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Category: NEWS

  • 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.

     

  • CIF researchers represented on Global Conference AIDS2016

    CIF researchers Ivdity Chikovani and Lela Sulaberidze participated in AIDS 2016 conference that was held in Durban, South Africa in July 2016. The conference assembled over 18,000 delegates from around the world. Scientists, policymakers, world leaders, and people living with HIV discussed together successes and challenges of the country and the current global
    epidemic trends.

    The conference was preceded by the 9th IAEN Pre-Conference, where Ivdity Chikovani presented the work on Transition from donor support. The Framework to assess country preparedness from external support and findings of the assessment in four EECA countries were presented. See the presentation here.

    Two posters were presented on AIDS 2016. Lela Sulaberidze presented Methodological challenges in estimating the size of key populations using innovative method. E-poster can be downloaded here.

    The second poster highlights HIV epidemiology among MSM population in Georgia. E-poster is available on the link.

    The Framework to assess country preparedness from external support and findings of the assessment in four EECA countries were presented. See the presentation on the link.

  • UHC 2030: Building an Alliance to Strengthen Health Systems

    Almost 100 experts were gathered together in Geneva in the end of June, to support transforming process from IHP+ to UHC 2030.

    The overall aim of UHC 2030 will be to support a movement for accelerated, equitable and sustainable progress towards Universal Health Coverage as well as the other health targets in the SDGs, including global security and equity.

     

    UHC 2030 will be a multi-stakeholder platform. It will be the place where a shared global vision for health systems and UHC is developed, emerging priorities are framed, bottlenecks identified and recommendations collectively proposed to accelerate progress towards UHC.

    The meeting gathered stakeholders’ ideas debating UHC 2030’s role in advocacy both globally and locally, and discussed ways of experience sharing, health systems strengthening and making progress towards UHC. The meeting was joined by donor representatives, government health officials from low-, middle- and high-income countries, multilateral institutions, NGOs, CSOs, members of the academe and the private sector.

    CIF director George Gotsadze as a plenary speaker contributed to the discussion and shared experience on health systems development progress and challenges in Georgia. He also stressed several critical points on how UCH2030 could help on global level and specifically for the Eastern Europe and Central Asia region.

    “Breaking the language barriers for knowledge transfer would be an area were UHC2030 could play significant role. As I have seen in the concept note, knowledge dissemination is one of UHC2030 core objectives, but unfortunately this knowledge dissemination largely translates disseminating in English. Rarely we see disseminating in French, in Spanish, in Chinese or in any other languages that belongs to UN family of languages.” said George Gotsadze. A video of the plenary session is available here.

    UHC2030 continuous working to provide practical guidance to countries and help them strengthen coordination around health systems strengthening towards UHC.

  • CIF Pharmaceutical Price and Availability Study (Fifth Wave Results)

    The Curatio International Foundation has released the results of the fifth wave of the Pharmaceutical Price and Availability (PPA) study in Georgia. The study set out to generate further evidence regarding pharmaceutical prices and availability in the country through the continuous monitoring of the prices of medicine. One of the chief aims of the study is to inform and strengthen health policy and contribute to evidence-based discussions around current trends and processes in pharmaceutical market in Georgia.

    The study analyzes the current, as well as the previous four waves of the PPA studies that have been conducted by CIF since 2009. The main findings of the research responds to two important questions:

    1. What is the trend of physical and financial availability for Generic (LPG) and Originator rand (OB) drugs in Georgia, and how is the treatment cost linked to the availability?
    2. How is Georgia’s pharmaceutical sector being developed after the introduction of the new prescription policy?

    The answers to these questions are available in the main findings of the study:

