Designup

Category: 2015

  • Hosting Health Systems Global Secretariat

    Introduction and Overview

    Health Systems Global (HSG) is the first international membership organization fully dedicated to promoting health systems research and knowledge translation.

    Starting from March 1st, 2015 Curatio International Foundation hosts the HSG secretariat, which was previously housed in the Center for Health and Infectious Disease Research at the University of Copenhagen.

    Dr. George Gotsadze, Director and President of Curatio International Foundation assumed the role of the Executive Director of Health Systems Global. He leads secretariat together with the communications team from  Institute of Development Study (Brighton, UK) and strives for the HSG to become a stronger society.

    CIF will hand over secretariat management to another LMIC country in 2020.

    HSG Financial Supporters Since 2015 

    Alliance for Health Policy and Systems Research

    Bill and Melinda Gates Foundation

    Canadian Institute for Health Research

    China Medical Board

    Doris Duke Charitable Foundation

    Global Affairs Canada

    Global Ideas Fund at CAF America

    International Development Research Centre, Canada

    Rockefeller Foundation

    Robert Wood Johnson Foundation

    Swedish International Development Cooperation Agency

    USAID

    Wellcome Trust

    Project Objectives and Contributions

    To connect health systems research and policy communities globally to contribute to the attainment of better health, equity, and well-being.

    About the Global Symposia

    Health Systems Global organizes a symposium every two years to bring together its members with the full range of players involved in health systems and policy research. There is currently no other international gathering that serves the needs of this community.

    The venue chosen for each meeting facilitates inclusion of participants from a specific part of the world and a focus on that region, although each is a global meeting in terms of content and representation. Each symposium is determined to:

    • Share new state-of-the-art evidence;
    • Review the progress and challenges towards implementation of the global agenda of priority research;
    • Identify and discuss the approaches to strengthen the scientific rigour of health systems research including concepts, frameworks, measures, and methods;
    • Facilitate greater research collaboration and learning communities across disciplines, sectors, initiatives, and countries.

    Previous global symposia were held in Montreux, 2010, Beijing 2012, Cape Town 2014, Vancouver 2016 and the fifth one will take place in Liverpool during October 8-12, 2018 and is expected to bring together around 3000 global participants.

    Detailed information about the 5th global symposium on the Health Systems Research is available on the website.

  • Evaluation of UNICEF’s Contribution in Central and Eastern European Five Countries

    Curatio International Foundation conducted an evaluation of UNICEF’s contribution to the reduction of under 5 mortality in five countries: Kazakhstan, Kyrgyzstan, Moldova, Serbia, and Uzbekistan. The evaluation covered 12 years from 2000 – 2012 and was performed in 2014-2015.

    UNICEF’s Regional Office for the CEE/CIS commissioned this Multi-Country Evaluation, as one of a series of such exercises, to a) document progress in reducing under-5 and infant mortality and morbidity and to generate lessons on how this was accomplished; b) inform programs aimed at scaling-up evidence-based and equity-focused interventions; and c) enable better partnering with national governments to advance the child health and rights agenda.

    The evaluation was based on a Theory of Change to reduce and close the equity gap in under-5 and infant mortality and morbidity in the CEE/CIS and applied both UNICEF MoRES framework and the WHO essential health system functions approach.

    Evaluation findings are assembled across the following key areas: Impact on the health status of children; Equity; Relevance; System-level changes; UNICEF’s contribution; Sustainability

    The study found a reduction in infant and under-5 mortality and morbidity over the evaluation period, although equity gaps exist in different geographical, gender and socio-economic groups. The evaluation concluded that UNICEF-supported programmers addressed the most important causes of infant and under-5 morbidity and mortality and were mostly successful in identifying and applying the right interventions to address the health system bottlenecks.

    Key Recommendations

    The evaluation recommended to sharpen equity-focus of programming, consider not sufficiently addressed underlying causes of child mortality and morbidity and addressing persisting bottlenecks at health system and community levels.

