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Category: Europe & Eurasia

  • 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.

  • EPIC Studies – Governments Finance, On Average, More Than 50 Percent Of Immunization Expenses, 2010–11

    Journal Health Affairs publishes a new Article EPIC Studies: Governments Finance, On Average, More Than 50 Percent Of Immunization Expenses, 2010–11 coauthored by CIF team member Keti Goguadze.

    Abstract: Governments in resource-poor settings have traditionally relied on external donor support for immunization. Under the Global Vaccine Action Plan, adopted in 2014, countries have committed to mobilizing additional domestic resources for immunization. Data gaps make it difficult to map how well countries have done in spending government resources on immunization to demonstrate greater ownership of programs. This article presents findings of an innovative approach for financial mapping of routine immunization applied in Benin, Ghana, Honduras, Moldova, Uganda, and Zambia. This approach uses modified System of Health Accounts coding to evaluate data collected from national and subnational levels and from donor agencies. We found that government sources accounted for 27–95 percent of routine immunization financing in 2011, with countries that have higher gross national product per capita better able to finance requirements. Most financing is channeled through government agencies and used at the primary care level. Sustainable immunization programs will depend upon whether governments have the fiscal space to allocate additional resources. Ongoing robust analysis of routine immunization should be instituted within the context of total health expenditure tracking.

    The online version of the Article 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.

  • TB Community Systems Strengthening in Georgia

    We are glad to announce that Curatio International Foundation has been selected to be Round 7 Challenge Facility for Civil Society (CFCS) grantee under the Stop TB partnership financial support.

    TB Community Systems Strengthening (TBCSS) project in Georgia aims – to build up integrated and comprehensive response to TB that is patient-centered and includes strong partnership with communities and civil society.

    The project will have 3 main objectives:

    1. Assess legal and social environment and civil society capacity, gaps and needs for engaging civil society in TB community response;
    2. Organizational strengthening for sustainable development of civil society in the TB field and
    3. Improve linkages, coordination and networking of TB constituencies, civil society organizations, state and other actors and those objectives will be achieved in two phases.

    Updated information about activities and achievements will be provided and share through social media during the project lifecycle.

  • 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. 

  • Strengthening Capacity of Civil Society for Promoting Research Evidence into Policy Development in Georgia

    Strengthening Capacity of Civil Society for Promoting Research Evidence into Policy Development in Georgia
    The idea of initiating the project was prompted by aggressive health and insurance market oriented reforms focusing on hospital sector privatization and financing of health care services through the private insurance companies. Implicit risks posing this campaign and fast pace of implementation needed to be mitigated through effective and evidence informed policies and regulations.

    The project aims to achieve development of policies that are: a) evidence informed; b) tailored to Georgia’s social, economic and cultural context, and c) responsive to public interest. Curatio International Foundation intends to contribute to achieving this goal by allying two distinct networks of NGOs and strengthening their capacity in delivering evidence into policy process. The alliance gathers experts in their own operations field, been active as watchdogs for health sector reforms on one hand and focusing on mental health issues on another hand.

    Curatio International Foundation embarked on a strategy of using evidence-informed advocacy as an essential ingredient in the policy development process. The Evidence to Policy is viewed through institutional lens rather than individual, therefore it focuses on interventions on institutions and on strengthening the links between institutions within and outside of the NGO networks through trainings of NGO staff and establishing Information Exchange Platforms. Training topics were informed from the assessment of capacity needs undertaken prior to project launch.

    As a result of this project it is expected that:

    * The capacity of NGOs involved in the network will be increased in accessing, acquiring and communicating available evidence to policy makers;
    * NGOs will develop better capacity to identify policy relevant research evidence and use the means of communication to effectively influence the policymakers;
    * NGO and stakeholder understanding about how they could engage with each other will improve “bonding” and “bridging” ties that link researchers, policy makers and NGOs involved in evidence informed policy making.

    NGO networks involved in alliance are:
    1. Network of NGOs already active as watchdogs and advocacy groups for health sector reforms:
    a. Georgian Young Lawyer’s Association (GYLA)
    b. Transparency International Georgia
    c. Open Society Georgia Foundation (Soros Foundation national chapter)
    d. Association of Young Economists of Georgia (AYEG)
    e. Economic Policy Research Centre

    2. Network of NGOs focusing on mental health issues:
    a. Georgian Association for Mental Health (GAMH)
    b. Mental Health Coalition
    c. Association of People in Need of Special Care (APNSC)
    d. The Georgian Association for Psychosocial Aid “Ndoba”

  • 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.