirea accesului populatiei laserviciile de prevenire si testare;

# de femei gravide care au beneficiat de servicii deconsiliere i testare voluntara

# Numrul femeilor gravide HIV-pozitive, careprimesc un curs de profilaxie ARV pentru a reduceriscul de transmitere de la mam la ft

# de puncte de oferire a serviciilor asistate pentru a prestaservicii de consiliere si testare voluntara (CTV)# de laboratoare care dispune de capacitatea de a oferiservicii de testare HIV de nalt calitate# de pacienti cu IST de la institutiile medicale care suntdiagnosticati, tratati si consiliati in mod adecvat# si procentul utilizatorilor de droguri injectabile

(UDI) care au beneficiat de pe urma programelor deprevenire

# si procentul lucratoarelor sexului comercial (LSC)

care au beneficiat de pe urma programelor decomunicare

# si procentul lesbienelor, gay-ilor, bi-sexualilor si

trans-sexualilor care au beneficiat de programe decomunicare

# soferilor de curse lungi acoperiti de programele deprevenire

cons matorilor de drog ri acoperiti de terapia de


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SITUATIA EPIDEMIEI HIV/SIDA LA FINELE ANULUI 2009

In conformitate cu prognoza efectuata de catre Banca Mondiala in anul 2001, primele ipoteze pentru

prognoza epidemiei in Moldova au fost ca nu o sa existe o crestere neta a populatiei si ca populatia sexualactiva reprezinta jumatate din populatia totala de 4,2 milioane. Modelul nu a luat in consideratie migratia cafactor (fapt de a dus la o subestimare a ratei de crestere a HIV) si ca, baza estimata era de 12 400 infectii cuHIV, la inceputul lui 2001. Aceasta preconiza ca, in absenta unor interventii, prevalenta epidemica va creste

de la 600 per 100 000 de adulti in 2001 - la 1900 per 100 000 la inceputul anului 2011 (Banca Mondiala).Graficul de mai jos (Figura 1) ilustreaza prevalenta prezisa pentru 2001 - 2010 si cazurile predominanteinregistrate in 2001 2009.

Figura 1

Predictions vs notified HIV cases in theRepublic of Moldova during 2001 - 2009

50000


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Pana la sfarsitul 2009 au fost raportate cumulativ 5,625 de cazuri HIV pentru ambela maluri ale Nistrului. PrevalentaHIV (date cumulative) la sfarsitul anului 2009 este de 157.4 per 100.000 persoane.

Figura 2

Evolution of HIV incidence during 1987 - 2009in the Republic of Moldova

er100000population

5

10

15

20

25


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Dynamics of HIV and AIDS cases in the Republic of Moldovaduring 1987 - 2009

Year

1985 1990 1995 2000 2005 2010

a

bsolutenumber

0

200

400

600

800

1000

HIV cases

AIDS cases

Cota-parte a infectiilor in randul UDI a inceput sa scada in 2003, atat datorita stabilizarii transmiterii in randul

UDI, cat si inceperii raspandirii epidemiei in randul populatiei generale (Figura 4).UDI reprezinta 12,16% din taote cazurile noi de HIV inregistrate pe parcursul anului 2009 (704), fata de

17,85% in 2008, 30,37% in 2007, 38.18% in 2006, 42,77% in 2005, 50,1% in 2004 si 55,0% in 2003. Pemalul drept, numarul UDI din toti nou infectatii cu HIV pe parcursul anului 2009 reprezinta 7,86% fata de19,69% din stanga Nistrului unde interventiile orientate spre UDI au inceput mai tarziu si au fost mai putinintense.


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In 2009 aceasta a fost calea de transmitere pentru 81.25% de cazuri HIV inregistrate in 2009 (88.08% pe malul drept alraului si 69.88% pe malul stang al raului).Printre noi infectatii cu HIV, rata de femei a ajuns la 42,75% in 2009 (43,47% pe malul drept si de 36,61% pe

malul stang).Figura 5

Dynamics of new HIV cases in the Republic of Moldovaby ways of transmission in 1987 - 2009

Year

1990 1995 2000 2005 2010

absolutenumber

0

200

400

600

800

1000

All cases

Non-IDUs

IDUs


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respondentilor pentru a ajunge la persoane greu de accesat), si sunt raportate datele pentru Chisinau care se refera lasubpopulatia generala, in timp ce ambele valori de baza (48% in 2004) si rezultatele raportate pentru BSS anterior(66,2% in 2007) se refera la beneficiarii programelorHR de pe intreg teritoriul acoperit de studiu.

Nota cu privire la tinta propusa: Target inserted for Year 2 as this is the year that first BSS under grant was conducted,67% value based off on mid-point between original Year 1 and Year 3 targets.

2. Procentul tinerilor (15-24 ani) care raporteaza folosirea prezervativelor la ultimul contact sexual cu

un partener ocazional.

Indicator deieire Procentul tinerilor (15-24 ani) care raporteaza folosireaprezervativelor la ultimul contact sexual cu un partener ocazional. Valoarea debazValoar

e An

73.0% 2006

Anul 1 Anul 2 Anul 3 Anul 4 Anul 5

Tinta 73% Nu se aplica

Rezultat 78.5% Nu se aplica

Primul sondaj cu privire la Cunostintele, Atitudinile si Practicile tinerilor referitor la HIV/SIDA (Studiul KAP ) in cadrulgrantului a fost desfasurat in 2008. Conform Sondajului, 78,5% din respondenti au raportat utilizarea prezervativului laultimul contact sexual. Studiul a cuprins teritoriul Republicii Moldova (cu exceptia teritoriul de la malul stang alraului Nistru). Urmatoarele sondaje KAP sunt planificate pentru anul 3 si anul 5 de implementare a Grantului.


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MTCT (%) in the Republic of Moldovaduring 2002 - 2009 per annual cohort

Year

2001 2002 2003 2004 2005 2006 2007 2008 2009

%

0

20

40

60

80

100

120

40.0

100

31.6

12.7

5.2

15.0

1.50.0

Implementarea PTMC in 2004, inclusiv testele antenatale opt-out de rutina pentru pacienti au avut drept rezultat testareaa cel putin 98% de gravide prezentate la controlul antenatal pe parcursul ultimilor ani (99.5% in 2009) si aproximativ80% din femeiele HIV infectate au urmat terapia ARV pentru a preveni transmiterea de la mama la copil (79.9% in2009). Aceasta masura a avut drept rezultat reducerea semnificativa a procentului de copii infectati cu HIV nascuti lamame HIV infectate.

4 P t l d ltil i l iil HIV i i i t d 12 l i d l i iti t t t l i


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Percentage of adults and children with HIV stillalive 12 months after initiation of HAART

Year

2005 2006 2007 2008

%

0

20

40

60

80

100

80.7

76.4

88.3188.0


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Majoritatea indicatorilor cheie (12 din 16 raportabili) au fost implementai cu succes i intele propuse au depit sau auajuns la peste 90% la sfritul perioadei de raportare. Ali patru indicatori au fost realizai parial, trei din acetia suntindicatori de acoperire - # i procentul de lucrtori ai sexului comercial acoperii cu programele de outreach, # depacieni cu IST la instituiile medicale care sunt diagnosticai corect, tratai i consultai, # i procentul de PTHS care au

facut screenig-ul pentru TB i unul se refer la calitatea serviciilor - # de laboratoare care au capacitatea s ofere serviciide testare HIV de calitate nalt n conformitate cu decizia de reorganizare a serviciilor de transfuzie de snge.Ultimul indicator - # de gravide care au fost acoperite de serviciile de testare i consiliere voluntar - continu s fie maijos dect inta propus, realizarea redus a acestuia fiind cauzat n mare parte de faptul c serviciile CTV au fost lansaterecent. Reeaua a fost suplimentat treptat (n 2008 pe malul drept iar n 2009 pe malul stng). Nu toate centrele de CTVfondate funcioneaz i nu toate din cele care funcioneaz i exploateaz la maxim capacitatea. Serviciile CTV necesitn continuare eforturi de perfecionare pentru a atinge inta propus.

Mai jos sunt figurile (5 i 17) n care sunt artate realizrile per domeniul indicatorului. Valorile intelor cumulative

atinse per semetru pentru anul raportat de implementare pentru fiecare dintre indicatori, sunt reprezentate n anexa 1.

Objectivul 1

SDA: Prevention: PMTCT

Indicator 1.1

Figura 8 Number of pregnant women reached with voluntary testingand counseling services

utenumber

40000

50000

60000

70000

n total 28,304 de femei gravide (att primact i a doua testare) au beneficiat de serviciide consiliere i testare oferite de centrele deCTV pe parcursul anului raportat pe ambelemaluri ale rului Nistru.


