Category: 2017

Closing Project: Tuberculosis Community Systems Strengthening in Georgia
The Curatio International Foundation has fulfilled a Tuberculosis Community Systems Strengthening (TBCSS) Project in Georgia, funded by the Stop TB partnership in the frame of Challenge Facility for Civil Society (CFCS) round 7 program. The goal for the project was to strengthen community response that is integrated and a part of a comprehensive response to TB in Georgia.

The Curatio International Foundation studied CSO engagement in patient-centered quality TB community care in the country and developed directory of civil society organizations (CSOs) and TB communities that have been enrolled in providing TB education, prevention, support, treatment adherence and care services among various target groups in recent past.

Project revealed major challenges for community engagement in the TB response in Georgia:

Limited funding opportunities for CSOs: Donor-funds are of limited scale; and the Government of Georgia has never funded TB CSOs for delivering TB services.

Limited capacity of CSOs: The mapping of CSOs has demonstrated that CSOs, and particularly less experienced TB-specific community-based groups, lack capacity for organizational management, fundraising, program financial management, leadership, etc.

Uneven geographic distribution of CSOs: There are only few CSOs that are engaged in TB services and mostly they are operational in Tbilisi, the capital city. Community based system for TB is not developed in regions and the number of CSOs is not evenly distributed geographically.

Within the project we had number of significant achievements addressing the challenges:
1. TB Georgia Coalition (TBGC) was registered as a non-profit, nongovernmental organization on October 30, 2017. That has generated new expectations among member organizations and increased their motivation to become more active in the field.
2. Member organizations of TBGC have benefited from each training organized under the CFCS Rd7 grant. CSOs representatives underwent intensive training on organizational management and leadership; program management cycles; program planning and budgeting, communication and presentation skills.
3. The Patients’ Union for the first time ever received funding under the Global Fund TB grant and was contracted as a sub-sub recipient organization in a consortium with the community-based organization (CBO) – New Vector. The Memorandum of Understanding between the National Center for Tuberculosis and Lung Diseases and local CBO – New Vector and the Patient Union, has been signed on November 9, 2017, with the aim to improve treatment adherence for TB patients.
4. Visibility of TB CSOs has increased through CFCS mapping and assessment results dissemination at the Country Coordination Mechanism (CCM) meeting, and national consultation meetings.
Since its establishment TBGC participated in several high level meetings and actively has been engaged in the discussions on critical issues regarding patient centered TB care in Georgia. Significant progresses has been made in this direction, however, involvement of civil society and TB communities in the national TB program is in its initial stage.

TB CSO directory document is available here.
March 22, 2018
Primary Health Care Systems: Georgia case study

Curatio International Foundation publishes Georgia case study of primary health care system (PRIMASYS). The PRIMASYS case study covers key aspects of primary health care system, including policy development and implementation, financing, integration of primary health care into comprehensive health systems, scope, quality and coverage of care, governance and organization, and monitoring and evaluation of system performance.

The PRIMASYS case study applied a framework looking at how the primary health care system works and what factors (both contextual and related to policy changes) have influenced access to and performance of primary health care in Georgia since 1994. Documents review and in-depth interviews with key stakeholders were conducted in 2017 in order to understand barriers and facilitators of the system reforms in Georgia.

Georgia PRIMASYS case study emphasizes that Georgia’s health care system has undergone radical reforms over the last two decades, significantly influenced by external drivers such as political dynamics, macroeconomic factors, international partners’ involvement and internal processes.

The current PHC system in Georgia offers accessible and affordable services to the population, with differentiated benefits to those in greater need. However, the system still requires significant improvements to achieve its ultimate goal of delivering comprehensive, continuous and people-centered care.

Georgia PRIMASYS case study was part of the series of 20 PRIMASYS case studies globally developed with the support of the Alliance for Health Policy and Systems Research in collaboration with the Bill & Melinda Gates Foundation. The case studies will serve as the basis for a multi-country analysis of primary health care systems, to understand the systems-level determinants of primary health care performance, and to draw cross-cutting lessons learned in the implementation of primary health care policies and systems reforms and interventions.

Download the full report.

March 16, 2018
Integrated Bio-behavioral surveillance and population size estimation survey among Female Sex Workers in Tbilisi and Batumi, Georgia
This study represents the subsequent wave of Bio-Behavioral Surveillance Surveys (BBS) surveys undertaken among Female Sex Workers (FSW) since 2002. The current study was conducted in 2017 using the Time-Location Sampling technique and 350 FSWs was recruited in total in two survey locations – 200 in Tbilisi and 150 – in Batumi. The objective of the 2017 BBS was to measure the prevalence of HIV, Hepatitis C, Gonorrhea and Syphilis among FSWs, provide measurements of key HIV risk behaviors and generate evidence for advocacy and policy-making.