    To learn more, download full evaluation report.

     

  • Final Evaluation of Gavi’s Support to Albania

    After the conclusion of Gavi’s support period (2014) to the Albania, Curatio International Foundation conducted the evaluation study and assessed financial and programmatic sustainability through an in-depth analysis of Albania’s experiences and immunization programme performance before, during and after the conclusion of Gavi’s support period to the country.

    The evaluation also identified factors contributing to the sustainability of these programs and their achievements. The evaluation considered the types and quality of support received and the way in which Gavi’s support to Albania was considered.

    Main Findings:
    • The coordination mechanism between partners  established at the time of Gavi support continues to operate, although the frequency of the meetings has decreased
    • All Gavi supported activities have been continued : The Hep B and pentavalent vaccines and Auto-Disable (AD) syringes are fully financed by the Government, and are safeguarded in the MoH budget
    • Stable and high immunization coverage rates (> 95%) for all antigens included in the national immunization schedule have been sustained as of today at the national and district levels
    • Achievements in safe injection have been sustained in Albania
    • After Gavi support ended, Albania has continued to introduce new vaccines
    • The budget planning mechanism used for vaccine procurement during the Gavi support period has been maintained and institutionalized
    • The use of the UNICEF procurement mechanism for purchasing all vaccines in the immunization schedule has been sustained.

    The full report of the evaluation is now available on the GAVI’s website, please visit the page for more information.

  • HIV risk and prevention behaviours among Prison Inmates in Georgia, 2015

    Curatio International Foundation continues implementation of Bio-Behavioral Surveillance Surveys (BBS) among Key Affected Populations (KAP’s) with the aim to measure HIV prevalence among KAP’s, monitor risk behaviors among these groups and generate evidence for advocacy and policy-making.

    The current study describes the most recent wave of BBS surveys among prisoner population in Georgia (Bio-BBS surveys among prisoner population have been implemented since 2008).  Study also was looking at STI (Syphilis) prevalence. CIF implemented this study together with partner organisations – Center for Information and Counseling on Reproductive Health – Tanadgoma and the Infectious Diseases, AIDS and Clinical Immunology Research Center.

    The study used a Simple Random Sampling (SRS) Method. A sample of 300 prisoners were recruited in the survey from 3 penitentiary establishment located in Tbilisi, Rustavi and Kutaisi.

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

    Major findings:

    Socio-demographic characteristics

    • The median age of prisoners was 34, with the age ranging from 18 to 78 years, majority (74.1%) were with the secondary education. Less than half (46.8%) of the inmates were married.
    • Median duration of imprisonment is 1.5 years years, ranging from 0.08 to 19 years.

    Sexual behavior

    • Sexual practices among prisoners was not high (35.2%). However, mostly heterosexual contacts were being reported (95.3%), only 4 respondents reported having both heterosexual and homosexual contacts and only 1 inmate said it was homosexual contact.
    • As for the condom use during the last anal intercourse, 3 out of 5 respondents said it was used, and other reported not using condom due to the trust towards the partner.

    Drug Use Behavior and Additional Risks

    • Slightly more than half of the respondents (52.2%) reported having used drugs in their lives. Out of those, who have ever used drugs, 87.9% reported use of injecting drugs and 68.8% – use of non-injecting drugs.
    • Only 10.3% of the respondents reported using non-injecting drugs during the last 12 months, and only 8 inmates reported having used injecting drugs. It is noteworthy that none of the inmates reported needle/syringe sharing during the last 12 months.
    • Additional risks related to HIV exposure were found to be also small. Almost one third of the prisoners (31.6%) reported having done tattoo while in prison. Only five prisoners reported using shared syringes for treatment purposes and 3% used razors that were used by the others. Alcohol use is extremely low in prisons – 3% reported using it during the last 12 months.

