Category Archive for "HIV/AIDS and Desease Surveillance"

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.

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HIV risk and prevention behaviours among Prison Inmates in Georgia, 2015

HIV risk and prevention behaviours among Prison Inmates in Georgia, 2015Curatio 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. 

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Bio-Behavioral Surveillance Survey among Men who have Sex with Men in two major cities of Georgia, 2015

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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.

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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.

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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.

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Population Size Estimation of Men Who Have Sex with Men in Tbilisi, Georgia

Journal Plos One publishes an article authored by CIF researchers, Population Size Estimation of Men Who Have Sex with Men in Tbilisi, Georgia; Multiple Methods and Triangulation of Findings

Curatio International Foundation conducted the population size estimation of men who have sex with men (MSM) in Tbilisi, Georgia in 2014. The authors compare estimates of MSM population living in Tbilisi with other estimates in the region.

In the absence of a gold standard for estimating the population size of MSM, this study reports a range of methods, including network scale-up, mobile/web apps multiplier, service and unique object multiplier, network-based capture-recapture, Handcock RDS-based and Wisdom of Crowds methods. To apply all these methods, two surveys were conducted: first, a household survey among 1,015 adults from the general population, and the second, a respondent driven sample of 210 MSM. We also conducted a literature review of MSM size estimation in Eastern European and Central Asian countries.

Our size estimates of the MSM population (1.42% (95%CI: 0.9% ~ 2.53%) of the adult male population in Tbilisi) fall within ranges reported in other Eastern European and Central Asian countries. These estimates can provide valuable information for country level HIV prevention program planning and evaluation. Furthermore, we believe, that our results will narrow the gap in data availability on the estimates of the population size of MSM in the region.

To read the article please click here.

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HIV risk and prevention behavior among People Who Inject Drugs and among Men who have Sex with Men

HIV

Curatio International Foundation is implementing the research project to measure the prevalence of HIV and hepatitis C to provide measurements of key HIV risk behaviours and to generate evidence for program planning, advocacy and policy-making.

The research studies two different risk groups: 1. Men who have Sex with Men (in Tbilisi and Batumi) and 2. people who inject drugs (in 7 cities of Georgia).

The project is implementing together with following Georgian organizations: Bemoni Public Union, Georgian AIDS, Clinical Immunology Research Center and Tanadgoma – Center for Information and Counseling on Reproductive Health.

Currently Georgia belongs to the group of countries with concentrated HIV epidemics. As of October 7, 2015 a total of 5,257 HIV cases have been registered by the national HIV surveillance system. The National Center for Disease Control and Public Health (NCDCPH) reported 564 new cases of HIV in 2014 (15.1 new cases per 100,000 populations). Since the first reports of HIV in the late 1980s in Georgia, injecting drug use was the major route of transmission. However, for the last three years heterosexual contacts became a dominant route of HIV spread. HIV infections acquired through injecting drug use accounted for 35.7% (0.7% higher than in 2013).  The previous Bio-BBS study conducted in six cities of Georgia, in 2012 suggests that HIV prevalence among this KP equals to 3.0% through the country, and it varies from 0.4% to 9.1% depending on the geographic location. The current study revealed that HIV prevalence equals to 2.2% through the country.  Bio-Behavioral Surveillance Survey among key populations is critical for adequate planning and scaling-up of preventive interventions.

The current study is supported by the Global Fund to fight HIV/AIDS, Tuberculosis, and Malaria. The study will be finalized by the end of 2015.

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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.

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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.

 

 

 

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Awaiting the results of Prisoners’ Behavior Surveillance Survey (BSS)

Curatio International Foundation together with Infectious Diseases, AIDS and Clinical Immunology Research Center and Association Tanadgoma has conducted the Behavior Surveillance Survey with biomarker component.

The study report of Behavior Surveillance Survey with biomarker component among 210 prisoners will be available in early fall.

The study was carried out in the framework of the Global Fund project “Establishment of evidence-base for national HIV/AIDS program by strengthening the HIV/AIDS surveillance system in the country” by the Curatio international Foundation in collaboration with Infectious Diseases, AIDS and Clinical Immunology Research Center and Association Tanadgoma. The study covered Tbilisi and regional city Kutaisi.

In the framework of the same project the sentinel surveillance among STI patients and Behavior Surveillance Surveys with biomarker component among Intravenous Drug Users (IDUs), and Commercial Sex Workers (CSWs) have been carried out.

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