NDPHS Expert Group on HIV/AIDS and Associated Infections Progress report 19 April, Chair Dr. Ali Arsalo and ITA Ms Outi Karvonen

Transcription

1 NDPHS Expert Group on HIV/AIDS and Associated Infections Progress report 19 April, 2012 Chair Dr. Ali Arsalo and ITA Ms Outi Karvonen

2 Relevance and context of the EG HIV/AIDS & AI work?

3 Necessary to aim at comprehensiveness HIV IDU TB HIV continuously a wide problem risk groups: IDUs, migrants, MSM, prisoners spreading in RF, Eastern Europe and Central Asia Co-infections: HIV and tuberculosis tightly connected with each other High correlation between IDU and HIV

4 Risk behavior Vulnerable groups Defects of the service systems Social problems IDU HIV Tuberculosis Other co-infections

5 Reported no. of HIV-infection per inhabitants in the EPI-NORTH cooperation area, 2010 Source: * 2009 Outi Karvonen and Northwest CSR Helsinki District AIDS Centre, St. Petersburg

6 TB prevalence in ND Area ,6 5,5 6, , ,5 25 Source: Dr. Kristiina Salovaara FILHA

7 HIV-infection among newly detected tb-patients in NW Russia

8 TB, HIV and TB/HIV, Russian Federation, Number of all registered TB cases Number of all HIV-infected persons %TB/HIV among all TB patients Number of registered persons with TB/HIV Число больных туберкулезом, состоящих на учете (форма 33) Число зарегистрированных больных ВИЧ-инфекцией (форма 61, после 2004 г. без учета ФСИН) Доля пациентов с сочетанной инфекцией среди больных туберкулезом Число зарегистрированных случаев сочетанной инфекции (форма 61 без ФСИН) 7.0 Number of patients Абс. число больных Civil sector R. Zaleskis St. Petersburg % пациентов с сочетанной инфекцией % TB/HIV among TB patients

9 Estimated price of TB treatment Normal tuberculosis drugs 6 months 730 MDR tuberculosis drugs 24 months Total costs vs , not including human suffering Source: Dr. Kristiina Salovaara FILHA

10 NDPHS Goals for the HIV/AIDS & AI Expert Group Goal 2: Prevention of HIV/AIDS and Associated Infections in the ND-area has improved Goal 3: Social and health care for HIV infected individuals in the ND area is integrated

11 Tasks of the EG HIV/AIDS & AI Aiming at impacts and added value through Advocacy Project facilitation: support to project identification, planning, looking for partners, provision of information about funding etc Developing and sharing of information etc. NOTan implementing organization

12 Projects under the umbrella of the HIV/AIDS Expert Group Project status in April 2012 Around 40 projects completed 14 projects ongoing A few projects under consideration WE ARE FACING TWO VERY SERIOUS PROBLEMS: Deteriorating IDU-HIV-TB situation Lack of funds to respond to the situation 02/05/

13 Development of internal Strategy and Action Plan for the EG HIV/AIDS & AI Analytical discussions aiming at comprehensiveness Description of the situation using Problem Tree Translation from problems to an Objective Tree Next steps: Importance of the management component Supporting policy development and advocacy functions Selection of priorities for provision of technical support Making use of Logical Frameworks Development of projects if funding is available!

14 Containing the spread of HIV and TB in the ND Region Goal 2: Prevention of HIV/AIDS and Associated Infections In the ND Area has improved Goal 3: Social and health care for HIV infected Individuals In the ND Area is integrated 2.1. Reinforcing policy recommendations 2.2. Geographical areas and partners for projects are identified and involved 3.1. Review of best practices on integration of social and health care services for HIV + people is prepared 2.3. Best practices document(s) developed

