Category Archive for "2009"

Article on Springer-Determinants of Risky Sexual Behavior Among Injecting Drug Users in Georgia

Curatio International Foundation has published the article on Springer, Aids and Behavior Section. The article covers the findings of CIF’s recent study on Injection risk practices and risky sexual behaviors among injection drug users (IDUs) and their sexual partners particularly vulnerable to HIV. The purpose of the study was to describe and understand determinants of high-risk sexual behavior among IDUs in Georgia. A cross-sectional, anonymous survey assessed knowledge, behavior and HIV status in IDUs in five Georgian cities (Tbilisi, Gori, Telavi, Zugdidi, Batumi) in 2009. The study enrolled in total 1,127 (1,112 males, 15 females) IDUs. Results indicate that occasional sexual relationships are common among male IDUs, including married ones.

Authors of the article are: Ivdity Chikovani, Ketevan Goguadze, Ivana Bozicevic, Natia Rukhadze & George Gotsadze.

See the abstract on Springer.

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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).

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Paper on Prevalence of HIV among injection drug users in Georgia published on Journal of International Aids Society, 2011

In February 15, 2011 the Journal of International Aids Society Published the paper by CIF on Prevalence of HIV among injection drug users in Georgia.

Georgia is categorized as a low-HIV-prevalence country. According to the national HIV registry data, there has been a sharp increase in newly diagnosed cases since 2004, with a steady increase since 2008. Annually, almost half of the newly diagnosed cases are revealed at the AIDS stage of disease. There is regional heterogeneity in HIV prevalence with higher rates in the capital (Tbilisi), regions bordering Turkey, and in the conflict zone of Abkhazia. Injection drug use remains a major risk factor for HIV transmission. In 2009, more than 70% of new HIV infections were attributed to injection drug use or sexual contact with an injection drug user.

Drug abuse and its related health and social consequences are critical challenges facing Georgia. As a bridge between Europe and Asia, Georgia and other south Caucasian countries serve as a drug trafficking route into Russia and Europe. The conflict regions may also have conditions that support drug trafficking. No reliable estimates on the extent of drug use in Georgia currently exist

Since the Injection drug use remains a major risk factor for HIV transmission in Georgia authors of the study aimed to characterize the prevalence of HIV among injection drug users locally.

To assess the knowledge and behavior in injection drug users a cross-sectional, anonymous bio-behavioral survey in combination with laboratory testing on HIV status was conducted in five Georgian cities in 2009. A snowball sample of 1127 eligible injection drug user participants was investigated.

Read the full paper at Journal of International Aids Society web site.

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Price, availability and affordability of medicines in Georgia-2009-2011

The present report unveils the findings of the study “Price, availability and affordability of medicines in Georgia” implemented over the course of three years- 2009-2011 in the capital Tbilisi and regional cities. The study was supported by the World Bank and the Open Society Institute.

The survey looked at availability and price of Innovative Brands and their equivalent low price generics, analyzed collected data by type of medicine, regional differences as well as by type of pharmacy. The survey also looks at medicine mark-ups and compares with mark-ups in European countries, measures affordability of standard treatments as percent of average subsistence monthly allowance and provides comparison of the standard treatments by innovative brands and equivalent low price generics.

The present report “Price, availability and affordability of medicines in Georgia” attempted to obtain reliable data on these aspects and documents tendencies of change over the course of three years. Over the course of three years the study covered almost all licensed pharmacies and 52 types of medications in the capital Tbilisi and regional cities.

The power point presentation document and brief study report can be viewed here (yet avaialble only in Georgian).

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Findings of the pharmaceutical market study in 2009-2011 years

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.

Giorgi Gotsadze, the Curatio International Foundation Director: “Through the study we provide strong evidence to decision and policy makers on the current condition of the pharmaceutical market. We hope that this study will foster debates between the 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.

The survey measures the quality of access to medicines in both pharmacy chains and independent pharmacies. In 2011, Pharmadepo and Parmacenter added to the pharmacy chains involved in the survey (PSP, Aversi, GPC) in 2009-2010.
The survey looks at the access to medicines by years as well. It analysis the impact of amendments made in 2009 to the Law on Drugs on the access to medicines and medicine prices in Georgia. The survey analysis how the changes influence the patients’ treatment costs in patients with different diagnosis.

The survey has found that:

• The market has witnesses a tougher rivalry since 2009, which has likely led to the reduction of markups of brand-name products. Markups decreased most in 2001;
• The year 2011 witnessed an increase in access to both brand-name products and their cheap generic equivalents;
• Despite improved affordability the market is experiencing a lack of generic products;
• Access to medicines varies by regions. Access, especially the access to generic medicines, in some regions is still low;
• The level of access is highest in the Pharmadepo/Pharmacenter pharmacy chain and lowest in independent pharmacies, which is likely to be the result of unequal competition among pharmacies;
• Even though there is a decreasing trend in medicine markups, the markups in Georgia are higher than in European states, which means that Georgian importers add more funds to medicine prices than European ones (which should respectively lead to higher profits). Consequently, the share of pharmaceutical costs in the national healthcare spending in Georgia is much higher compared to European states.
Impact on Standard Treatment Costs:
• There has been a decreasing trend in the standard treatment price for the past three years;
• In 2011 standard treatment costs decreased more in case of treatment by brand-name medicines compared to treatment by generic products, however the treatment by generic medicines requires less spending because of low retail price of such medicines.
The survey of prices and availability of medicines was divided into three phases and conducted in Georgia in 2009-2011. The first and third stags were financed by the World Bank, while the second one – by the Open Society Institute.CIF presents the results of the study exploring “Price, availability and affordability of medicines in Georgia”.

