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Category: Publications

  • 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.

  • 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.

  • 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:
    1. HIV risk and prevention behavior among Female Sex Workers in two cities of Georgia – Bio-Behavioral Surveillance Survey with Population Size Estimation in Tbilisi and Batumi, 2014
    2. HIV risk and prevention behavior among Female Sex Workers in two cities of Georgia, 2012
    3. Bio-Behavioral Surveillance Survey among People Who Inject Drugs in 7 cities of Georgia, 2015
    4. HIV prevalence and risk behaviors among key populations- Study Findings Published, 2012

  • Article: Barriers to delivering mental health services in Georgia with an economic and financial focus: informing policy and acting on evidence

    A new paper discusses the economic and financial barriers to delivering mental health services in Georgia and assessing the opportunities for reform that can support the development of strategies for change.

    The article was published in BMC Health Services Research, authored by researchers from Curatio International Foundation – Lela Sulaberidze, Ivdity Chikovani, Maia Uchaneishvili, George Gotsadze and researcher from Imperial College London – Stuart Green.

    The analysis identified a variety of local economic barriers, including: the inhibition of the diversification of the mental health workforce and services due to inflexible resources; the variable and limited provision of services across the country; and the absence of mechanisms to assess the delivery and quality of existing services. The main financial barriers identified were related to out of pocket payments for purchasing high quality medications and transportation to access mental health services.

    Whilst scarcity of financial resources exists in Georgia, there are clear opportunities to improve the effectiveness of the current mental health program. Addressing system-wide barriers could enable the delivery of services that aim to meet the needs of patients. The use of existing data to assess the implementation of the mental health program offers opportunities to benchmark and improve services and to support the appropriate commissioning and reconfiguration of services.

    The article has open access and it is downloadable here.

    Also check our ResearchGate profile to access this and other interesting papers authored by CIF researchers.

  • 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.

  • 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.

  • Article: Determinants analysis of outpatient service utilization in Georgia: can the approach help inform benefit package design?

    Curatio International Foundation conducted secondary data analyses of Health Service Utilization and Expenditure survey (2 waves), conducted by Ministry of Labor Health and Social Affairs of Georgia, supported by WHO and The World Bank.

    We studied factors that impact utilization of outpatient health services in Georgia. Several important findings have been revealed, that can be successfully used to update existing outpatient service package and make it more relevant to the needs of Georgian population.

    1. Household income is linked to service consumption – Families with high and middle income are more likely to use outpatient services than those who have low income;
    2. Out of the pocket payment is one of the important barriers for service usage, in particular increase of service costs by one Georgian Lari reduces the use of outpatient services by 2%;
    3. Patients with chronic illness are less likely to use outpatient services, compared to patients with acute health problems – frequency of outpatient service utilization is 2 times less;
    4. Utilization of outpatient services is affected by the age factor – people from 45 to 64 are less likely to use outpatient services and often seek self-treatment.

    To respond to the above listed challenges, it is important to fit outpatient service packages to the population needs.

    The recent changes in the Universal Health Care Program, initiated by Georgian government and launched in May, 2017 will be a step forward to improve population financial protection. The changes respond to the research findings and recommendations in regard of outpatient services, that are fully represented in the article.

    [vc_button url=”http://curatiofoundation.org/wp-content/uploads/2017/05/12961_2017_Article_197.pdf” text=”Download full article” size=”” align=”left” type=”primary” outlined=”0″ icon=”” target=”_blank”]

     

  • Barriers and Facilitators to Adherence to Treatment Among Drug Resistant TB Patients in Georgia

    [vc_row][vc_column][vc_column_text]Tuberculosis is a global challenge to public health throughout the world. Poor adherence to treatment remains a significant problem that prevents countries from obtaining high treatment success rates that is essential for health systems to control the epidemic and decrease spread of the disease.

    In 2016 Curatio International Foundation conducted a qualitative study to investigate factors that enhance or hinder treatment adherence among Drug Resistant TB patients (DR-TB) in Georgia. The study revealed different types of factors affecting treatment adherence among DR-TB patients and grouped them into structural, social, personal and health system factors according to the study conceptual framework. The study made it clear that all factors are closely interlinked and mutually influence each other.