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Figura 9 Number of HIV-postive pregnant women receivinga complete course of ARV prophylaxis to reducethe risk of mother-to-child transmission

Year

SemI.2008 SemII.2008 SemI.2009 SemII.2009

Absolutenumber

0

50

100

150

200

250

Targets

Results

n total 107 de femei gravide infectate cu HIVde pe ambele maluri ale Nistrului au primittratament ARV profilactic pentru a preveniTMC n perioada raportat.

Copii nscui la mame HIV+ primesctratament ARV profilactic i sunt asigurai cuformule de lapte pentru o perioada de 12 luni.

SDA: Prevenirea: Testare i Consiliere

Indicator 1.3

Figura 10 Number of service delivery sites supported toprovide voluntary counseling and testing (VCT) services

Absolutenumber

10

20

30

40

50

Pe durata perioadei raportate extinderea reelei

de CTV a continuat cu crearea a opt cabinetede CTV n stnga Nistrului. Din fondurileRundei 6 PI CIMU HSRP a echipat n total49 de centre pe ambele maluri ale Nistrului(41 pe malul stng n 2008 i 8 pe malul stngn 2009), dintre acestea 44 erau funcionale lasfritul perioadei de raportare.

n acelai timp, n total sunt 61 de centre CTV


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Not: Unul din laboratoarele de transfuzie a sngelui menionat mai devreme (2008) a fost nchis la nceputulanului 2009 i toate activitile acestuia n ceea ce privete testarea i prelucrarea sngelui i produsele din sngeau fost preluate de Centrulo Naional de Transfuzie a Sngelui.

SDA: Prevenire: diagnosticarea i tratamentul IST

Indicator 1.5

Figura12 Number of patients with STIs at health care facilitieswho are appropriately diagnosed, treated and counseled

Year


Absolutenumber

0

2000

4000

6000

8000

10000

12000

Targets

Results

n total au fost diagnosticate, tratate iconsiliate pe parcursul anului de raportare,

4,177 de cazuri noi de IST dintre care 2,564de cazuri de Sifilis i 1,613 de cazuri deGonoree

SDA: Prevenire: BCC outreach n comunitate

Indicator 1.6

Figure 13 Number and percentage of injecting drug users (IDUs)reached with prevention programmes

Numarul cumulativ de UDI care au fost


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Figura 14 Number and percentage of commercial sex workers (CSWs)reached with outreach programmes

Year


Absolutenumber

800

900

1000

1100

1200

1300

1400

1500

1600Targets

Results

(18.5%)

(18.9%)

(20.4%)

(21.6%)

(17%)

(20%)

(25%)

(30%)

Numrului cumulativ de LSC care au beneficiat de servicii pn la sfritulperioadei de raportare a fost de 1,116, inclusivvalorile de baz. Numrul de noi beneficiariinclui n programele de asisten n perioadade raportare este de 141.

Au fost trei proiecte care au inclus activiti deprevenire pentru LSC, unul n Chiinu, unuln Orhei i altul n regiunea de nord a rii care(Bli i Ungheni). Serviciile prestate LSC aufost urmtoarele: educaia de la egal la egal,

distribuirea prezervativelor, instruirea idistribuirea materialelor informaionale,schimbarea seringilor, consiliere i referine,gestionarea ITS, etc.

Indicator 1.8

Figura 15 Number and percentage of lesbian, gay, bi-sexual andtrans-sexual reached with outreach programmes

Absolutenumber

760

780

800

820

840

860

880

900

920 Targets

Results

(15.2%)

(15.4%)

(15.6%)

(16.6%)

(16%)

(17%)

(18%)

Numrul cumulativ de 829 de LGBT care au beneficiat de servicii include valoarea de

referin. n total au fost inclui 61 de beneficiari n programele de asisten nperioada de raportare.

Serviciile (educaia de la egal la egal,distribuia prezervativelor i a materialelorinformaionale, consiliere i referine,gestionarea ITS, etc.) sunt furnizate grupuluiint prin intermediul unui proiect


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component a perfecionrii anuale/bianuale pentru oferii de camioane.

Indicator 1.10

Figura 17 Number of drug users reached with drug substitution therapy

Year

Sem I.2008 Sem I I.2008 Sem I.2009 Sem I I.2009

Absoluten

umber

0

50

100

150

200

250

300

350

400

Targets

Results

n total 204 de beneficiari noi au fost nrolain tratamentul de substituie cu metadon n2009. De la nceputul impelmentrii grantuluin program au fost inclui n total 358 depacieni.

n total cu terapia de substituie sunt acoperite3 proiecte (toate din ele active n parteadreapt a Nistrului), 2 n sectorul civil (nChiinu i Bli) i unul n sectorulpenitenciar (n 5 instituii penitenciare).

De la 31 decembrie 2009, zilnic detratamentul de substituie beneficiaz 270 depacieni (inclusiv pacienii care au nceput

tratamentul mai devreme i l urmeaz ncontinuare).

Obiectivul 2

SDA T T l i i l (ARV) i i i


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SDA: Tratament: Profilaxia i tratamentul infeciilor oportuniste

Indicator 2.2

Figura 19 Number of opportunistic infections cases diagnosedamong PLWHA and receiving treatment

Year

Sem I.2008 Sem II.2008 Sem I.2009 Sem II.2009

Absolutenumber

0

200

400

600

800

1000

1200

1400

1600

1800

2000Results

Targets

n total au fost nregistrate i tratate 806 decazuri de infecii oportuniste n rndulpacienilor cu HIV/SIDA de pe ambele maluriale Nistrului.

SDA: Activiti colaborative TB/HIV: Depistarea intensiv a cazurilor noi n rndul PTHS

Indicator 2.3

Figura 20 Percentage of PLWHA screened for TB

100

n 2009, 60% PTHS au fcut screening-ul pentru tuberculoz (2158 PTHS din 3595


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susinere.

Obiectivul 3

SDA: Sistemul de informare i Cercetare Operaional

Indicator 3.1

Figura 22 Number of health units with capacity to implement thenewcomputerized national M&E system

YearSemester I.2009 Semester II.2009

Absolutenumber

0

10

20

30

40

50

60

70

Targets

Results

n perioada de raportare, 61 de instituii au fostechipate cu TI pentru implementarea

sistemului M&E (SYME HIV/IST), din care23 implementeaz SYME HIV (Centrul deMedicin Preventiv) i 38 implementeazSYME IST (seciile de boli infecioase de lainstituiile medicale raionale i municipale).

Personalul medical responsabil de sistemulSYME HIV/IST a fost instruit adecvat nutilizarea calculatorului i a programului.

Not : cursurile de instruire n utilizarea SYME HIV pentru personalul Centrelor de Medicin Preventiv au fostamnate din Decembrie 2009 pentru Ianuarie 2010, cnd nivelul regional de verificare a datelor a atins nivelulnaional, cu scopul de a evita cltoriile suplimentare din regiuni i de a reduce costurile pentru transport.

O


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Indicator 1,2,3 - 2

Figure 24 Number of service deliverers trained in peerand community programs

Year


A

bsolutenumber

0

200

400

600

800

1000

1200

1400

1600

1800

Targets

Results

The service deliverers trained under thisactivity include six categories of specialists:

- SDs trained in peer and communityprograms for IDUs,

- SDs trained in peer and communityprograms for LGBT,

- SDs trained in peer and communityprograms for CSWs,

- SDs trained in peer and communityprograms for migrants,

- SDs trained in peer and community programs for PLWHA and

- Young people trained in peer-education.

During reported year a total of 54 service deliverers have been trained, out of them: 28 have been trained in peerand community programs for migrants and 26 in peer and community programs for PLWHA.

The number of peer educators trained is much higher than the planned due to the fact that peer education activitieshave been co-financed which allowed the involvement of a higher number of young people in the project.


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PROJECT ACCOMPLISHMENTS AND RESULTS

OBJECTIVE 1: To reduce sexual and mother-to-child transmission (MTCT) of HIV/STIs and

reduce transmission via needle sharing by scaling up the access of population to prevention and

testing services

SDA 1: Prevention. Behavioural change communication mass

A series of activities have been implemented under this SDA in view of increasing awareness of young people

about HIV/AIDS, changing behavior of young people of reproductive age through nationwide communicationcampaigns and encouraging the general population to undertake an HIV test. Increasing mass mediarepresentatives capacity on non-discriminatory language to be used in HIV/AIDS and in delivering messages aboutPLHA and AIDS.

