Abstract



IUSTI GUIDELINES DRIVEN DEVELOPMENT OF THE REPUBLIC OF MOLDOVA STI REGULATORY FRAMEWORK

Mircea Betiu,

Iulia Emet

Nicolae Testemitanu State University of Medicine and Pharmacy, Republic of Moldova,

Department of Dermatovenereology   

Sexual transmitted infections (STI) remain to be a pivotal domain of the health sector, which gains substantial medical and public interest. Sexual health is essential in ensuring a decent quality of life.

In 1991, after dissolution of USSR, Republic of Moldova became an independent state. Disruption of economic networks led to financial and social crisis. On other hand, increasing cultural interchange between East and West Europe has triggered a rapid penetration of sexual oriented products on local markets, what caused a profound shift in sexual lifestyle, especially among youngsters. Thus, in 1990s, Republic of Moldova together with other newly independent states of former Soviet Union has faced a major epidemic of STIs, especially of syphilis. Therefore, incidence of syphilis in 1988 was 7.1 cases per 100000 population, it started to raise in early 90s with 117,9 cases in 1994 and reached its historical maximum in 1996 when 200,7 cases per 100000 population were confirmed.  Incidence of gonorrhea, trichomoniasis and other STIs has increased too.

In the USSR system of STIs evaluation has been based on a centrally controlled nationwide clinical dermatovenereology service that rigorously supervised all cases of STIs often neglecting protection of patients personal data as well as their human rights.  Clinical management of STI cases differed significantly from Western countries: patients with syphilis have been treated as inpatients by prolonged courses of injections of penicillin up to 4 weeks instead of modern regimens using benzathine penicillin for outpatient management of cases, provocation techniques in the diagnosis and management of gonorrhea, as well as immunotherapeutic methods in the treatment of a range of STIs without any evidence based support were applied as well.

Old-fashioned standards and increasing number of STI cases have pushed local dermatovenereologists to look forward for new STI guidelines. Thus, in 2003 with financial support of SOROS Moldova Foundation, we became a part of project for “Developing evidence-based standards for STI management in Eastern Europe and Central Asia” guided by IUSTI, WHO-Europe and UNAIDS. During this project dermatologists from Moldova had an unique opportunity to visit leading STI centers in UK, interchange and gain knowledge from main experts in the field. As a result, in 2005 the project core group specialists has elaborated National Guidelines on STIs management, which was entirely based on IUSTIs evidence supported recommendations.  In 2017 this guideline was successfully re-edited and served as a regulatory STI management base, including the National Clinical Protocol for Syphilis, which has been endorsed by MOH recently.

Implementation of National STI Guidelines and continuing compliance with it of dermatologists from all over the country made it possible for Republic of Moldova to validate Elimination of Mother to Child Transmission of Syphilis at global WHO level in 2016, being one of the first countries to achieve that status worldwide. We sustained that commitment through 2 subsequent revalidations in 2018 and 2020.

Finally, we would like to conclude that maintenance of our National STI Service and success it has achieved would have not been possible without the support of IUSTI team, who remains our trustworthy partner.


61|mircea.betiu@usmf.md|W1-7
34 IUSTI Congress - European Congres on Sexually transmitted Infections and HIV/AIDS
TAMING THE TIDE of STIs & HIV
Bucharest, September 3-5,