Also available: 1. HIV risk and prevention behaviors among People Who Inject Drugs in six cities, Georgia, 2017

2. Population Size Estimation of People who Inject Drugs in Georgia 2016-2017

The first ever FSWs population size estimation survey took place in 2014, in combination with the Bio-BSS survey. The study was implemented within the GFATM-funded project “Behavioural and Biological Surveillance and Population Size Estimation Surveys among key populations (Injecting Drug Users, female Commercial Sex Workers) conducted by Curatio International Foundation, Center for Information and Counseling on Reproductive Health – Tanadgoma. Biomarker component for BBS was implemented by the Infectious Disease, AIDS and Clinical Immunology Research Center.

Download the full report here.

Related Content:
March 6, 2018
Assessing impact of donor co-financing and transition policies on TB Commodity Procurement
Introduction and Overview

Curatio International Foundation recently started implementation of the project entitled: Assessing impact of donor co-financing and transition policies on TB Commodity Procurement. The project is financially supported by Stop TB partnership and UNOPS, initiated by Global Drug Facility (GDF).

The assignment will last 10 months and aims to assess positive and negative implications of The Global Fund’s (TGF) Sustainability, Transition and Co-Financing Policy (STCP) that may have on TB commodity procurement practices on a country level in EECA region.

Based on the goal of the assignment the project has the following objectives:
- Develop a methodological approach necessary for systematically documenting and assessing challenges and opportunities related to the TB commodity procurement practices arising from TGF’s STCP;
- Using the methodological approach and standard tools, systematically assess and document experiences related to TB commodity procurement practices during and after the transition in the countries that have graduated from TGF support or are already implementing STCP and paying for parts of TB commodity purchase.
Expected Results

After the successful completion of the project scientific article describing the key findings from the all assessed EECA region countries will be published in peer reviewed international journal.

The project findings will support countries to be aware of existing gaps and take appropriate actions for change.
February 22, 2018
The Interview on population size and Human Immunodeficiency Virus risk behaviors of People who Inject Drugs in Georgia

The interview is based on the latest wave of the integrated Bio- behavioral surveillance survey conducted People Who Inject drugs (PWID) in 7 cities of Georgia. The research aims to measure the prevalence of Human Immunodeficiency Virus (HIV) and Hepatitis C virus (HCV) among PWID, define key risk behaviors related to HIV and generate evidence for advocacy and policy development.

The research was conducted in cooperation with the Bemoni Public Union and with the financial support of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Curatio International Foundation is grateful to Tamar Sirbiladze, the technical expert of the study for answering the questions.

1. What is the estimated number of drug users and related trend in the country?

According to the latest survey the estimated number of injecting drug users is 52,500. The rate of prevalence among adults (18-65 years old) is 2,24%. This is a rather high rate – we come third after Seychelles and Russia with the number of problem drug users. It should be emphasized that there is a clear trend of a steady increase in the number of PWID – such survey has been conducted in Georgia since 2009 and every two years the number of people who inject drugs increases by several thousand people.

Download the study findings: Population Size Estimation of People who Inject Drugs in Georgia 2016-2017

2. Which drugs are used mostly? Has anything changed compared to previous surveys?

Buprenorphine (Subutex and Suboxone) and heroine, especially its cheap variety – raw heroine (not pure heroine) are leading injecting drugs. Compared to the previous waive of the survey (2014), Buprenorphine consumption has almost doubled, while the heroine consumption rate has slightly decreased; the level of use of homemade injecting drugs prepared through mixing different medications bought from pharmacies – so-called Krokodil (Desomorphine), Vint (Methamphetamine) and Jeff (Methcathinone) – has sharply decreased. And a new injection drug has appeared – the so-called ‘niddles’ (‘Ephedra Vint’, the injecting drug prepared from evergreen Ephedra bush needles having a stimulating effect).

As for non-injecting psychoactive substances, consumption of cannabis (marijuana) and psychoactive medications is still very common among this population. Basically, they use psychoactive drugs with a dizzying effect. It should be noted that compared to previous years the rate of use of these medications has decreased.

3. Which risk behaviors are associated with PWID? What about a sharing practice?

In terms of the risk of HIV infection, PWID behaviors are basically divided into two groups. These are risk behaviors related to drug injection and sexual behaviors. Compared to previous surveys, the proportion of safe injection became better in every city; the practice of sharing previousely used needles/syringes and other injecting equipment has decreased. As for a sexual behavior, condom use with paid and occasional sexual partner is high, however, using condom with a regular sexual partner still presents a problem.