Implementation of Dance4Life project aimed at increased awareness of young people aboutHIV/AIDS

During reported period the project Dance4Life (D4L) was launched in Balti (January 2009) extending the coverage ofthe progect. The D4L school teams and Agents of Change continued the implementation of HIV prevention activities

targeted at young people.A total of 30 Heart Conection Tours (HCT) in schools were implemented by the D4L school teams covering about 2,350young people with HIV related information (HIV transmission, myths about HIV and AIDS, issues of solidarity withPLWHA, etc.) and Dance4Life information.At the same time 29 Act4Life events were implemented within D4L project by voluntairs teams.The Act4Life events consisted of HIV prevention presentations in schools, distribution of informational materials andHIV focused discutions with people, contests on best knowledge about HIV and AIDS between teams, poetry constestsdedicated to HIV prevention Life costs nothing, nothing is so precious as life is!, contest of essays Life has the priority before all. STOP AIDS, theater performance She is like you, demonstration of HIV prevention


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Dance4Life school teams during the D4L rebranding

event, 07.11. 2009

Heart Conection Tour in liceum Lucian Blaga, Chisinau,

21.11. 2009

Informational and promotional materials have been printed within Dance4Life project and distributed during HeartConection Tours and Act4Life (brochures about HIV and D4L project, stickers, pocket calendars, T-shirts, cups, pens).

HIV prevention courses targeted at training Agents of Change for the promotion of prevention activities were conductedin schools during reported period. 421 young people attended 11 five days courses.

Conduct social events8 social events were organised during the year aimed at bringing information about HIV to people like:

dance mobs. contests between D4L teams from schools on the best knowledge about HIV and AIDS, best dancing of the

Dance4life drill, etc. dance4Life events in schools and youth camp focussed on bringing useful information about HIV and AIDS to


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Increasing participation of journalists in writing messages on HIV/AIDS issuesThe yearly award for the best media message on HIV/ADS issues has been lounched at the beginning of the reported

year in view of encouraging mass media participation. 82 materials have been submitted by 14 jurnalists by the end ofthe year and 6 journalists from different types of media (TV, newspapers, electronic magazine) from both national andregional levels received awards for the best coverage of HIV issues.

Produce film with educational character on HIV and AIDSA documentary with educational caracter was produced. 261 copies of the film Find it all, in two languages, wasdistributed to various institutions and organisations from the field. The film was also presented within the School FilmFestival dedicated to AIDS Memorial day (May 11-21, 2009) and Human Right festival.

Translate and copies of educational and documentaries films from international practice regardingHIV and AIDs

Six educational documentaries from international practice regarding HIV/AIDS, earlier selected and approved by CCMTWG, were translated in Roumanian and subtitled. A total of 339 copies were distributed among media, NGOs and allinterested parties for dissemination and use in prevention activities targeted at young people.

The table below shows the results reached for indicators from extended list under this SDA versus targets.Table 2

Indicators

Intended cum.

results at Dec. 31,2009

Actual cum. result

at Dec. 31, 2009

Number of HIV/AIDS TV and radio programmes broadcasted 20 81Number of HIV/AIDS social events conducted 26 21Number of copies of films distributed to TV stations and NGOs 70 261Number of TV debates broadcasted 20 6Number of journalists participating in mass media training onHIV/AIDS

50 53


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Free replacement feeding milk formula for children born from HIV positive pregnant women has been ensured to reducetransmission of HIV/AIDS to chidren. 121 children born from HIV+ women have been provided with free replacementfeeding milk formula in order to prevent infection spread through breast alimentation from mother to child. The childrenget milk formula for a 12 months period.

There are currently 3 health facilities providing the minimum package of PMTCT services, namelly RepublicanDermato-Venereal Dispensary and Penitenciary Pruncul Hospital on right bank and AIDS Center, Tiraspol, on left bank.

Ensure prevention of mother to chiald transmition of syphilisInvestigation of pregnant women to syphilis and proper treatment of mothers and children tested positive to syphiliswere ensured. A total of 239 children and mothers with syphilis were offered proper treatment (procain paniciline).

Strengthen human resources capacity for PMTCT

Capacity building has been ensured through training of medical workers (family doctors, maternity main specialists,gynecologists and other medical workers) in offering PMTCT services. 51 health specialists from Chisinau and 7rayons medical institutions have been trained during reported period.

Revision and reprinting of the national PMTCT GuidelinePMTCT guidelines have been revised and adjusted according to international and local standards and protocols andapproved by the Counsil of Experts. 2000 copies were printed and will be distributed to medical institutions, NGOs, etc.

The table below shows the results reached for indicators from extended list under this SDA versus targets.

Table 3

Indicators

Intended cum.

results at Dec. 31,

2009

Actual cum. result

at Dec. 31, 2009

% of pregnant women undertaking an HIV test 98 99.5Number of infants born from HIV+ mothers that were checkedup within 2 months after birth

200 206

Number of infants born from HIV-positive mothers that receivemilk substituents and prophylactic ARV treatment

230 252


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The number of people from vulnerable groups (IDUs, CSWs, MSM) reached with VCT services during the year is lowaccounting for 397 people only. Additional efforts are required from both VCT and NGOs networks to increase thecoverage of vulnerable group through openingt the VCT service to these groups and strengthening the referal system atNGO level. Bringing VCT services closer to beneficiaries should be analysed.

For the first time in 2009 a lot of HIV rapid tests (saliva based) has been procured and distributed to VCT cabinets.

Establishment of a green lineA hotline that offer confidential, non-judgmental and anonymous service to people about HIV infection and AIDS hasbeen establishe within the National Center of Preventive Medicine, AIDS Center (phone no. 0 800 808 08) andsupported (coordinator, operators, telecomunication costs covered).

The aim of the service is to provide listening, referral and

educational service to callers and to encourage the increaseof community participation in HIV/AIDS awareness /prevention / education. The counseling is done at no cost forthe caller by four counsellors six day of the week from 8AMto 8PM. A total of 839 people have been counseled on HIVby the green line.In view of promoting the service a flyer and a poster have been printed and distributed to Centers of PreventiveMedicine, Rayonal Hospital, Centers of Family Medicine,

NGOs from the fild and other institutions, but also to borderpassing point, Airport and Train Station.

Strengthen human resources capacity for VCTCapacity building has been ensured through training of 50 health staff involved in VCT services. A 5 days training forVCT councilors and infection diseases physicians from medical institutions from Transnistria has been organised underthe extension of VCT services in the region. At the same time two one day trainings have been conducted for Northern


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SDA 5: Supportive environment: Blood Safety

Activities under this SDA have been targeted at securing safety of blood transfusion to prevent transmission of HIVinfection and blood transmitted infections during provision of medical assistance requiring transfusion of blood andits components and for HIV surveillance.

Ensuring blood safetyThe Blood Transfusion Service has been supported to assure security of blood transfusion in country thrpough highquality testing of blood samples. The three laboratory facilities have been continuously supplied with ELISA test kits toscreen donor blood in country.During reported year, 86,095 blood samples were tested (86,904 blood donations).

ELISA test kits have been supplied to AIDS laboratories all over the country (14 surveillance laboratories) to assure HIVsurveillance. During reported year, 356,647 HIV ELISA tests (surveillance) were carried out by the AIDS laboratorynetwork to 298,314 persons. A total of 704 new cases have been diagnosed in 2009 (445 cases in Moldova and 259cases in Transdniester region).


Indicators

Intended cum.

results at Dec. 31,2009

Actual cum. result

at Dec. 31, 2009

Number of blood samples tested for HIV 491,664 773,170 4

SDA 6: Prevention. STI diagnosis and treatment

Activities under this SDA have been targeted at ensuring free access for population to STI treatment anddiagnostics.


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SDA 7: Prevention. Youth Education and Prevention

Activities under this SDA aimed at scaling up the existing peer-education network and communication to fosterpeer-education activities for both in- and out-of-school young people. Scaling up the national network of YouthFriendly Health Services. Supporting the implementation of LSBE in general secondary and upper secondaryeducation.

Scaling-up of the Youth Frindly Health Services (YFHS) networkTwo Youth Friendly health Centers have been established during reported period on the left bank of Dniester river, onein Tiraspol and one in Rabnita. The renovation of facilities has been ensured and the centers were equipped withnecessary logistic equipment and furniture. At the same time, a study visit to a Youth Friendly Health Center (YFHC) on

right bank was organised for the specialists from Transdniester region in view of making them familiar with the basicprinciples of a YFHS, the servicies provided, etc.These YFHCs are part of the national network of YFHS and will provide young people with informational, health andpsychological services.