    HIV knowledge and HIV testing practice

    • The majority of the respondents (91.4%) report that they have heard about HIV/AIDS.
    • Knowledge about HIV, measured by the Global AIDS Response Progress Report Indicator, was low – 23.3%. In general, level of knowledge on HIV has not changed from 2011 to 2015.
    • HIV testing offer in prisons as well as uptake by the prisoners has increased, which demonstrated successfulness of the HTC cabinets established by the prevention programs within the penitentiary system.

    Sexually Transmitted Infections (STI)

    • Awareness on STIs in general is high. Majority (91.0%) of the respondents have heard about STIs, knowledge or health-seeking behavior of the prisoners has not changed since 2012.

    Interventions/Media

    • Prisoners have various sources of getting information on HIV and STIs, the most trustful of them being TV, booklets, NGO representatives as well as healthcare workers.
    • The study revealed statistically significant increase in the percentage of the respondents (25.2% in 2015 vs 18.3% in 2012, p<0.05) who were covered by preventive program.

    HIV and Syphilis prevalence

    • The HIV prevalence found by the survey was 2%. In the previous survey the prevalence was 0.3%. However, this increase is statistically not significant.
    • Prevalence of syphilis was low. Comparison of syphilis prevalence with the data of 2012 survey demonstrated statistically significant decrease (p<0.001).

    Full study report is available here. 

  • Bio-Behavioral Surveillance Survey among Men who have Sex with Men in two major cities of Georgia, 2015

    Bio-Behavioral Surveillance Survey among Men who have Sex with Men in two major cities of Georgia, 2015

    Curatio International Foundation continues implementation of Bio-Behavioral Surveillance Surveys (BBS) among Key Affected Populations (KAP’s) with the aim to measure HIV prevalence among KAP’s, monitor risk behaviors among these groups and generate evidence for advocacy and policy-making.

    The current study describes the most recent wave of BBS surveys among Men who have Sex with Men (MSM) in Georgia (Bio-BBS surveys among MSM have been implemented since 2007).  Study also was looking at HCV and STI (Syphilis) prevalence among MSM. CIF implemented this study together with partner organisations – Center for Information and Counseling on Reproductive Health – Tanadgoma and the Infectious Diseases, AIDS and Clinical Immunology Research Center.

    The study used a cross-sectional design and respondent‐driven sampling methodology (RDS). A sample of 415 MSM18 years and older were recruited in the survey in two major cities of Georgia: Tbilisi and Batumi.

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

    Major findings:

    Socio-demographic characteristics

    • The median age was 28 years in Tbilisi and 29 – in Batumi, majority had secondary level education, had never been married, big proportion of MSM had permanent work, and majority’s monthly income was less than 500 GEL.
    • The study did not reveal high proportion of heavy alcohol use or injecting drug use, indicating that there is no overlap with key populations such as MSM and PWID.

    Sexual behavior

    • MSM had different types of both male and female sex partners (regular, occasional and commercial).  The median number of male partners (anal/oral partners) in the last 12 months 6 in Tbilisi and 5 – in Batumi. Tbilisi number is higher than that of 2010.
    • Out of MSM that reported anal partner during the last year, 63.2% in Tbilisi and 78.8% – in Batumi used a condom during their last anal sexual contact. Condom use at last AI in Tbilisi in 2015 slightly higher compared to 2010 (61.7%).
    • Overall more than 50% of MSM reported having female sex partner  (regular, occasional or paid) during the last 12 months- 55.4% in Tbilisi and 53% in Batumi. More than two thirds (71.2% in Tbilisi and 65.9% in Batumi) said they used a condom at last sexual intercourse with their female partner.Since 2010 there is increase in condom use at last sex with female partners in Tbilisi. As for Batumi, this rate is also high.

    Condoms and lubricants

    • There was a slight increase in the proportion of MSM who reported receipt of condoms from preventive programs during the last 12 months in Tbilisi from 40.3% in 2010 to 43.5% in 2015.
    • Awareness about condoms stays high.
    • Awareness about the lubricants as well as their reported use during the last AI has improved vastly in Tbilisi and is also high in Batumi. These are higher indicators compared to the previous surveys, which can be explained by provision of free lubricants by preventive programs, started since 2014.