15 NDPHS HIV/AIDS&AI EG Second draft of the Problem Tree (blue boxes) for internal Action Plan Goal 2: Prevention of HIV/AIDS and related diseases in the ND Area has improved O.T Reinforcing policy recommendations O.T Geographical and priority thematic areas as well as key populations at higher risk in urgent need for further local or regional projects are identified, partners to be involved in these projects are recommended and project planning supported Goal 3: Social and health care for HIV infected individuals in the ND Area is integrated O.T Best practices document(s) developed O.T Review of evidence based experiences and best practices on integration of social and health care services for HIV + people is prepared Ineffective prevention with harmful impacts of HIV, AIDS & AI (TB, hepatitis B & C, syphilis, gonorrhea)in the ND Area due to Insufficiency of international cooperation and joint activities (to be adapted according to prevailing conditions within countries) 1. Existing policies and practices do not fully support the prevention of the spread of HIV and AIs 1.1. HIV+ should be involved in decision making 1.2. Insufficient follow-up of HIV+ in general 1.3. Insufficient follow-up of HIV+ in key groups 1.4. Necessity to integrate HIV surveillance with STI, hepatitis and TB surveillance 1.5 Existing services do not reach relevant groups 1.6. Insufficient research at international standards 1.7. Insufficient use of results from program monitoring and evaluations 1.8. Decision makers are not aware about future costs caused by infections and their treatment 1.9. Inadequacies and defects of legislation Some countries do not include sexual health education in schools curricula Insufficiency of advocacy and lobbying skills to inform decision makers in HIV recourse allocation and to recommend optimal choices based on local characteristics The role of civil society is too weak Insufficient understanding of HIV and AIs in the society Insufficient knowledge about second generation HIV surveillance practices 2. Unsatisfactory monitoring and provision of epidemiological info in the ND Area 2.1. Prevalence and risk behavior patterns are not known (MSM, CSWs, IDUs) 2.2. Insufficient information about the situation of HIV, TB and AIs among IDUs 2.3. Insufficient information about bridging populations (sex partners of IDUs, female partners of MSM, clients of CSWs) 2.4. All pregnant women are not automatically tested for HIV and hepatitis 2.5. Insufficient services for migrants 2.6. Lacking information about ethnic minorities, including Roma and marginalized people 2.7. Neglected children, including minors involved in commercial sexual exploitation 2.8. Insufficient information from prisons 2.9. Sex tourists and travelers are not reached sufficiently 3. Continuous spread of HIV, TB and associated infections 3.1. High share of late presenters (low CD4) among new HIV PHC and GPs are not sufficiently involved in prevention and testing 3.3. Unsatisfactory quality of counseling not using established and evaluated methods 3.4. LTC services do not sufficiently cover needs of vulnerable groups 3.5. Insufficient public awareness about the need for active case finding and crosstesting between HIV TB, hepatitis and STIs 3.6. Lack of access to specific services for IDUs, including harm reduction and services outside big cities 3.7. Lack of sexual health education in schools and other institutions curricula, including sexual minorities, prevention of HIV and STIs 3.8. Insufficiency of youth-friendly services 3.9. Insufficiency of targeted prevention programs for specific groups (migrants, MSM, CSWs, HIV+, IDUs) HIV+ are not sufficiently involved in planning and implementation of prevention programs Insufficiency of collaboration partners 4. Deteriorating infectious disease situation of risk groups, migrants and other minorities 4.1. General awareness about TB is weak 4.2. MDR and XDR TB are increasing 4.3. Need for education about TB among population, medical professionals and decision makers 4.4. Insufficient TB infection control especially in HIV settings (including LTSCs) 4.5. Co-operation between civilian and penitentiary TB services is weak 4.6. Collaboration between TB and narcology services is insufficient 4.7. International treatment standards are not always met and followed properly 4.8. Lack of outreach work and social support among risk groups for TB 5. Complexity of the HIV- AIDS-TB situation is not properly responded by traditional approaches 5.1. Adherence to treatment is not satisfactory 5.2. Insufficient crosssectoral control and management mechanisms and approaches 5.3. Too narrow involvement of stakeholders in development of TB and HIV projects and approaches 5.4. More & closer collaboration & projects with Russian drug police is needed 5.5. Wider scope is needed in consulting relevant authorities 5.6. Insufficient training of GPs and other PHC staff on raising awareness of mass media, general population and service providers on contacting, servicing and educating risk groups) 5.7. Insufficiency of new approaches for international collaboration and partnerships 5.8. The potential of EU Public Health Program not been used 5.9. Insufficient attention on promotion of best practices with country specific approach 6. Insufficient capacity of the health care systems to respond to the burden of HIV, TB and AIs 6.1. The health and social care systems are not sufficiently responding to and coping with prevailing challenges, including migration 6.2. Insufficient access to treatment 6.3. Insufficient adherence to treatment 6.4. Adequate case management is not always in place 6.5. Need to develop the service system according to practical needs 6.6. Insufficient capacity of PHC in the identification, vaccinations and referring for treatment of associated chronic infections (e.g. HBV & HCV) 6.7. HIV care needs to be more integrated in the PHC 6.8. Currently, the approaches separating HIV and PHC and sexual health services are discriminating and violating basic human rights CSR Helsinki Lack of knowledge about and access to post-exposure prophylaxis 6.9. Work-places are Insufficiently covered