Participation of young people in the prevention of HIVPeer-education activities have been scaled up in year 2008 by extending the network of peer-educators to 7 new regionsof the country (Anenii Noi, Calarasi, Cimislia, Leova, Orhei, Stefan Voda and Telenesti). The project Young peoplepreventing HIV, supported by the Ministry of Education and co-financed by UNICEF aims at training at least four

peer-educators on HIV/AIDS and one adult mentor in every single community in 7 rayons in view of covering youngpeople with educational activities provided by peers.

Training peer educators in teritories. During reported year, 41 follow-up workshops have been organised for peereducators and adult mentors from the 7 raions involved in the project. A total of 1,020 persons, including 816 peereducators (PE) and 204 coordinators, have participated in the workshops targeted at evaluating Pes activity over theyear, challenges faced, lesson learned and future actions. The follow up workshops constitute a continuation of PEstraining which follows one year after the basic training (summer schools organised in year 2008) and contribute toensuring sustenability of HIV/AIDS information activities conducted by PEs.


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IndicatorsIntended cum.results at Dec. 31,

2009

Actual cum. resultat Dec. 31, 2009

Number of people reached by peer educators 15,000 25,810SDA 8: Prevention. Youth Education and Prevention

Activities under this SDA targeted at increasing involvement of communities, parents and religious organizations inHIV/AIDS prevention. Developing and piloting HIV/AIDS workplace policies.

Promoting HIV prevention activities through religious organizationThe Strategy on HIV/AIDS of the Orthodox Church has been developed during reported period in collaboration withMoldovan Mitropolia, the documented printed and distributed via Moldovan Mitropolia and other institutions workingin the field of HIV/AIDS. There are curently three ogranisations partnering for the implementation of religiouscomponent activities: Mitropolia of Chisinau and of Moldova, Association of Cristian-Orthodox Students, newspaper"Altarul Credintei".

At the same time a brosure on HIV-prevention to be used by church has been developped and transferred to OrthodoxMitropolia for distribution.

Capacity building. The capacity building for religiousworkers on HIV/STIs/substance abuse prevention has been ensured through two TOT trainings forrepresentatives of the Moldovan Mitropolia targeted atintroducing the representatives of the Orthodox churchto HIV issues, based on the strategy developed, suggestcorrect and scientifically proved information, andstimulate the involvement of the church in HIV and


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1 project run in penitenciary sector covers all Moldovas prisons with HIV/AIDS/STI prevention activitiesthrough IEC materials and condom distribution and 8 penitentiary institutions from right bank with needleexchange (Pruncul, Rusca, Cricova - 2 penitentiaries, Branesti, Soroca, Leova and Balti).

The services provided through these projects included peer education, needle exchange, condom distribution,

information and education, counseling and referral to health services, including HIV counseling.By the end of reported period the number of injecting drug users reached with prevention programmes reached 13,050(comulative number).

At the same time, a project aimed at developing self support groups for IDUs was implemented in 6 sites out of which 4are covered with harm reduction projects. The objective of the project was to develop capacity of self support groupcoordinators, informing beneficiaries and developing groups in new sites. One to three self support groups are organisedweekly in each site.

Reabilitation services for IDUsDuring reported year the delivery of psychosocial assistance and reabilitation services for drug users engaged in theharm reduction programmes has started within the Republican Narcological Dispensary. The project aimed at reducingbehavioral, emotional and intellectual-amnestice disorders subject to psychoactive substances abuse. At the same timethe development of technical capacity of staff involved in the implementation of social reabilitation has been planned fornext year along with the elaboration and approval of the guidelines on Psicho-social reabilitation of drug addictedpersons. A total of 65 persons have been included into the program during the year.

Substitution therapy (OST)

Substitution therapy with methadone is provided on right bank in both civil and pnitentiary sector through three GOsprojects: 2 projects run in civil sector through Republican Narcological Dispensary in Chisinau and City Hospital in

Balti. 1 project in penitenciary sector through the Department of Penitentiary Institutions covering 5 institutions (no.

18 Branesti, no. 15 Cricova, no. 16 Pruncul, no. 7 Rusca and Soroca). The extension of the project to two morepenitenciaries is planned for year 2010.

During reported period a total of 204 new beneficiaries have been included in the program and the total number of daylypatients on OST as of December 31, 2009 was 270 patients (it included as well patients that started treatment earlier than


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Capacity building of service deliverers has been ensured through training in peer and community programs for LGBT.18 reprezentatives of them LGBT community have been equipped with knowledge and skills in harm reduction outreachactivities. HIV prevention and risk behaviours, HIV transmission within LGBT were some of the issues covered withinthe training.

Community outreach to mobile population, migrants and repatriated personsHIV/AIDS/STI prevention activities for truck drives and migrants have been implemented through two NGOs one foreach target group.The services for truck drivers (education and distribution of informational materials, condom distribution, counselling,referrals, etc.) are provided through one project covering Chisinau and Balti sites. A total of 4,261 track drivers havebeen covered with educational activities as part of their professional trainings during reported period.

Prevention activities targeted at migrants included distribution of informational materials and condoms and coveredborder passing point (Leuseni, Sculeni towards Romania), Airport and Train Station (towards Russia - Moscow and

Sankt Petersburg destinations).

In order to inform mobile population about HIIV/STIs prevention, a brand mobile unit (truck) circulated over the holidayseason (from December 14, 2009 to January 14, 2010) when the number of migrants circulating increases substantialy.The truck labelled with the message protects your family and yourself from HIV and STIs" and accompanied by samesound message has circulated on the streets leading to Chisinau railway station, North and South Car Stations.


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Strengthening of human resourse capacity has been supported in order to improve management of HIV prevention invulnerable groups. Specialists active in harm reduction participated to such international events, study visits, trainingsabroad as: European Comissions Forum of the civil society in HIV/AIDS, Bruxelles, Belgium; training HIV/AIDSsurveillance in vulnerable groups and population size estimates, WHO knowledge hub, Zagreb, Croatia; RegionalMeeting of the Global Fund to fight AIDS, Tuberculosis and Malaria, Sofia, Bulgaria; conference Health andPenitenciaries Madrid, Spain.

Development of protocols and standards. As a result of a participative process the standards on assistance, treatmentand support for IDUs have been developed and approved by the Ministry of Health Expert Counsil (order no.266 datedAugust 03, 2009):

clinical protocol Substitution therapy for HIV infected persons, standards Harm Reduction for Injecting Drug Users and standards Psychosocial Support for Drug Users.

The protocol has been printed and distributed to organisations working in substitution therapy in country and otherinstitutions from the field.

In view of extending the coverage with services, fourtransportation units have been supplied and maintenanceensured to set up mobile services for outreach to their targetgroup from remote areas, out of them two for interventionstargeted at IDUs in Chisinau and Tiraspol and two forinterventions targeted at CSW in Chisinau and Balti.

Outreaches meeting CSW in Balti.


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Scale up access of PLWHA to antiretroviral treatmentFirst and second line ARV treatment has been ensured through supply of drugs for year 2009 (for 960 persons, including41 children) and procurement of drugs for the next year (1,234 patients expected to be on treatment during year 2010).Appropriate storage and timely delivery as per ARV services orders has been ensured by the program.

A total of 362 new patients, including 6 children, have started HAART during reported period, out of them 249(including five children) in Moldova and 113 in Transdniester region (including one child).The total number of patients who ever started ARV treatment is 1,233 (1,197 adults and 36 children), out of them: 964on right bank of Dniester river (including 35 children) and 269 on left bank (including one child).As of December 31, 2009, the number of patients who were receiving antiretroviral therapy was 985 (776 on right bankand 209 on left bank) including 35 children (34 on right bank and 1 on left bank).

The number of patients included on treatment and respectively the number of patients on treatment by the end of year2009 increased substantially as compared to innitial planning (1,233 patients included on treatment versus 895). This hasproportionally increased the number of PCR and CD4/CD8 tests required for follow up.

ART is provided in three facilities covering both banks of Dnister river. Two in Moldova: the Republican Dermato-Venereal Dispensary for civilian sector and the Department of Penitentiary Institutions, Pruncul hospital for prisoners,and one in Transdniester region (out patient) within the AIDS Center, Tiraspol.

Ensure monitoring of patientsTechnical maintenance and operation of testing laboratories has been supported to ensure monitoring of patients intreatment (PCR and CD4).

In view of strengthening ARV services capacity for monitoring patients in treatment one flowcytometer for CD4/CD8counting (RDVD) and two PCR lines (RDVD and AIDS Center, Tiraspol), and additional equipment for maintenance ofthe temperature regime in laboratories has been supplyed. The laboratory personel has been trained in using the newequipment.