    HIV knowledge and HIV testing practice

    • Knowledge and testing on HIV showed significant improvement in Tbilisi since 2010 – from 19.9% in 2010 to 30.4% in 2015 (p (2-tailed), 0.001). In Batumi this indicator was measured the first time and reached 35.2%.
    • During the recent five years there is statistically significant improvement in MSM awareness where to get HIV test in case of necessity (p < 0.001), as well as in the proportion of MSM who were tested during the last 12 months and received results (p< 0.001). This can be explained by sustainable use of HIV rapid (finger prick) testing in the outreach under preventive programs, which makes HIV testing easily accessible to the target group.
    • Researchers also measured increase in testing uptake from 2012 to 2015, and it was also statistically significant (p (2tailed) – 0.07).

    Violence

    • Survey participants reported that they have experienced violence because of sexual orientation or homosexual behaviour in the last 12 months (32% in Tbilisi and 4.7% in Batumi). In Tbilisi violence rate has increased significantly compared to 2012.

    Program coverage / media

    • Coverage by preventive intervention measured by awareness of where to get a HIV test and receipt of a condom during the last 12 months increased from 20.9% in 2010 to 43.5% in 2015 in Tbilisi. In Batumi coverage is quite high – about 40%.
    • NGOs, internet and friends seem to be the major and best way for conveying messages to MSM.

    HIV, HCV and Syphilis prevalence

    • The most alarming finding of this study is increase in HIV prevalence in Tbilisi from 6.4% in 2010 to 25.1% in 2015. During last five years we observe three-fold increase of HIV prevalence. Batumi HIV prevalence is also very high – 22.3%.
    • Syphilis was detected in 35% of the MSM in Tbilisi and 24.6% – in Batumi.As for syphilis, its prevalence is quite high but does not show difference compared to 2010 results.
    • Hepatitis C prevalence was 7% in Tbilisi but much higher in Batumi – 18.9%

    Full study report is available here.

  • Population Size Estimation of People Who Inject Drugs in Georgia, 2015

    Bemoni Public Union together with Curatio International Foundation conducted a population size estimation study among injecting drug users in Georgia in 2015.

    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 (GFATM).

    Full report is avalable here.

  • Bio-Behavioral Surveillance Survey among People Who Inject Drugs in 7 cities of Georgia, 2015

    Curatio International Foundation continues implementation of Bio-Behavioral Surveillance Surveys (BBS) among Key Affected Populations (KAP’s) with the aim to measure HIV prevalence among KAP’s, monitor risk behaviors among these groups and generate evidence for advocacy and policy-making.

    The current study describes the most recent wave of BBS surveys among People Who Inject Drugs (PWIDs) in Georgia (Bio-BBS surveys among PWIDs have been implemented since 2002).  Study also was looking at HCV prevalence among PWIDs. CIF implemented this study together with partner organisations – Bemoni Public Union and Georgian AIDS and Clinical Immunology Research Center.

    The study used a cross-sectional study design. A sample of 2037 injecting drug users 18 years and older were recruited using respondent-driven sampling in seven major cities of Georgia: Tbilisi, Gori, Telavi, Zugdidi, Batumi, Kutaisi and Rustavi.

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

    Major findings:

