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Category: Health Systems Research

  • 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. 

  • HIV risk and prevention behaviors among Prison Inmates in Georgia, 2012

    By 2012 there were 23 000 prisoners in the Georgian penitentiary system. Georgia had one of the highest in the world prison population rate per 100,000.

    The main reason for imprisonment in Georgia is drug-related crime. The majority of prisoners are arrested for repeated use of drugs or for
    keeping them in small amounts. Despite the fact that conditions in the prisons have improved over the last years, still the situation remains very hard. Prisons areconsidered as endemic areas for diseases such as tuberculosis, HIV infection, and hepatitis B and C. According to various data, risk behaviors such as sharing syringes, needles and other injecting equipment are widespread in prisons. Testing for blood-borne infections in prisons started in 2005 with wide expansion since 2008. By 2012, there were about 6000 prisoners tested annually.

    This study represents the subsequent wave of Bio-BSS undertaken among prisoner population. The first Bio-BSS was conducted in 2008
    using the SRS technique and managed to recruit 211 prisoners in total. The objective of the 2012 Bio-BSS was to measure the prevalence of HIV and Syphilis among prisoners, to provide measurements of key HIV risk behaviours and to generate evidence for advocacy and policy
    -making.

    The study was implemented within the GFATM-funded project “Generate evidence base on progress in behavior modification among MARPs and effectiveness of preventive interventions, to inform policies and practice” by Curatio International Foundation (CIF), Center for Information and Counseling on Reproductive Health-Tanadgoma and the National Center for Disease Control and Public Health.

    Read the full version of the study.

  • 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…

     

     

     

  • The drivers of facility-based immunization performance and costs. An application to Moldova


    The drivers of facility-based immunization performance and costs.     An application to Moldova. This is the article an International peer reviewed Journal Vaccine published, Co-authored by experts from the Curatio International Foundation.

    The study was a part of a multi-country coting and financing study of routine immunization program, supported by the Bill and Melinda Gates Foundation.

    Few costing studies of primary health care services in developing countries evaluate the drivers of immunization program performance and cost. This exercise attempted to fill this knowledge gap and helped to identify organizational and managerial factors at a primary care, district and national level that affect the cost and performance of the routine immunization program in Moldova

    Visit ResearchGate to read and download the article.

  • Awaiting the results of Prisoners’ Behavior Surveillance Survey (BSS)

    Curatio International Foundation together with Infectious Diseases, AIDS and Clinical Immunology Research Center and Association Tanadgoma has conducted the Behavior Surveillance Survey with biomarker component.

    The study report of Behavior Surveillance Survey with biomarker component among 210 prisoners will be available in early fall.

    The study was carried out in the framework of the Global Fund project “Establishment of evidence-base for national HIV/AIDS program by strengthening the HIV/AIDS surveillance system in the country” by the Curatio international Foundation in collaboration with Infectious Diseases, AIDS and Clinical Immunology Research Center and Association Tanadgoma. The study covered Tbilisi and regional city Kutaisi.

    In the framework of the same project the sentinel surveillance among STI patients and Behavior Surveillance Surveys with biomarker component among Intravenous Drug Users (IDUs), and Commercial Sex Workers (CSWs) have been carried out.

  • Costs of routine immunization services in Moldova: Findings of a facility-based costing study

    An International peer reviewed Journal Vaccine, published an article Costs of routine immunization services in Moldova: Findings of a facility-based costing study. Authored by experts from the Curatio International Foundation.

    The study evaluates the total economic and unit costs of the immunization program in the Republic of Moldova as part of a multi-country study supported by the Bill and Melinda Gates Foundation.

    The study shows that the cost of fully immunizing a child in a middle-income country is much higher than previous estimates. The study findings could contribute to building a new evidence-base that will provide valuable inputs into the development of national and global policies, as well as contribute to better planning and management of the national immunization program in Moldova.

    Visit ResearchGate to read and download the article.

  • Analyses of Costs and Financing of the Routine Immunization Program and New Vaccine Introduction in the Republic of Moldova

    In 2012-2014 Curatio International Foundation implemented the costing study that aimed to evaluate routine immunization program costs and financing as well as incremental costs and financing of a new vaccine introduction in the Republic of Moldova.

    The study was a part of a larger effort to evaluate costs and financing of routine immunization in six countries (Moldova, Benin, Uganda, Zambia, Ghana, Honduras) supported by the Bill & Melinda Gates Foundation.

    The study generated new information that will help a) improve the planning of resource requirements and financing needs at the country level; b) improve the understanding of the total immunization program costs and unit costs, as well as delivery costs of Routine Immunization services and delivery costs associated with the introduction of a new vaccine and c) contribute to updating GAVI Alliance policies on new vaccine introduction support.

    The findings of our study provide critical information for discussing issues related to the affordability of new vaccine introduction in Moldova, and the financial sustainability of the national immunization program after it graduates from GAVI support.

    Please follow the links to read the final presentation, project report and policy brief.

       

  • Health Service Utilization for Mental, Behavioural and Emotional Problems among Conflict-Affected Population in Georgia

    An International peer reviewed Journal PLOS One has published an article Health Service Utilization for Mental, Behavioral and Emotional Problems among Conflict-Affected Population in Georgia: A Cross-Sectional Study, authored by experts from the Curatio International Foundation, and the London School of Hygiene and Tropical Medicine and GIP-Tbilisi.

    The article presents health care utilization patterns for mental, behavioral and emotional problems among the adult population in Georgia affected by 1990s and 2008 armed conflicts.

    The study suggests that there is limited use of formal health services for mental health problems among this population. The factors identified by the study that prevent from use of services are financial access barriers, especially for drugs, self treatment, poor referral pathways between primary and specialized care, lack of perception about mental health problems among the population. The paper discusses possible ways to improve mental health services in Georgia.

    Visit ResearchGate to read and download the article.

     

  • Healthcare Utilization and Expenditures for Chronic and Acute Conditions in Georgia: Does benefit package design matter?

    An International peer reviewed journal BMC Health Services Research publishes an article Healthcare utilization and expenditures for chronic and acute conditions in Georgia: Does benefit package design matter?, authored by experts from the Curatio International Foundation and London School of Hygiene and Tropical Medicine.

    The article presents study results, evaluating health care utilization and expenditures within the program: Medical Insurance for Poor in Georgia (MIP).

    The study assesses how the program effect varied for patients with different health conditions and identifies areas for improvement. The study documented that MIP had a more positive impact for patients with acute illnesses, while for beneficiaries with chronic illnesses, the positive impact was observed just during exacerbations.

    Increasing MIP benefits, particularly for patients with chronic illnesses, should receive priority attention if universal coverage objectives are to be achieved.

    Visit ResearchGate to read and download the article.