16 NDPHS HIV/AIDS&AI EG Third draft of the Objective Tree for internal Action Plan Incl comm. by Hans 0. Program management 0.1. Develop updated Action Plan for the EG Clarify the needs and expectations of members for the EG Prepare long-term Action Plan, including principles for EG meetings 0.2. Further development of reporting mechanisms and practices Follow-up reporting of projects and EG activities Reporting to the Secretariat and CSR Reporting to governments as relevant Making publicity as relevant 0.3. Promotion of project development Identification of relevant project ideas, based on the EG Action Plan Provision of support to identification of project partners Provision of support to project planning Provision of support for applications 0.4. Identification of funding sources and Goal 2: Prevention of HIV/AIDS and related diseases in the ND Area has improved O.T Reinforcing policy recommendations Strengthened prevention and reduction of impacts of HIV, AIDS & AI (TB, hepatitis B & C, syphilis, gonorrhea)in the ND Area through facilitation of cooperation by joint international activities (to be adapted according to prevailing conditions within countries) 1. Provision of support to policy development and cooperation 1.1. People living with HIV more involved in decision making 1.2. Improved follow-up of all HIV+, including medical care and counseling 1.3. Improved follow-up of HIV+ belonging to key risk groups 1.4. Improved integration HIV and STIs, hepatitis and TB surveillance 1.5. Improved access to existing services for relevant risk group 1.6. More research fulfilling international standards 1.7. Results from monitoring and evaluations of programs are effectively made use of 1.8. Decision makers are informed and aware of future costs caused by infections and their treatment 1.9. Updated legislation Sexual health education included in schools curricula Improved skills for advocacy and lobbying to inform decision makers on HIV resource allocation and to recommend optimal choices based on local characteristics Civil society organizations are more involved in prevention and support The understanding of HIV and Ais among the public has improved Improved knowledge about second generation HIV surveillance O.T Geographical and priority thematic areas and key populations at higher risk in urgent need for further local or regional projects identified, partners for these projects recommended and project planning supported 2. Improved monitoring and data on epidemiological situation in the ND Area 2.1. Improved data on prevalence of hiv and hepatitis among risk groups (MSM, CSWs, IDUs) 2.2. Mechanisms developed to deliver data on the situation of HIV, TB and AIs among IDUs 2.3. Effective approaches developed to collect relevant data on bridging populations (sex partners of IDUs, female partners of MSM, clients of CSWs) 2.4. Improved HIV and hepatitis testing coverage in pregnant women 2.5. Increased counselling and testing services for migrants 2.6. More and better data on prevalence and risk behaviour in ethnic minorities, including Roma and marginalized people 2.7. More and better data on prevalence and risk behaviour in neglected children, including minors involved in commercial sexual exploitation 2.8. Mechanisms in place to produce data on situation of infectious disease in prisons 2.9. Mechanisms developed to reach sex tourists and travelers more effectively 3. Effective prevention of the spread of HIV, TB and associated infections 3.1. Decreasing share of late presenters (low CD4) among newly diagnosed HIV More involvement of PHC and GPs in prevention and testing 3.3. The quality of counseling improved by using established and evaluated methods 3.4. Needs of vulnerable groups are met through LTC services 3.5. Improved public awareness about the need for active case finding and cross-testing between HIV TB, hepatitis and STIs 3.6. Access to specific services for IDUs, including harm reduction, total prevention packages and services outside big cities 3.7. Sexual Health education included in schools and other institutions curricula, including information on sexual minorities and HIV and STI prevention 3.8. Availability of youth-friendly services 3.9. Availability of targeted prevention programs for specific risk groups (migrants, MSM, CSWs, HIV+, IDUs) People living with HIV are involved in planning and Implementation of prevention programs Networks of collaboration partners established Knowledge about and access to postexposure prophylaxis for HIV and hepatitis B are available Goal 3: Social and health care for HIV infected individuals in the ND Area is integrated O.T Best practices document(s) developed 4. Improved tuberculosis situation in risk groups, migrants and other minorities 4.1. The general awareness among professionals and the public about TB is improved 4.2. The number of cases of MDR and XDR TB is decreasing 4.3. TB information Programs implemented among the public, professionals and decision makers 4.4. TB infection control programes implemented especially in HIV settings (including LTSCs) 4.5. Improved collaboration between civilian and penitentiary TB services 4.6. Improved collaboration between TB and narcology services 4.7. International treatment standards on TB are met 4.8. Outreach work and social support methods among risk groups for TB are developed O.T Review of evidence based experiences and best practices on integration of social and health care services for HIV + people is prepared 5. Complexity of the HIV and TB situation recognized and new approaches developed 5.1. Improved adherence to treatment of double infections 5.2. Improved crosssectoral disease control, management, mechanisms and approaches 5.3. Wider involvement of stakeholders in the development of TB and HIV projects and approaches 5.4. More & closer collaboration & projects with Russian drug police developed 5.5. Guidance are developed to motivate the use of wider scope in consulting goverment authorities 5.6. Training of GPs and other PHC staff developed and implemented on raising awareness of mass media the public and service providers on contacting, servicing and educating risk groups) 5.7. New approaches developed for international collaboration,partnerships and networking 5.8. Effective use of the potential of EU Health Program 5.9. Promotion of best practices with country specific approach 6. Improved capacit of the health care systems as respons to the burden of HIV TB and AIs 6.1. The health and social care systems are capable to respond effectively to and cope with prevailing challenges, including migration and IDUs 6.2. Functioning access to treatment 6.3. Improved adherence to treatment 6.4. Adequate case management is in place 6.5. Strengthened service systems to met clients practical needs 6.6. Improved capacity of PHC concerning the identification, vaccinations and referring for treatment of associated chronic infections (e.g. HBV & HCV) 6.7. Strengthened integration of HIV care in the PHC 6.8. PHC & sexual Health services are provided without stigmatisation, discrimination and violation of basic Human rights 6.9. Improved Involvement of workplaces