4. How would you evaluate the current situation with HIV and Hepatitis C prevalence?

It should be noted that the prevalence of HCV among PWID is much higher compared to HIV.

The average indicator of HIV prevalence has actually not changed since 2015; the survey revealed 47 confirmed HIV positive cases. The previous waives of the bio-behavioral surveilence survey also demonstrated a high prevalence of Hepatitis C virus.

Download the study findings: HIV risk and prevention behavio rs among People Who Inject Drugs in seven cities of Georgia, 2017

5. Which cities in Georgia have a high prevalence of HIV and Hepatitis C?

According to the survey, Batumi has the highest HIV and HCV prevalence rate among the seven cities of the survey. Gori and Kutaisi also have leading positions in terms of HIV prevalence; the survey showed a decrease of HIV prevalence in Zugdidi in 2017, which had the highest rates during the previous two waives. Rustavi has the HIV lowest prevalence. The prevalence of HCV is also high in Tbilisi, Gori and Kutaisi, while Telavi has the lowest indicator.

6. 27% of study population have never been tested for Hepatitis C. Should we raise PWID awareness of the existing risks?

It is necessary to inform general population and especially the injecting drug user population about testing for Hepatitis C as well as about treatment. Unfortunately, the population has wrong opinions and views about the Hepatitis C elimination program. Some of our respondents are afraid to be involved in the program because of negative stereotypes associated with the treatment and, therefore they do not get tested either. Other drug users cannot get tests because they cannot afford clinical, laboratory and instrumental examinations.

7. According to the survey, 71% of PWID are unemployed and an average monthly income of the one third of respondents ranges from GEL 100 to GEL 300. Is this factor related to the risk behaviors the survey focuses on?

This is a rather interesting question, however our survey cannot answer this question. Generally, it is rather difficult to answer the question why people engage in behaviours posing risk to their health. There is a combination of a number of factors. One of the factors in term of PWID is the way of preparing a drug – if a drug solution is prepared in a common vessel, the risk of sharing injection equipment is higher; frequency of injection is another factor – the more frequently the person injects drugs, the higher is the probability of risky injection behaviors. Peer norms and views, level of awareness etc. also affect drug use behaviors. Coming back to your question, it is widely known that people with a higher social and economic status take much better care of their health.

8. The age of initial drug use for injecting and non-injecting drugs are 19 and 16 respectively, is this compatible with the global statistics?

According to our surveys, the age of initial drug use and injection has actually not changed since 2009. The figures do not differ much from other countries’ data.

9. According to the survey, the level of referral to narcological institutions is low. Almost half of respondents (47%) says that they do not want to undergo treatment. Does this figure indicate some gaps in access to the service or can it be explained by other factors?

We should point out in the first place that a wide range of behaviors related to drug use can be divided into two main categories in medical terms: casual drug use and drug addiction. Those people who do not use drugs regularly are not addicted, therefore they do not need treatment. As for drug addiction, i.e. the people who do need treatment, the main obstacle for them is access to treatment services – the number of hospital beds for this category of patients is limited. There is a sharp imbalance between the center and a region in terms of access to a respective service. The number of patients financed nationwide is limited. Therefore, patients have to wait for a long time to get a free treatment. Currently, the majority of drug addicts have to cover treatment costs themselves, which is one of the key obstacles to the treatment.

February 13, 2018
Population Size Estimation of People who Inject Drugs in Georgia 2016-2017
Bemoni Public Union together with Curatio International Foundation conducted a population size estimation study among injecting drug users in Georgia during 2016-2017.

Also available: HIV risk and prevention behaviors among People Who Inject Drugs in six cities, Georgia, 2017

This study estimated the size of People Who Inject Drugs using different estimation methods to provide the most plausible estimates. The study was carried out in conjunction with the Bio Behavioral Surveillance Survey among injecting drug users.

The study was financially supported by the Global Fund to fight AIDS, Tuberculosis and Malaria.

Full report is available here.

Related Content:
February 1, 2018
HIV risk and prevention behaviors among People Who Inject Drugs in seven cities of Georgia, 2017
Curatio International Foundation together with Bemoni Public Union has conducted HIV prevalence and risk behaviors survey among People Who Inject Drugs in Georgia.

Also available: Population Size Estimation of People who Inject Drugs in Georgia 2016-2017

Current study represents the latest wave of Bio-Behavioral Surveillance Surveys among People Who Inject Drugs. Objective of the study was to measure prevalence of HIV and Hepatitis C among PWID, provide measurements of key risk behaviors and generate evidence for advocacy and policy-making.