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The ARV drug resistance technical capacity has been strengthened through support for participation of one laboratoryspecialist in a one week long on-job training in the Republican Scientific and Practic Centre of Epidemiology andMicrobiology, Minsk, Belarus, focused on interpretation of results of investigations for drug resistance.

SDA 3: Treatment: Prophylaxis and treatment of opportunistic infections

The following activities have been implemented under this SDA in view of bringing additional value to theHAART and ensuring lower rates for mortality owing to AIDS by appropriate testing and treatment of opportunisticinfections (OI).

Proper diagnoses of oportunistic infections ((viral hepatites, herpes simplex, toxoplasmosis and cytomegalovirus) inpatients on HAART and treatment of cases has been ensured along with specific antiretroviral treatment through

continuous supply of tests and OI drugs to ARV treatment service.A total of 806 cases in HIV/AIDS patients were registered and received treatment for opportunistic infections duringreported period, on both banks of Dniester river.

SDA 4: TB/HIV collaborative activities: Prevention of TB disease in PLWHA

Activities under this SDA aimed at ensuring lower rates for mortality owing to AIDS by proper diagnostic andtreatment of PLWHA for TB.

TB/HIV coinfected patients who are not in need of HAART have been ensured with cotrimoxazol profilactic treatmentto prevent other oportunistic infections and lower mortality owing to coinfection.60.0% of PLWHA on evidence at the end of the year 2009 have been screened for tuberculoses (2,158 PLWHA fromthe total of 3,595 PLWHA on evidence) and 7.5% out of them have been administered cotrimoxazol (268 out of 3,595).The testing of PLWHA and treatment for TB is ensured under the GFATM Round 6 TB Grant.

SDA 5: Care and support for chronically ill


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One training course for service deliveres from Homeand Community-based care and support has beenorganised in view of strengthening capacity inpalliative care for people living with HIV/AIDS. 26

people attended the event getting familiar with the principles of palliative care, palliative carecharacteristics for HIV/AIDS, monitoring of symptomsin patients with HIV/AIDS, guidance on compliance toARV treatment, etc.

Ensure adherence to ARV treatment for PLWHAThe program supported interventions targeted at increasing antiretroviral treatment adherence. In this regard peer to peercounseling has been ensured for PLWHA on ART and transportation related costs of patients on ART to and fromChisinau (RDVD) were covered. A total of 2,522 transportation related costs of patients from outside Chisinau toRDVD for ART monitoring, reception of ARV drugs or other issues have been reimbursed. About 2,509 PLWHA(case) benefited of health care counseling peer to peer counseling during reported period.

Human resourse capacity in adherence to antiretroviral treatment continued to be strengthened. During reported year atraining for 20 health care specialists and representatives of NGOs assisting PLWHA was conducted.

The table below shows the results reached for indicators from extended list under this SDA versus targets.

SDA 6: Stigma Reduction in all settings

The activities have been implemented under this SDA targeted at reducing stigma and discrimination towards


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At the same time two other trainings have been organised during the year. One for 23 specialist from 12 ludothequesfrom all over the country targeted at equiping participants with information about HIV/AIDS, way of transmission,myths about HIV/AIDS, prevention stigma and discrimination, education of tolerance, etc. The second one targeted stafffrom the 6 ludotheques covered by the project and aimed at increasing participants knowledge and skills in NGO

establishment and fundraising.

Improved quality of life of children vulnerable to HIV (Summer Camps)A summer camp was organised in august for children voulnerable to HIV and their parents. A total number of 30persons, 16 children aged from 4 to 14 years old and 14 adults (parents, grandparents, tutors, etc.) spent their time at thesummer camp. The main inclusion criteria were the HIV status of children and/or their relatives. The children includedwere selected with the support of NGOs working with PLWHA. The camp activities were structured to have leisure timeassociated with seminars.

Summer Camp. Official opening of ludotheque Pescarus, Balti.



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Transdniester region was supported for CCM Informational Bulletin to ensure even presentation in the bulletin ofnews/events from both banks.

Technical assistance provided by the chiefs and secretaries of CCM technical working groups has been ensured.

Capacity and partnership building has been assured through supported participation of CCM secretariat reprezentativesin international events, such as Global TB Control and medical assistance offered to patients, Beijing, China, March 29 -April 4, 2009 and Regional Meeting for the Grant Recipient Countries from Eastern Europe and Central Asia, Sofia,Bulgaria, November 24-26, 2009.


Indicators

Intended cum.

results at Dec. 31,

2009

Actual result at

Dec. 31, 2009

Number of NGOs in the AIDS network 25 40 10

Policy makers attending joint trainings and meetings at CCM 120

93 (cumulative for

year 2009)11

NGO representatives attending TWG and CCM meetings 9057 (cumulative foryear 2009)12

SDA 2: Total Coordination and partnership development (national, community, public-private)


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The Third Moldovan Forum of NGOs active in HIV/AIDS and tuberculosis was organised during reported period (June11-12, 2009). The concept of the forum was coordinated with the League of people living with HIV/AIDS, the HIVprevention and Harm Reduction Network and the network of NGOs active in HIV/AIDS and drug addiction,Ministry Health, Ministry of Social Protection, Child and Family, UNAIDS, WHO, UNICEF and other partners.

The event gathered 120 reprezentatives of civil sector, governmental and international organizations throughoutMoldova, including Transdniester region and UTA Gagauzia and focused on development of civil societyinvolved in HIV/AIDS and TB control, strengthening the partnership between governmental institutions andNGOs, especially NGOs representing the interests of persons infected or affected by HIV/AIDS, improvement ofthe regulatory issues pertaining to HIV/AIDS and NGOs, regional development, etc.


Indicators

Intended cum.

results at Dec. 31,

2009

Actual cum. result

at Dec. 31, 2009

Number of CCM Informational Bulletins distributed 7,200 3,500 13

Number of NGOs representatives trained 200 142

Number of NGOs meetings conducted 8 24

SDA 3: Information system & Operational research

The following activities have been implemented under this SDA in view of supporting implementation of


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The SYMETA system infrastructure has been strenthened through supply of IT equipment for SYME HIV/STIs (PC +printer, including installment services) for the region of Transdniestria.On right bank of Dniester river the equipment has been delivered in year 2008 to both national and local level to ensuretimely reporting of data at all levels, from the primary tier to the top-most M&E Units. The M&E Unit of National

Center of Public Health has been supplied with IT equipment for the proper functioning of the unit. STIs module wasinstalled on computers before delivery to medicasl units (municipal and rayon medical institutions' infection diseasedepartments). The HIV module was finalised in late 2009 and only partially installed in Centers for Preventive Medicinefrom right bank of Dniester river.By the end of reported period a total of 61 sites were properly equipped with IT for the implementation of the nationalM&E system (SYME HIV/STI), out of them 38 implementing SYME ITS ((municipal and rayon medical institutions'infection disease departments) and 23 sites implementing SYME HIV (Centers for Preventive Medicine).

Training for personnel involved in SYME HIV/STIsA total of 194 medical staff that are/will be involved in SYME HIV/STIs data collection, input and analysis(dermatovenerealogist and infectionists from medical institutions, specialists from Centers of Preventive Medicine, etc.)trained in computer use and SYME HIV/STI use.

Conduct operational researchAn HIV/AIDS Sentinel survellance in most-at-risk groups (BSS) was conducted in year 2009 with linked anonymous

testing to HIV, VHC and VHB. The BSS survey targeted at determining the knowledge on HIV, risky behavioursrelated to HIV and health seeking behaviours in the target groups representatives (IDUs, FCSWs and prisoners) bothcovered and uncovered by Harm Reduction Programmes. According to BSS results, 37.5% of IDUs from Chisinau sitehave adopted behaviours that reduce transmission of HIV.

The translation of the study report of the Behavioral Sentinell Surveyance conducted in year 2007 14 has been supported.The bilingual report will be printed at the beginning of year 2010.


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PROJECT MANAGEMENT

PI CIMU HSRP has developed a data base for the management of inventories and follow up of supplies (primarydelivery to national institutions, and secondary delivery - from national to sub-national level) of goods procured underthe grant (pharmaceuticals, health products, commodities, equipment both medical and non-medical, transportationunits, etc.) (figure 24).

Figure 24


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In order to ensure program activities continue while Phase 2 is negociated, a three month extension of Phase 1 withadditional funding has been signed on December 4, 2009 (Q9 budget of $ 323,200.00).

Round 6 Phase two budget has been consolidated with R8 budget and forms the budget for 1st mplementation period of

the single stream of funding (MOL-S10-G07-H).