17 Decreasing incidence of HIv & AI Decreasing risks on social exclusions Positive impacts on the burden of health care system and economy Strengthened prevention of HIV & AI in the NDPHS Region Strengthened prevention of the spread of HIV in the NDPHS Region Prevention of HIV and related stigma Prevention of HIV and TB, Including training Control the spread of HIV/AIDS in the Barents and ND Region HIV prevention among Reproductive-aged women in Karelia Mobile facility for youth to prevent HIV & drug abuse Peer education in Archangelsk [in HIV] TB/HIV collaboration In Murmansk Development of low threshold services in Leningrad Region TUBIDU: tb control among vulnerable groups On-going projects Strengthening municipal anti-drug networking in Murmansk Region Networking for prevention of drug addiction and HIV in NWR MSM survey in 33 countries Hepatitis & HIV: study and prevention In 10 EU countries European AIDS Conference Tallinn, May, 2011 Collaboration btw STI clinics Arch. & Oslo Media training in increasing tolerance concerning HIV/AIDS In Karelia Vera 2; HIV prevention among CSWs in NWR Developing services for IDUs in Kgrad (HIV&tb) Youth campaigns in HIV & drug abuse prevention Strengthening response to HIV & TB in NWR (Kgrad) Primary prevention of HIV among youth in Kgrad Projects under consideration Prevention of HIV in prisons and among ex-inmates Comprehensive project on HIV, TB & prisons together with EG PPHS Prevention of HIV among women (EGs PPHS & HIV/AIDS Training on governance of HIV prevention in NWR Project status not known Health promotion to prevent HIV Speak AIDS social marketing in Baltic countries and Poland Project ideas