    Main Findings

    AVAILABILITY

    • Currently, OB availability is almost two-times higher compared to LPG
    • The observed trend in decreased LPG availability can be attributed to several factors:
      • Insufficient knowledge and/or trust in the quality of LPGs among consumers and providers
      • Low demand for LPGs among the population caused by physician reluctance to prescribe generic medicines
      • The revenue-maximizing strategy of pharmaceutical suppliers
    TRENDS IN PRICING STRATEGIES
    •  It is likely that increased competition caused by legal changes in the country’s drug laws in late 2009 determined the downward trend in the OB prices observed during 2009-2012 waves, albeit OB prices rebounded and significantly increased in 2016
    • OBs are largely imported from western countries. Therefore, it is possible that the price increase documented in 2016 can be partially attributed to the significant devaluation of the country’s national currency against the USD and Euro that began in late 2014, and continued throughout 2015. Consequently, OB prices increased in both pharmacy networks and in independent pharmacies
    • In 2015, MoLHSA initiated a new prescription policy with the aim of reducing the level of irrational drug use in the Country. The importance and/or need for prescription system introduction is unquestionable, like in many other countries; however, the insufficiency and/or lack of the necessary instruments for the effective operation of the system most likely allowed pharmaceutical companies to use this initiative to further increase their profits. This assumption is supported by the fact that while in 2012 markups were largely comparable for prescription and non-prescription drugs, in 2016, we observed significant changes in behavior. Namely, markups for prescription OBs are now 89% higher compared to non-prescription OBs, and markups on prescription LPGs are currently 210% higher compared to non-prescription LPGs
    • Surprisingly, locally-manufactured LPGs are sold at a higher price compared to their imported equivalents, most likely affording greater profit potential to local manufacturers. Along with the marketing strategies used by the largest retail networks (also linked to local manufacturing), the promotion of locally-produced drugs over imported drugs helps local producers effectively use their market power in a poorly-regulated marketplace
    EMERGING POLICY RECOMMENDATIONS

    A single policy intervention in a complex pharmaceutical market like Georgia’s will most likely fail to meet its objective i.e. a reduction in costs to the public, and improved access to pharmaceuticals. Therefore, the government needs to immediately implement a multi-pronged policy to better address the issue.

    This policy should include the following:

    1. The introduction of reference pricing on the market – the government can achieve this by learning from other countries’ (high/low/middle-income) experiences and best practices. Through observing others’ experiences, the most appropriate reference pricing methodology can be utilized to further facilitate the regulation of drug prices in the country.
    2. Encourage the use of generic prescription drugs and enforce the generic substitution in the prescription of medicines.
    3. Introduce strict rules and controls for drug promotion, marketing, education, and sponsorship gifts to doctors.
    4. Enhance pharmaceutical market monitoring to adequately adjust for weaknesses in the policy or its implementation.

    The full report is available here.

     About the Study

    The study was conducted using World Health Organization (WHO) standard methodology. The survey looked at the prices and mark-ups of 52 medicines (brand-name medicines and their generic equivalents) in six regions of Georgia.

    CIF has been conducting the PPA study since 2009. The results of the study’s previous waves were released in 2010, 2011, 2012 and 2014.

     

  • Assessment of GAVI Alliance HSS support to Tajikistan

    In August 2014, Curatio International Foundation conducted an assessment of GAVI Alliance HSS support to Tajikstan to provide solid evidence of to what extent the support achieved its objectives and contributed to strengthen the health system of the country.

    The assessment aimed to identify successes, key challenges and lessons learned that may help GAVI Alliance to improve the design and implementation of future HSS support to Tajikistan and other countries. The assessment covered the period of GAVI’s HSS grant to Tajikistan from 2008-2014.

    The full report of the assessment is now available on GAVI’s website. Please visit the page for more information.

    You can also download the full report here.

  • 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.

  • Infographic: HIV/AIDS in Georgia

    Though preventive programs are focused on the high risk population, we face slightly but growing tendency of HIV/AIDs among general population.

  • 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. 

  • Washington DC hosts workshop Immunization Costing: what have we learned, can we do better?

    On May 17-18 EPIC Immunization Costing hosts workshop Immunization Costing: what have we learned, can we do better? in Washington DC.  CIF executive director George Gotsadze and Business Develop
    ment unit director Ketevan Goguadze are invited to attend the event.

    George Gotsadze will be one of the panelist in the panel discussion: Sustainable institutional linkage and improving immunization program implementation, taking place on May 18 in frame of the workshop.

    About the event: EPIC supports a community of practice comprised of researchers and practitioners concerned with measuring immunization program cost and financial flow – and utilizing such information to improve program operations and mobilize resources.

    A 300 members’ community from more than 50 organizations are involved in immunization programs across the globe, exchanging information and enabling new approaches, collect and use cost information to improve vaccine delivery.

    The workshop is sponsored by Bill and Melinda Gates Foundation and organized by Harvard School of Public Health.

  • 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.