The negociations with the sub-recipients for years 3-5 of grant implementation have started. The sub-recipientscontracted in phase one have been invited to develop and submit working plans and budgets for phase two based onRequest for Continued Funding submited to GFATM. Three out of the four sub-recipients are to be contracted for nextthree years (Soros Foundation-Moldova, AIDS Foundation East West (AFEW) and National Youth Resource Center)and one additional sub-recipient will be contracted begginning with fouthe year of grant implementation for thedevelopment curricula and support materials for "Health education" course for students in colleges and vocational

training institutions and training of teachers.

PROCUREMENT AND SUPPLY CHAIN MANAGEMENT

Procurement of health and non-health products under the Global Fund grant is conducted based on World Bankprocurement regulations, namely: (a) The procurement of goods have been made in accordance with the provisions ofSection I ofthe Guidelines for Procurement under IBRD Loans and IDA Creditspublished by the Bank in January 1995and revised in January and August 1996, September 1997 and January 1999 (the Guidelines). The Banks standard andsample bidding and contracting documents for the procurement of goods have been used for International Competitive

Bidding (ICB), International Shopping and National Shopping (ISh and NSh); (b) Consultants hired for training andtechnical assistance have been employed in accordance with the Banks Guidelines on Selection and Employment ofConsultants by World Bank Borrowerspublished by the Bank in January 1997 and revised in September 1997, January1999 and May 2002.

Procurement of health sector goods has been done in line with Global Fund Quality Assurance Policy forPharmaceutical Products and data on price, quality of ARV drugs is timely entered into the Price ReportingMechanisms.


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CD4/CD8) and by substantial increase in price of tests compared to initially budgeted amounts. The deficit has been metfrom savings generated by sub-recipients and under pharmaceutical procurement.

Consequently remaining funds (variance of 108,802.11 US Dollars) have been committed with prior GFATM

agreement for ARV drugs final payment, storage of drugs, HIV tests supply, printying of BSS survey, etc.

Overall expenditures are in line with the budgets. The cumulative disbursed funds per program objective during programlife are presented in the graph below.

- Objective 1: To reduce sexual and mother-to-child transmission (MTCT) of HIV/STIs and reducetransmission via needle sharing by scaling up the access of population to prevention and testing services;- Objective 2: To ensure and foster equal access of the people living with and affected by HIV/AIDS

(PLWHA) to social and health services, and fight discrimination and stigma; and

- Objective 3: To strengthen government and community capacity to cope with the HIV epidemic throughpartnerships and enhanced coordination.

Figure 25

Cummulative disbursed funds per programmeobjectives vs. planned (year 2009)

mount(US$mln.)

2

3

43.67

3.56

1.99

2.21


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between the PR and the SR, whether the implementation of the program activities is in accordance with the agreed uponworkplan(s), and whether expected results and outcomes are achieved.PI CIMU HSRP has follow-up with the SRs to discuss any outstanding issues, discrepancies in the reported results ordata quality-related issues prior to accepting the report. The results of the review and recommendations have been

discussed with SRs.

The financial monitoring of sub-recipients has been provided on quarterly bases by an audit company contracted by PICIMU HSRP. SRs reported expenditures have been quarterly reviewed including budget vs. actual expendituresanalysis, checking the reported balance against the SRs bank statements, etc.PI CIMU HSRP has follow-up with the SRs to discuss any outstanding issues prior to accepting the financial report andresponding to SRs payment requests.

Quarterly meetings have been held with SRs, implementing organisations and the M&E Unit of National Center of

Health Management to discuss implementation progress, problems and solutions, data reported, collection mechanisms,timeliness of submission, data validation, quality-related issues, etc. CCM secretariat is also invited to participate inthese meetings.

Monitoring visitsPI CIMU HSRP performed monitoring visits to Sub-recipients and medical institutions on both banks of river Dniesterand both civil and penitentiary sectors, related to use of ARV and OI drugs, reagents and consumables, equipment andother goods supplied under the grant. During reported period a total of 29 visits have been conducted, out of them 20 to

rayonal medical institutions on both banks of Dniester River, 6 to Penitenciary institutions, 2 to republicam medicalinstitutions and one to the sub-recipient implementing communication activities. Feedback of findings andrecommendation has been ensured.

Data use & disseminationPI CIMU HSRP has timely reported progress according to preestablished regularity: to Global Fund on semiannualbasis, and to CCM and MoH, MoE, MoF on quarterly basis. An annual progress report (for Year 1) has been submittedto Global Fund 3 months after the end of first year of implementation, and translated copy submitted to CCM fordissemination.


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CONCLUSION

1. The Program continued to provide significant support in implementation of the National Program on Preventionand Control of HIV/AIDS/STIs. About 50% of budget spent in year 2009 for the national response to HIV/AIDS arefrom international resources, the higherst rate (63%) coming from GFATM Round 6 grant.

2. After 24 months of implementation the following should be listed:

HIV/AIDS laboratory service has been scaled up (primarely to Transdniester region) and continued to be timely anduninterruptedly ensured with consumables and reagent.

VCT cabinets network has been extended to Transdniester region increasing access to quality VCT services allover


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CHALLENGES FACED DURING YEAR 2 OF IMPLEMENTATION

Despite the extenssion of the VCT network allover the country the coverage with VCT services remaines lowespecially in voulnerable groups. Refferal system needs to be strengthened or services should be brought closer tothe end users.

The inclusion of people with advanced HIV infection in ARV treatment has substancially exceeded planned targets,increasing proportionally follow up costs and travel reimbursements cost for patients in ART.

Savings generated as a result of qualitative management of grant have been mainly directed to ensure proper followup of patients in ART which increased dramatically due to substantial increase in number of patients in ART


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Annexes

Annex 1. Programmatic resultsCumulative targets achieved per semester for first two years of implementation for each of the specified indicators

No. Objective Service Delivery Area Indicator Target/resulta

Cumulative over the semesters

P1 P2 P3 P41 To reduce sexual and

mother-to-childtransmission (MTCT) ofHIV/STIs and reducetransmission via needlesharing by scaling upthe access of populationto prevention and testingservices

Prevent ion: PMTCT 1.1 Number of pregnant women reached withvoluntary testing and counseling services

Target N/A N/A 30000 60000

Achieved N/A N/A 17780 348401.2 Number of HIV-postive pregnant women

receiving a complete course of ARVprophylaxis to reduce the risk of mother-to-child transmission

Target 50 100 165 230

Achieved 43 123 181 230Prevention: Testing andCounseling

1.3 Number of service delivery sites supportedto provide voluntary counseling and testing(VCT) services

Target N/A 34 N/A 34

Achieved N/A 40 40 44Prevention: Blood safetyand universal precaution

1.4 Number of laboratory facilities withcapacity to provide high quality HIV testing

servicesTarget

3(includingbaseline)




Achieved





Prevention: STIdiagnosis and treatment

1.5 Number of patients with STIs at health carefacilities who are appropriately diagnosed,treated and counseled

Target 2500 5000 7500 10000

Achieved 2055 4711 6728 8888Prevention: BCC -community outreach

1.6 Number and percentage of injecting drugusers (IDUs) reached with prevention

programmes Target11,830/35,850

30%12,547/35,850

35%13,264/35,850

37%14,340/35,850

40%

Achieved

12,194/35,850

34%

12,451/35,850

34,7%

12,787/35,850

35,7%

13,050/35,850

36.4%1.7 Number and percentage of commercial sex

workers (CSWs) reached with outreachprogrammes Target

877/5,16017%

1,032/5,16020%

1,290/5,16025%

1,548/5,16030%

Achieved957/5,160

18.5%975/5,160

18.9%1,053/5,160

20.4%1,116/5,160

21.6%


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1.8 Number and percentage of lesbian, gay, bi-sexual and trans-sexual reached withoutreach programmes Target

755/5,00015.1%

800/5,00016%

850/5,00017%

900/5,00018%

Achieved760/5,00015.2%

768/5,00015.4%

782/5,00015.6%

829/500016.6%

1.9 Number of truck drivers reached withprevention programmes Target 1500 3000 4500 6000

Achieved 1073 3248 5518 75071.10 Number of drug users reached with drugsubstitution therapy

Target 25 50 80 110

Achieved 34 154 262 358

2 To reduce sexual andmother-to-childtransmission (MTCT) ofHIV/STIs and reducetransmission via needlesharing by scaling upthe access of populationto prevention and testingservices

Treatment:Antiretroviral treatment(ARV) and monitoring

2.1 Number of people with advanced HIVinfection that have started antiretroviralcombination therapy

Target





Achieved





Treatment: Prophylaxisand treatment foropportunistic infections

2.2 Number of opportunistic infections casesdiagnosed among PLWHA and receivingtreatment

Target 332 665 997 1330

Achieved 241 1097 1566 1903

TB/HIV collaborativeactivities: Intensifiedcase-finding amongPLWHA

2.3 Number and percentage of PLWHAscreened for TB

Target N/A 90% N/A 90%

Achieved N/A 55.8% N/A 60.0%Care and support: Careand support for thechronically ill

2.4 Number of people living with HIV/AIDSreached with care and support services

Target 500 1000 1500 2000

Achieved 720 1161 1612 1896

3 To strengthengovernment andcommunity capacity tocope with the HIVepidemic through

partnerships andenhanced coordination

Information system &Operational research

3.1 Number of health units with capacity toimplement the new computerized nationalM&E system Target N/A N/A 23 66

Achieved N/A N/A 37 61

1,2,3

Supportive environment:Strengthening of civilsociety and institutionalcapacity building

1,2,3.1

Number of healthcare providers trained Target 250 1000 1060 1845

Achieved 43 1017 1533 18971,2,3.