    Socio-demographic characteristics
    • The vast majority of participants reported being unemployed, and 51% of PWIDs mentioned having a monthly income of less than 300 GEL;
    • The median age of initiating non-injection drug consumption and injection drug use has not changed since 2012 and equals 15-16 years and 18-20 years, respectively.
    Drug Scene and other contextual factors
    • Non-injecting drugs consumption has not changed  radically since 2012. About a quarter of young PWID who reported non-injection drug use mentioned use of new psychoactive drugs.
    • Injected drug scene has significantly changed during last years. Heroin is the most frequently used substance among drug users in Georgia followed by buprenorphine. Heroin use dropped in 2012 and then increased to the same level in 2015 (58.1%).  Buprenorphine use also dropped in 2012 and increased up to 26% in 2014-2015. Alternatively, lower proportion of PWID reported use of homemade opioid-type drugs like Desomorphine and Amphetamine type stimulants (so called “Vint”, “Jeff”) compared to 2012.
    HIV knowledge and HIV testing practice
    • Knowledge of HIV/AIDS among PWID remains relatively good. The majority is aware of primary transmission risks associated with injection and sexual behavior.
    • There is significant increase in proportion of PWID who were tested during last 12 months and know their status. Increase is observed across all cities. In general one in four injecting drug user has been recently tested on HIV.
    Sexual behavior
    • More drug injectors have safe sexual contacts with occasional partners than in previous years in some study locations, although protective behavior remains at alarmingly low levels and needs special attention.
    Access to and coverage of treatment and harm reduction interventions
    • The majority of PWIDs have never attended drug treatment facilities. Only 6% underwent or was still under any kind of treatment.
    • Coverage of preventive programs (minimal coverage) has increased from 24% to 32.4% since 2012.
    • While awareness about syringe exchange programs has improved in Telavi, Batumi, and Zugdidi, in general, knowledge about the program remains low and needs to be improved. Substitution therapy programs are much better known among PWIDs.
    HIV and HICV prevalence
    • The combined dataset analysis of all seven cities shows that HIV prevalence in 2015 was 2.2% (95% CI 1.53-2.99) and has not changed since 2012, when HIV prevalence was  3.0% (95% CI 2.20-4.04) because of overlapping confidence intervals. An estimate for PWID living with HIV varies from the lowest 0.9% (95%CI, 0%-4.3%) in Rustavi to the highest 4.8% in Zugdidi (95%CI, 0.2%-11%). Batumi and Zugdidi remain the cities with highest HIV prevalence rates.
    • The study revealed alarmingly high HCV prevalence (66.2% – in all seven cities).

    Full study report is available here.

  • BioBehavior Surveillance Survey results were represented to the members of Parliament of Georgia

    Curatio International Foundation together with BEMONI PUBLIC UNION (BPU) represented BioBehavior Surveillance Survey results to the Members of Parliament of Georgia.

     

    The study was conducted in seven major cities of Georgia (Tbilisi, Gori, Telavi, Zugdidi, Batumi, Kutaisi and Rustavi) with a sample of 2037 injecting drug users 18 years and older. The current study describes the most recent wave of Bio-BBS surveys among PWIDs in Georgia (Bio-BBS surveys among PWIDs have been undertaken since 2002).  The study was funded by the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM).

    Study Findings

    Socio-demographic characteristics

    • The median age of initiating non-injection drug consumption and injection drug use has not changed since 2012 and equals 15-16 years and 18-20 years, respectively.

    Drug Scene and other contextual factors

    • Non-injecting drugs consumption did not demonstrate major changes since 2012. CNS depressants and hallucinogens were reported as the most popular drugs for consumption with a slight decrease observed since 2012. About a quarter of young PWID who reported non-injection drug use mentioned use of new psychoactive drugs.
    • Injected drug scene has significantly changed during last years. Heroin is the most misused substance among drug users in Georgia followed by buprenorphine. Alternatively, lower proportion of PWID reported use of homemade opioid-type drugs like Desomorphine and Amphetamine type stimulants (so cold “Vint” and “Jeff”) compared to 2012. Thirty-five percent of the survey participants are active opioid-dependent.
    • Injection in other countries has dramatically grown across all survey locations and this trend is notable since 2009. HIV risk behaviors increase while abroad, as exhibited by the four-fold increase in rates of sharing injection equipment in other countries compared to Georgia.

    HIV knowledge and HIV testing practice

    • Knowledge of HIV/AIDS among PWID remains relatively good. The majority is aware of primary transmission risks associated with injection and sexual behavior.
    • There is significant increase in proportion of PWID who were tested during last 12 months and know their results. Increase is observed across all cities. In general one in four injecting drug user has been recently tested on HIV.

