Category Archive for "Presentation"

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.

 

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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.

პარლამენტი

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. 

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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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Civil Society Forum organized by Country Coordination Mechanism

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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.

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CIF’s contribution to Investing in Global Health and Development

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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.

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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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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.

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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

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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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Catastrophic Health Expenditure Analysis in Georgia

On October 26, 2011 the researcher of the Curatio International Foundation Natia Rukhadze presented the findings of Catastrophic Health Expenditure Analysis in Georgia at the “Seminar on Health Financing Reforms in Georgia” held in MoLHSA.

The study was funded by the World Health Organization (WHO) and uses the data from nationally representative Integrated Household Survey (HIS) conducted by National Statistical Office (GEOSTAT) on an annual basis; Study looked at trends in household catastrophic health spending during 2006-2010 among different population groups. The purpose of the study was to look at population level impact of the Government’s health financing reforms initiated in 2006/07 and aimed at providing state subsidized health insurance to extremely poor.

See the full report of the study.

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