2Number of service deliverers trained in peerand community programs Target 100 124 150 174

Achieved 0 1614 1640 1668

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Annex 2. Cash Flow

A. Country: REPUBLIC OF MOLDOVA

B. Disease: TUBERCULOSIS AND AIDS

C. Grant number: MOL-607-G03-H

D. Principal recipient: Public Institution "Coordination, Implementation and Monitoring Unit of the Health System RestructuringProject"

E. Current period opening date (dd/mm/yy): 01.07.09F. Current period closing date (dd/mm/yy): 31.12.09

G. Disbursement request number: 6

H. Currency: USD

Consolidated Program (Local or Normal ReportingCurrency)

Line item (a) Current Period Cumulative for the year Cumulative for the program life

Planned Actual Variance Planned Actual Variance Planned Actual Variance

SOURES

1. Cash received from the Global Fund R6 AIDS 1,384,799 1,384,799 3,021,144 3,021,144 6,734,272 6,734,272

2. Interest income, Global Fund Grant no.MOL-607-GO3-H 571 571 1,718 1,718 8,157 8,157

3. TOTAL SOURES 1,385,370 1,385,370 3,022,862 3,022,862 6,742,429 6,742,429

USES

514 -514 1,182 -1,182 2,505 -2,505HIV/AIDS/STIs 1,161,237 1,640,207 -478,970 2,765,586 3,422,400 -656,814 6,411,073 6,299,766 111,307

OBJECTIVE 1: SCALE UP ACCESS TO PREVENTION ANDTESTING

1,052,949 719,464 333,485 1,575,804 1,849,380 -273,576 3,673,604 3,560,860 112,744

PREVENTION SDA 1: Behavioural change communication- mass media

64,670 83,293 -18,623 137,975 150,037 -12,062 292,820 304,703 -11,883

A 1.1Conducting a radio marathon on reducing stigmaand discr.tow.PLWHA and people afected by HIV/AI

10,000 8,820 1,180

4. A 1.1.1 Development of scenario 200 200

5. A 1.1.2 Technical direction, sound, sound editing 2,500 2,500

6. A 1.1.3-HR-Elaboration, registering and editing of additionalmaterials

1,900 4,840 -2,940

7. A 1.1.3-CP-Elaboration, registering and editing of additionalmaterials

100 3,980 -3,880

8. A 1.1.4 Honorariums including VAT (director, 2 persons forediting, 2 sound direction, 3 presenters 4,500 4,500

9. A 1.1.5 Transport rent and guarantee of direct transmissionsfrom the regions

800 800

A 1.2 Conducting social events covered in media with theparticip.of the opinion leaders& diff.stars

10,000 10,000 20,000 29,464 -9,464

10. A 1.2.1 Scenario preparation and elaboration of plan forimplementing of the social event

600 600 1,200 1,003 197


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11. A 1.2.2 Elaboration of informative and promotion materials 3,400 3,400 6,800 3,457 3,343

12. A 1.2.3 Transport expenses 400 400 800 1,103 -303

13. A 1.2.4 Press kits and media technical assistance 1,400 1,400 2,800 9,659 -6,859

14. A 1.2.5 Implementing team briefing 1,000 1,000 2,000 919 1,081

15. A 1.2.6 Honorariums (local coordinator, implementing team) 3,200 3,200 6,400 13,322 -6,922

A 1.3 Organizing broadcasted debates regardingHIV/AIDS/STI with the participation of the population

6,975 21,552 -14,577 6,975 31,499 -24,524 14,450 54,824 -40,374

16. A 1.3.1 Scenario preparation and elaboration of plan forimplementing the debates rounds on TVchan.

600 736 -136 600 1,446 -846 1,500 2,866 -1,366

17. A 1.3.2 Transport expenses (for the team of presentors,assistants and technical TV personnel and p

300 137 163 300 269 31 600 533 67

18. A 1.3.3 Equipment and rent of the debates and editing room 2,250 676 1,574 2,250 1,329 921 4,500 2,994 1,506

19. A 1.3.4 Mobile studio decorations 750 750 750 750 1,500 3,420 -1,920

20. A 1.3.5 Editing of TV debates (studio and equipment) 2,475 274 2,201 2,475 538 1,937 4,950 1,066 3,884

21. A 1 .3.6 Honorariums (local coordinator, director, 1 lightspecialist, 1 prezentors)

600 1,089 -489 600 2,139 -1,539 1,400 4,187 -2,787

22. Overhead AFEW H/SR/004 18,039 -18,039 23,777 -23,777 34,888 -34,888

23. Audit AFEW H/SR/004 601 -601 2,002 -2,002 4,871 -4,871

A 1.4 Conducting trainings for journalists regardingmedia qualitative coverage of HIV/AIDS issues

2,625 5,566 -2,941 5,400 5,566 -166 11,000 11,107 -107

24. A 1.4.1 Organization of 2 annual trainings for mediarepresentatives (15 persons) (including: transp

2,625 5,359 -2,734 5,250 5,359 -109 10,500 10,720 -220

25. A 1.4.2 Preparation of press kits for media (4 annual kits) 104 -104 150 104 46 300 184 116

26. A 1.4.3 Media monitoring 104 -104 104 -104 200 204 -4A 1.5 Production of films with education characterregarding HIV and AIDS

5,000 4,976 24

27. A 1.5.1 Elaboration of the scenario and all coordinations forshootings

450 1,246 -796

28. A 1.5.2 Production equipment (3 video cameras, TV car,transport, editing room, audio registering st

2,300 610 1,690

29. A 1.5.3 Transportation cost 100 170 -70

30. A 1.5.4 Honorariums (director, 2 camera-men, 1 editingperson, 1 sound direction, 1 lights speciali

1,450 2,150 -700

31. A 1.5.5 Multiplication of movies and technical expenses forbroadcasting

300 360 -60

32. A 1.5.6 Translation, subtitles 400 440 -40

A 1.6 Translation and producing copies of educationaland documentary films from internat.practice

2,000 2,000 2,000 1,218 782 4,000 2,436 1,564

33. A 1.6.1 Delivery of the copies of educational and documentaryfilms

60 60 60 130 -70 120 260 -140

34. A 1.6.2 Translation and subtiteling of the documentary 400 400 400 400 800 800

35. A 1.6.3 Honorariums (translator, video equipment expert) 340 340 340 300 40 680 600 80

36. A 1.6.4 Multiplication and distribution of the documentary 1,200 1,200 1,200 388 812 2,400 776 1,624

A 1.7 Increasing participation of journalists in writingmessages on HIV/AIDS issues

2,800 2,903 -103 2,800 2,903 -103 5,300 5,703 -403

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37. A 1.7.1 Awards for journalists (3 awards for I place (radio, TV,written media), 3 awards II place

