Designup

Category: Presentation

  • 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.

  • Barriers and Facilitators to Screening and Treatment of HCV among IV drug-users in the Republic of Georgia: A Formative Qualitative Study

    Status: Closed

    Introduction and Overview

    In Georgia HCV treatment has become accessible to the population through a new government initiative. This initiative entails the provision of costly HCV treatment drugs at a lower cost (60% lower than the market price) to the patients who have completed HCV diagnostic testing. The hepatitis C program has been placed high on the country’s political agenda, which demonstrates the priority of this public health problem. Since 2008, harm reduction programs operating in all major cities of Georgia provide free HCV antibody testing to PWIDs along with other preventive interventions. On average 2,000 IDUs get tested, and around 50% screen positive for exposure to HCV annually. Although preventive programs encourage HCV positive individuals to continue with further diagnostic procedures and treatment, the care and treatment outcomes for these individuals is unclear. Greater knowledge regarding the facilitators and barriers to diagnosis and care is urgently needed to ensure the country provides the most effective coverage of the population, and to help guide the implementation and refinement of the government’s new hepatitis C program.

    Organizations involved in the research

    The Curatio International Foundation (leading), Public Union Bemoni (partner) and New York University College of Nursing have considerable experience in the field of public health research, qualitative research methods, HCV research and studies with PWIDs.

    Expected Results and Their Application

    The implementation of this research will generate evidence that will in turn inform the future design of the Hepatitis C program. Specifically, the research findings will help to identify the barriers and facilitating factors to providing adequate HCV care and treatment. Additionally, it will assist in guiding the design of strategies to remove these barriers and enhance enabling factors, thus increase the effective coverage of the program.

    Sustainability Implementation Plan

    In Georgia there is no evidence regarding the factors that influence PWIDs decision to take the HCV test and to seek treatment following a positive test. Moreover, since the introduction of the government’s Hepatitis C program, there is a changing context (a decrease in the financial barriers), the influence of which, is interesting to investigate. Therefore, the findings of this research will be unique

    Read the report >>

     

  • 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.

     

  • 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. 

  • 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…

     

     

     

  • Civil Society Forum organized by Country Coordination Mechanism

    On January 29, at Courtyard Marriott Hotel was held a Civil Society Forum organized by Country Coordination Mechanism. The forum was part of country dialogue process regarding HIV/AIDS and Tuberculosis issues. During the meeting, civil society representatives shared results of their work and challenges that still exists.

    Curatio International Foundation presented the latest data on HIV prevalence and transmission modes in the Key Affected Populations. Presented data was mainly based on the surveys repeatedly conducted by CIF (Bio-Behavioral Surveillance Survey and Population Size,
    MOT Study) and existing epidemiological situation in the country.

    For more detailed information see the presentation.

  • CIF’s contribution to Investing in Global Health and Development

    Since the creation of the Global Fund, the world’s financing instrument in the fight against AIDS, TB and Malaria the role of private foundations has significantly increased in contributing to funding, participation in its governance and to the strategy of the organization.

    The Global Fund partners with non-governmental organizations, Foundations and private companies in four major areas: Contributor of Resources, Grant Implementer, Advocacy and Services, and Pro Bono Goods and Services. Curatio International Foundation (CIF) is the key partner listed among large business organizations such as Infrastructure Leasing & Financial Services Limited (IL&FS), Anglogold Ashanti, Shell Foundation, Oil Search Limited etc.

    In order to assess the role they play in development aid, particularly in the field of health, Friends of the Global Fund Europe organized a conference bringing together European and American foundations to share experiences and perspectives on global health issues and how they could build effective partnerships with the Global Fund. The event took place on December 12, 2012 in Paris, France.

    The conference was a golden opportunity for participants to meet with representatives of European and American foundations involved in global health. The event was welcomed and leaded by high level guests such as Executives from world’s leading foundations, large businesses and the government.

    The conference agenda focused on three topics:

    – What is the contribution of foundations to health and development?
    – Can European foundations do more in global health and how?
    – How can European foundations build effective partnerships with the Global Fund ?

    George Gotsadze, Director of Curatio International Foundation made the presentation on the role of CIF in implementing Global- fund funded programs.

  • Fourth Wave Results of Pharmaceutical Study Published

    Curatio International Foundation has completed a study exploring ‘Price, Affordability and Availability of Medicines in Georgia’. The study was divided into three stages and carried out in 2009-2001.

    The key aim of the study is to improve affordability and availability of medicines for the population.

    Based on a three-year observation of pharmacies and different medicines in Georgia, Curatio International Foundation studied the practice in the pharmaceutical sector and came up with recommendations based on research findings. The recommendations will be presented to the broad audience of the health sector – the Health Care Committee of Parliament, the Ministry of Health, the insurance sector and other interested parties.

    The study was conducted using the methodology of the World Health Organization (WHO). The survey looked at prices and mark-ups of 52 medicines (brand-name medicines and their cheap generic equivalents) over the period of three years in licensed pharmacies nationwide.

    Findings and recommendations of three stages were unveiled in December 2011.

    Read more on study methodology, findings and recommendations- Presentation (available in English) and Brief (available in Georgian).

  • Presentation of the findings of Assessment of Complex Non-Communicable Condition in Low Income Countries

    Use of Multi-Method Rapid Evaluation to Assess Complex Non-Communicable Condition in Low Income Countries

    At Geneva Health Forum 2012 Curatio International Foundation presented a study preliminary findings which looks at evaluation of health systems performance in low-resource settings with regard to diabetes management. With the use of multi-method rapid evaluation the authors assess complex non-communicable condition (diabetes) in five Former Soviet Union countries.

    The study seeks to identify core problems and pragmatic policy options will be developed to address these gaps. The study is implemented in the frame of the 7th framework program supported HITT-CIS project.

    Authors: Dina Balabanova, Martin McKee, Ivdity Chikovani, Oksana Ivanuto. Presented by Ivdity Chikovani

    See the abstract here.

    See the Newsletter.

  • Poster Presentation at Copenhagen 2012 Conference on HIV

    Curatio International Foundation presented two posters at Copenhagen 2012 Conference- HIV in Europe.

    One of the posters presented results of Bio-Behavioural surveys among Injecting Drug Users in five cities of Georgia in 2008-2009 and specifically explored Low testing uptake and their determinants among this high risk group in Georgia. Authors: Ivdity Chikovani, Ketevan Goguadze, Natia Rukhadze, George Gotsadze

    The poster was presented in the session – Lessons learned in the implementation of HIV testing strategies for IDUs.

    Another poster addressed issues around late diagnoses for HIV care. The National HIV/AIDS database for 2000-2010 was analysed and characteristics of high risk groups for late diagnosis in Georgia were identified. Authors: Ketevan Goguadze, Ivdity Chikovani, Natia Rukhadze, George Gotsadze

    The posters can be seen at the HIV in Europe web site:

    Low testing uptake and their determinants among IDUs in Georgia

    High risk groups for late HIV diagnosis in Georgia