Study presentation and small study report (available in Georgian).

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CIF Study Published in BMC Magazine, The Role of Supportive Supervision on Immunization Program Outcome- a randomized filed trial from Georgia

The research article by CIF and international experts has been published in BMC International Health and Human Rights 2009. Article is a part of the supplement: The fallacy of coverage: uncovering disparities to improve immunization rates through evidence.The Canadian International Immunization Initiative Phase 2 (CIII2) Operational Research Grants.

In the republic of Georgia, a country where widespread health care reforms have taken place over the last decade, an intervention was recently implemented to strengthen performance of immunization programs. A range of measures were taken to ensure that immunization managers carry out their activities effectively through direct, personal contact on a regular basis to guide, support and assist designated health care facility staff to become more competent in their immunization work. The study addresses the issues of human resources and its management in improving immunization coverage rates and aims to document the effects of “supportive” supervision on the performance of the immunization program at the district level in Georgia.

Follow the link to learn more about methods and results of the survey.

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Become Part of a New Insurance Culture!- Presentation

The presentation describes dynamic of health insurance development in Georgia, parameters of insurance and insurance systems and different policy choices/options the country faces in Health Insurance Field. The presentation also describes state financed and co-financed health insurance  products. Author of the presentation: Devi Khechinashvili. Full version is available in English and in Georgian.

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Opportunities for Change-Presentation

The presentation describes the importance of the pharmaceutical sector, factors conditioned development of the draft Bill on Changes and Amendments to the Georgian Law on Drugs and Pharmaceutical Activities, which has been passed by the Parliament of Georgia 10th of August, 2009 and became effective from October 15, 2009. The presentation also describes key concepts, recommendations rendered to the Ministry of Labor, Health and Social Affairs in 2007, including the information on which recommendations accepted and which of them ignored by the Ministry; The presentation also provides recommendations for further improvement of the legislation. Author of the presentation: Vakhtang Megrelishvili. Full version is available in English and in Georgian.

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Premium Estimates for the 2009 State Health Care Benefit Program for the Poor

It is estimated that during 2009 up to 900 000 poor individual will be covered by the Program. Monthly Premium estimations done by CoReform/CIF hired actuaries in September 2008 have already submitted to the MoLHSA to inform 2009 State Budget allocations, namely: a) average premium 12.64 Gel per month per person that makes 151.68 Gel per person per annum; b) different premium coefficients estimated for the following scenarios: i) age and sex; ii) different age groups (age 0-49; age 50-74; age 75 and above); iii) age, sex and family size; iv) age, sex and region; The premium estimations informed GoG Decree #32 dated February 19, 2009, where average premium exceeds 12.64 GEL and equals 15 Gel per month, largely because of Government’s policy decision to further expand insurance package for the Poor.

Premium Estimates for the 2009 State Health Care Benefit Program for the Poor (ENG)
Premium Estimates for the 2009 State Health Care Benefit Program for the Poor (GEO)

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Statement for the Media-The Study on Injected Drug Users Completed

Only 1/4 of Intravenous Drug Users are getting tested for HIV, putting their wife’s and girlfriends and the rest of the Georgian population at risk for a widening epidemic

Curatio International Foundation, a Georgian think tank, says “motivating IDUS to get tested is the key to prevention.”

According to a recent study by Curatio International Foundation and Public Union Bemoni, the Injecting Drug Users (IDUs) can put their regular sex partners at risk of HIV infection by having unprotected sex with them.

The study, which was conducted in 2009 in five different locations in Georgia (Tbilisi, Batumi, Zugdidi, Telavi and Gori) found that only 25% of intravenous drug users have been ever tested for HIV through their lifetime -even though the testing is free and available in their communities.

The IDUs especially in Tbilisi are well educated and half are married. The majority of them started drug injection in their late teens. The most frequently injected drug by Tbilisi IDUs is subutex, while Batumi IDUs favor heroin.

The IDUs are quite knowledgeable on HIV transmission routes, however they still commit behaviors that pose risk to their sexual or needle partners.

About half of married IDUs have occasional sex partners and every second of them did not use condoms with such partners. This is particularly unconscionable because in most of cases IDUs do not use condoms with their wives, girlfriends.

Highest HIV rates and risky behavior were found among Batumi IDUs compared to other cities.

“Low uptake of testing services indicates that a large proportion of IDUs is unaware of their HIV status, which leads to high risk behaviors,” says Ketevan Goguadze, project manager, “Motivating IDUs to get tested is the most effective way to prevent spread this infection.”

The study was undertaken in 2009 under the Global Fund supported project implemented by Curatio International Foundation, a local think tank working on the health care issues, and its partner organizations.

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