    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 is downloadable below:[/vc_column_text][vc_empty_space][/vc_column][/vc_row][vc_row parallax_image=”” columns_type=”default” section=”” full_screen=”” vertical_centering=”” full_width=”” full_height=”” background=”” bg_color_info=”” img=”” parallax=”” parallax_bg_width=”110″ parallax_reverse=”” video=”” bg_type=”” parallax_style=”” bg_image_new=”” layer_image=”” bg_image_repeat=”” bg_image_size=”” bg_cstm_size=”” bg_img_attach=”” parallax_sense=”” bg_image_posiiton=”” animation_direction=”” animation_repeat=”” video_url=”” video_url_2=”” u_video_url=”” video_opts=”” video_poster=”” u_start_time=”” u_stop_time=”” viewport_vdo=”” enable_controls=”” bg_override=”” disable_on_mobile_img_parallax=”” parallax_content=”” parallax_content_sense=”” fadeout_row=”” fadeout_start_effect=”” enable_overlay=”” overlay_color=”” overlay_pattern=”” overlay_pattern_opacity=”” overlay_pattern_size=”” overlay_pattern_attachment=”” multi_color_overlay=”” multi_color_overlay_opacity=”” seperator_enable=”” seperator_type=”” seperator_position=”” seperator_shape_size=”” seperator_svg_height=”” seperator_shape_background=”” seperator_shape_border=”” seperator_shape_border_color=”” seperator_shape_border_width=”” icon_type=”” icon=”” icon_size=”” icon_color=”” icon_style=”” icon_color_bg=”” icon_border_style=”” icon_color_border=”” icon_border_size=”” icon_border_radius=”” icon_border_spacing=”” icon_img=”” img_width=”” ult_hide_row=”” ult_hide_row_large_screen=”” ult_hide_row_desktop=”” ult_hide_row_tablet=”” ult_hide_row_tablet_small=”” ult_hide_row_mobile=”” ult_hide_row_mobile_large=””][vc_column text_color=”” animate=”” animate_delay=”” width=”1/2″][vc_column_text]

    Barriers and Facilitators to Adherence to Tuberculosis Treatment Among Drug Resistant TB Patients in Georgi… by CuratioCIF on Scribd

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    Factors Associated Adherence to TB Treatment in Georgia_Report_Eng by CuratioCIF on Scribd

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  • Transition Preparedness Assessment

    Sustainability of national HIV and TB programs gains importance in light of recent changes in the global health landscape when external funders are redirecting resources to poorer states while phasing out from middle-income countries.

    Objectively evaluation of the country transition readiness is a key in the transition process. With this aim in 2015, Curatio International Foundation developed a Transition Preparedness Assessment (TPA) Framework with the Global Fund financial support and piloted in four Eastern European countries Belarus, Bulgaria, Georgia, Ukraine.

    The country Case Studies present findings in a standardized way that enable country stakeholders to prioritize areas that need most attention during transition planning and implementation. In addition, the assessment findings are useful for the donors to guide the country in the transition process. These countries share important similarities that are presented in the Synthesis Report. The three countries case studies are also downloadable below.

    Synthesis report – 4 countries
    Ukraine-case study
    Georgia-case study
    Belarus – case study

  • New Study Findings About Tuberculosis

    Curatio International Foundation together with the Partnership for Research and Action for Health organized a meeting at the National Center for Disease Control and Public Health on 26th of December, where two different study findings were represented. Studies aimed to reveal Referral Delay from Primary Care facilities to specialized TB centers and Health System Factors Affecting Adherence to Tuberculosis (TB) Treatment in Georgia. The project was implemented by financial support of the TDR,  the Special Programme for Research and Training in Tropical Diseases, hosted at the World Health Organization (WHO).

    CIF prezented qualitative research findings about adherence to Drug Resistant TB treatment and led discussion around the findings – what can be done to improve treatment adherence among TB patients, looking through health system lens. The study report will be available by the end of January, 2017.

    CIF inventorised all civil society organizations (CSO) working on Tuberculosis issues in Georgia, with the financial support of Stop TB Partnership through the CFCS round 7.  In the frame of this project TB CSO informational directory has been developed which is available here.