2,600 518 2,082 2,600 518 2,082 4,600 1,018 3,582

38. A 1.7.2 Expenses for the organization of the awards ceremony(room rent, catering)

200 2,385 -2,185 200 2,385 -2,185 700 4,685 -3,985

A 1.8 Organizing a Dance4Life event for youth to bebroadcasted

37,970 33,307 4,663 89,200 81,699 7,501 179,870 144,332 35,538

39. A 1.8.1 Media campaign elaboration 500 500

40. A 1.8.2 Implementing team trainings 200 200 1,000 7,500 -6,500

41. A 1.8.3 Testing of the concepts and design of the campaignpromotion and information materials

1,478 -1,478 1,952 -1,952 9,420 3,852 5,568

42. A 1.8.4-HR- Information materials production 4,000 4,000

43. A 1.8.4-CP- Information materials production 44,000 39,568 4,432 84,000 58,976 25,024

44. A 1.8.5 Promotion materials production (Tshirts, bandanas,stiks, etc)

6,220 -6,220 12,770 -12,770 5,000 16,470 -11,470

45. A 1.8.6-T- Campaign launch 200 200 200 150 50

46. A 1.8.6-PA- Campaign launch 200 200

47. A 1.8.7-T- Conduct trainings for youth (50 persons) 3,000 3,000

48. A 1.8.7-CP- Conduct trainings for youth (50 persons) 7,000 7,000 7,000 7,000 7,000 7,000

49. A 1.8.8-HR- Conduct final concerts (in Chisinau and inregions)

1,000 200 800

50. A 1.8.8-CP- Conduct final concerts (in Chisinau and inregions)

29,970 4,354 25,616 29,970 6,154 23,816 47,970 6,354 41,616

51. A 1.8.8-PA- Conduct final concerts (in Chisinau and in

regions)

1,000 19,000 -18,000

52. A 1.8.9-CP- Broadcasting of the concerts 2,000 2,000

53. A 1.8.9-PA- Broadcasting of the concerts 1,000 1,000 3,000 3,000 3,000 1,520 1,480

54. A 1.8.10 Honorariums (project director and 5 coordinators,dancers team, TV and concert presenters,

21,253 -21,253 4,830 21,253 -16,423 10,580 30,308 -19,728

A 1.10 Participation of local level experts at internationalevents for advocacy and exchange of exp

3,000 2,747 253 3,000 4,397 -1,397 6,000 9,827 -3,827

55. A 1.10 Participation of local level experts at internationalevents for advocacy and exchange of exp

3,000 2,747 253 3,000 4,397 -1,397 6,000 9,827 -3,827

A 1.11 Ensuring proper coordination of communicationactivities

6,600 13,685 -7,085 13,200 18,085 -4,885 26,400 26,885 -485

56. A 1.11.1 Hiring a Coordination Consultant 3,600 7,465 -3,865 7,200 9,865 -2,665 14,400 14,665 -265

57. A 1.11. 1 Hiring a coordination Assistant 3,000 6,220 -3,220 6,000 8,220 -2,220 12,000 12,220 -220

A 1.12 Ensure proper operations and coordination of theCommunication Coordination Unit

2,700 3,533 -833 5,400 4,669 731 10,800 6,329 4,471

58. A 1.12.1 Communication expences for the Coordination Unit 900 2,090 -1,190 1,800 2,762 -962 3,600 3,662 -62

59. A 1.12.2 Procurement of office consumables 600 1,443 -843 1,200 1,907 -707 2,400 1,907 493

60. A 1.12.2-D- Procurement of office consumables 760 -760

61. A 1.12.3 Ensure proper translation of documents 600 600 1,200 1,200 2,400 2,400

62. A 1.12.4 Transportation services for the Coordination UnitStaff

600 600 1,200 1,200 2,400 2,400

PREVENTION: SDA 2: Prevention of Mother to ChildTransmission

157,719 9,120 148,599 160,219 48,450 111,769 313,054 135,960 177,094

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Activities 157,719 9,120 148,599 160,219 48,450 111,769 313,054 135,960 177,094

63. A 2.1-CP-Advocacy and technical assistance for thesustainable integration of new services required

2,000 1,920 80 4,000 5,380 -1,380

64. A 2.1-PA-Advocacy and technical assistance for thesustainable integration of new services required

2,400 -2,400 500 2,880 -2,380 1,000 3,598 -2,598

65. A 2.2 Organizing a study tours for key health careprofessionals and managers

2,500 2,500 2,500 2,500 5,000 5,000

66. A 2.3 Orientation for health care managers from all regions 7,000 6,553 447 7,000 6,553 447 14,000 13,053 947

67. A 2.4-HR-Revision and re-printing of the national PMTCTGuidelines

900 900

68. A 2.4-CP-Revision and re-printing of the national PMTCTGuidelines

167 -167 472 -472 8,100 10,472 -2,372

69. A 2.5-HR-Development,editing and distribution of IECmaterials for the prevention of unwanted pregn

1,000 1,000

70. A 2.5-CP-Development,editing and distribution of IECmaterials for the prevention of unwanted pregn

4,000 2,000 2,000

71. A 2.6 Ensure testing of pregnant women before delivery, HIVtest (blood) Transnistria

15,000 15,000 15,000 15,000 30,000 16,163 13,837

72. A 2.7 Ensuring testing of pregnant women to HIV, first quarterof pregnancy

18,000 18,000 18,000 18,000 36,000 36,000

73. A 2.8 Prevention of mother to child transmission of syphilis,testing

15,000 15,000 15,000 13,343 1,657 30,000 13,343 16,657

74. A 2.9-CP-Ensure proper treatment of mothers and children

tested posit.to syphilis,procain penicilin

7,000 7,000 7,000 7,000 7,000 7,000

75. A 2.9-D-Ensure proper treatment of mothers and childrentested posit.to syphilis,procain penicilin

7,000 7,000

76. A 2.10 Reduce transmission of HIV/AIDS in pregnant womenand chidren

60,719 60,719 60,719 60,719 107,554 107,554

77. A 2.11 Reduce transmission of HIV/AIDS to chidren 32,500 32,500 32,500 23,281 9,219 57,500 71,951 -14,451

PREVENTION SDA 3: Testing and Counseling 30,000 9,804 20,196 47,000 48,807 -1,807 185,000 152,116 32,884

Activities 30,000 9,804 20,196 47,000 48,807 -1,807 185,000 152,116 32,884

78. 3.1-IE-Increase national capacity in providing VCT services ofhigh quality

2,584 -2,584 8,151 -8,151 15,000 21,683 -6,683

79. 3.1-CP-Increase national capacity in providing VCT services ofhigh quality

10,000 23,200 -13,200

80. 3.1-PA-Increase national capacity in providing VCT services ofhigh quality

5,000 5,000

81. 3.2 Training of health staff involved in VCT -305 305 7,000 6,195 805 7,000 6,195 805

82. 3.3-IE-Scale up access to VCT for the population 4,062 -4,062 40,000 70,639 -30,639

83. 3.3-PA-Scale up access to VCT for the population 28,000 28,000

84. 3.4 Procurement of HIV rapid test (saliva) for VCT andsurveillance

25,000 196 24,804 25,000 22,843 2,157 50,000 22,843 27,157

85. 3.5 Establsihment of a green line 1,000 6,597 -5,597 3,000 6,597 -3,597 6,000 6,597 -597

86. 3.5-IE-Establsihment of a green line 3,333 282 3,052 10,000 349 9,651 20,000 349 19,651

87. 3.5-CP-Establsihment of a green line 667 450 217 2,000 611 1,389 4,000 611 3,389

SUPPORTIVE ENVIRONMENT: SDA 4 Laboratory 140,692 64,137 76,555 140,692 240,175 -99,483 755,784 750,587 5,197

53

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4.1 Scaling up access of population to high quality testing 31,851 -31,851 146,426 -146,426 510,040 553,550 -43,510

88. A 4.1.1 Equipment for ELISA investigation 10,136 -10,136 80,000 62,466 17,534

89. A 4.1.2 Flowcytometer for CD4/CD8 counting completed withagitator type Vortex

10,177 -10,177 80,000 95,572 -15,572

90. A 4.1.3 PCR equipment 10,725 -10,725 35,445 -35,445 240,000 260,209 -20,209

91. A 4.1.4 Universal centrifuge 0-5000 rot./min. 35,930 -35,930 32,000 55,207 -23,207

92. A 4.1.5 Distillatory 814 -814 10,800 21,107 -10,307

93. A 4.1.6 Apparatus for the production of the bidistilled water 25,243 -25,243 30,000 27,547 2,453

94. A 4.1.7 Air conditioner winter/summer 7,555 -7,555 3,640 10,316 -6,676

95. A 4.1.8 Set of the laboratory furniture 21,126 -21,126 21,126 -21,126 22,400 21,126 1,274

96. A 4.1.9 Set of the laboratory furniture 11,200 11,200

4.2 Ensuring a high quality testing process 283 -283 3,760 9,006 -5,246

97. A 4.2.1 Procurement of a set of automated pippetes (1channel 5-50 mkl, 50-200 mkl, 200-1000 mkl -

283 -283 3,760 9,006 -5,246

4.3 Ensure an adequate temperature regime for stockingof reagents

41,500 5,338 36,162 41,500 27,413 14,087 41,500 27,413 14,087

98. A 4.3.1 Refrigerator -20 -40 deg

annual progress report-ro

Documents