    Sexual behavior

    • High risk sexual behavior remains one of the major problems among PWIDs.
    • Although, more drug injectors have safe sexual contacts with occasional partners than in previous years, but in Kutaisi, Batumi and Rustavi, however, protective behavior remains at alarmingly low levels and needs special attention.

    Access to and coverage of treatment and harm reduction interventions

    • The majority of PWIDs have never accessed drug treatment facilities. Only 6% underwent or was still under any kind of treatment.
    • Coverage of preventive programs (minimal coverage) defined as knowing where to get an HIV test and receiving at least one of the following program commodities: sterile injecting equipment, condom, brochure/leaflet/booklet on HIV/AIDS, and qualified information on HIV has increased from 24% to 32.4% since 2012.
    • While awareness about syringe exchange programs has improved in Telavi, Batumi, and Zugdidi, in general, knowledge about the program remains low and needs to be improved. Substitution therapy programs are much more well-known among PWID.

     HIV and HICV prevalence

    • The combined dataset analysis of all seven cities shows that HIV prevalence is 2.2% (95% CI 1.53-2.99) with no change since 2012 when HIV prevalence was 3.0 (95% CI 2.20-4.04). An estimate for PWID living with HIV varies from the lowest 0.9% (95%CI, 0%-4.3%) in Rustavi to the highest 4.8% in Zugdidi (95%CI, 0.2%-11%). Batumi and Zugdidi remain the cities with highest HIV prevalence rates.
    • The study revealed alarmingly high HCV prevalence (66.2% – in all seven cities).

    Presentation is avalable in Georgian. 

  • Regional High Level Dialogue 'Road to Success', Tbilisi, Georgia

    On September 28-30, 2015 Regional High Level Dialogue took place in Tbilisi, Georgia on Successful Transition to Domestic Funding of HIV and TB Response in EECA. The 320 delegates from 31 countries have agreed to work together in creating and implementing national transition plans from donor to national funding of HIV and tuberculosis (TB) response as well as ensuring the accountability of all stakeholders in the implementation of these plans. High-level ministerial representatives of the EECA countries, international donor organizations, and civil society activists have concluded the event by adopting the resolution on shared responsibility and partnership ensuring the prevention and care of HIV and TB in the EECA region.

    The event was hosted by the Ministry of Labor, Health and Social Affairs of Georgia and organized together by Eurasian Harm Reduction Network (EHRN), The Global Fund to Fight AIDS, TB and Malaria, United Nations Office for Drugs and Crime (UNODC), UNAIDS and World Health Organization (WHO) acting as the event co-organizers, and United Nations Development Program (UNDP) and World Bank as supporting agencies.

    Among other speakers at the Dialogue Ketevan Chkhatarashvili, president of the Curatio International Foundation has presented findings and reccomendations of  a study: Transition fromTGF support and programmatic sustainability in four EECA countries. The Study was funded by The Global Fund and implemented by CIF in: Belarus, Bulgaria, Georgia and Ukraine.

    You can watch the presentation video here:

  • CIF study results on 8th IAS Conference on HIV Pathogenesis, Treatment and Prevention

    Findings of population size estimation study among Man who have Sex with Men (MSM) was presented to the 8th International Aids Association conference on HIV Pathogenesis, Treatment and Prevention in Vancouver, Canada in July, 2015.

    The study was conducted by Curatio International Foundation in the capital city of Georgia, in 2014. In the study, the research team applied a novel modified capture-recapture method based on network sampling, which was first time used among MSM, with few modifications.

    Modified capture-recapture method provides reasonable population size estimates for the MSM when compared to the median estimates and their boundaries of other more established methods.

    Estimating size of MSM through modified capture-recapture method appeared to be feasible, simple, cost-saving and effective method that is valuable for future application.

    For more information, please see the presentation and CIF banner presented on the conference.

    Estimating the size of Men who have Sex with Men (MSM) using modified Capture-Recapture method based on net…