The study used a cross-sectional study design. 2 050 injecting drug users aged 18 years or more were recruited using respondent-driven sampling in seven major cities of Georgia: Tbilisi, Gori, Telavi, Zugdidi, Batumi, Kutaisi and Rustavi.

The document represents the research results in the following directions:
- Socio-Demographic Characteristics
- Drug Use History
- Drug Use Risk Behavior
- Knowledge of HIV/AIDS, Testing Practice and Self-Risk Assessment
- Sexual Behavior
- Exposure to Drug and HIV Prevention Programs and Social Influence
- Prevalence of HIV and Hepatitis C
In addition the study measured facilitating and hindering factors related to Hepatitis C testing and treatment. Also, the study estimated Opioid dependence among PWID.

Full report is available here.

The study was financially supported by the Global Fund to fight AIDS, Tuberculosis and Malaria.

Related Content:
February 1, 2018
Conference paper: The Study of Barriers and Facilitators to Adherence to Treatment among Drug Resistant Tuberculosis Patients in Georgia to Inform Policy Decision

The abstract has been submitted and accept for oral presentation at The Union 2017 – 48th Union World Conference on Lung Health, 11 – 14 October, 2017 Guadalajara, Mexico

The study outlines different health system factors as long as some social and economic elements influencing the adherence behavior to TB treatment among MDR-TB patients in Georgia. The study concludes that factors are closely interlinked and self-reinforcing.

The study provides evidence that may help policy-makers develop effective strategies for improving treatment outcomes among DR-TB patients. The study findings might be helpful for other countries in the region where TB burden is also high.

The study report and policy brief can be found here.

Download the abstract here.

November 16, 2017
Article: Human immunodeficiency virus prevalence and risk determinants among people who inject drugs in the Republic of Georgia

[vc_row][vc_column][vc_column_text]A new paper discusses HIV prevalence and risk factors among people who inject drugs in Georgia. The article was just published in The Journal of Infection in the Developimg Countries and is authored by Natia Shengelia, Ivdity Chikovani and Lela Sulaberidze.

In Georgia as in most Eastern European countries, injecting drug use still remains one of the leading transmission modes of HIV infection. A cross -sectional, anonymous bio-behavioral survey of PWID was conducted in seven cities of Georgia in 2014-2015. Overall 2,022 PWID were investigated. Bivariate and multivariate regression analyses were performed to identify association of HIV positivity with other factors.

Significant associations were found between HIV positivity and history of drug injection, older age at first drug injection, safe sex behavior last year and preventive program coverage. HIV prevalence among PWID is stable and remains at low level. Our study shows that preventive interventions influence the sexual behavior of HIV positive PWID, however, the majority of injecting drug users are still not reached with these interventions. A changing environment may present additional challenges for harm reduction and current safe practices may change unless continuously supported by innovative HIV prevention programming.

Download the full paper here.

The article is also available on ResearchGate platform.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column width=”1/1″][ultimate_spacer height=”30″][/vc_column][/vc_row]

November 13, 2017
Conference paper about realist evaluation: Informing policy, assessing its effects and understanding how it works for improved Tuberculosis management in Georgia
In the last week of October, 2017 Brisbane, Australia hosted International Conference for Realist Research Evaluation and Synthesis – Realist2017. Realist evaluation is complex sensitive approach and is useful for decision makers because rather responding the question “does the intervention or program work” Realist Evaluation indicates “What works for whom in what circumstances, and how?”

Curatio International Foundation and the partner institution – Institute of Tropical Medicine, from Antwerp, Belgium presented a work undertaken in the frame of #Results4TB project. During the session professor Bruno Marchal, Ariadna Nebot and Lela Sulaberidze discussed issues around Informing policy, assessing its effects and understanding how it works – Combining realist evaluation, cost analysis and impact assessment of a policy for better TB care in Georgia.

During the session, the conference audience was informed about the new project – provider Results-Based Financing for improved TB care management in Georgia that is currently being designed to be piloted from 2018 in the country. In this project, we use Realist Evaluation approach to evaluate mechanisms of effect and impact of the intervention. At the conference research team introduced insights of using Realist Evaluation to not only elicit the Programme Theory of the policy-makers and implementers, but also of the researchers, to help
- Policymakers to achieve a better view on the problem and the solution, and the conditions required to make it work
- Researchers to develop a better common understanding that would lead to a better research design, and an integrated data collection and analysis strategy
- Review of the existing evidence is supposed to contribute to better-informed policies and evaluations
During the presentation research team emphasized the following issues: 1. Insights into the program theory elicitation process, from concept to practice; 2. Participative methods applied during the program theory elicitation.

Please read the slightly modified presentation.
November 8, 2017