18 Goal 2: Prevention of HIV/AIDS and related diseases in the ND Area has improved O.T Reinforcing policy recommendations O.T Geographical and priority thematic areas and key populations at higher risk in urgent need for further local or regional projects identified, partners for these projects recommended and project planning supported Goal 3: Social and health care for HIV infected individuals in the ND Area is integrated O.T Best practices document(s) developed O.T Review of evidence based experiences and best practices on integration of social and health care services for HIV + people is prepared Strengthened prevention and reduced impacts of HIV, AIDS & AI in the NDPHS Region 0. Program mngment Control the spread of HIV/AIDS in the Barents and ND Region Umbrella project to implement the internal strategy (action plan) of the EG On-going projects Projects under consideration Project ideas 1. Provision of support to policy development and cooperation Development of policy recommendations on Integration of social And health care services for PLHIV Media training in increasing tolerance concerning HIV/AIDS in Karelia finalized recently 2. Improved monitoring and data on epidemiological situation in the ND Area MSM survey in 33 countries 3. Effective Prevention of the spread of HIV, TB and associated infections HIV prevention among reproductive-aged women in Karelia Mobile facility for youth to prevent HIV & drug abuse Development of low threshold services in Leningrad Region Strengthening municipal anti-drug networking in Murmansk Region Vera 2; HIV prevention among CSWs in NWR Youth campaigns in HIV & drug abuse prevention Prevention and early detection of HIV among MSM TUBIDU: tb control among vulnerable groups -3 (5) CSR Helsinki Developing services for IDUs in Kgrad (HIV&tb) -3(5) 4. Improved tuberculosis situation in risk groups, migrants and other minorities 5. Complexity of The HIV and TB situation recognized and new approaches developed TB/HIV collaboration in Murmansk (Terminated without explanations by the RF ministry) 6. Improved capacity of the health care systems as responses to the burden of HIV, TB and AIs Collaboration between STI clinics Archangelsk & Oslo Strengthening response to HIV & TB in NWR (prisons) NCM accepted for financing EG HIV/AIDS & AI Project situation April 2012

19 Using standardized reporting matrix? Need to develop our thinking about impact examples from the report of the EG HIV/AIDS & AI

20 EG HIV/AIDS & AI: Facts from the reporting period (6 months) LFA process and priorities Lack of funds Policy review under preparation More focus on aiming at impacts One project planning process in June Umbrella project planning in September 2012 (concerning the implementation of the EG Action Plan, funding will be sought from EU) Advocacy / information to decision makers in Finland planned (HIV-TB co-infection)

21 Thank you for your attention!

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23 Progress Report: Operational projects aiming at achieving the Goal 2 (Prevention of HIV/AIDS and Associated Infections in the ND-area has improved) OT 2.2. Geographical and priority thematic areas, as well as key populations at higher riskin urgent need of further local or regional projects are identified, and partners to be involved in these projects are recommended, and project planning supported European MSM Internet survey on knowledge, attitudes and behaviouras to HIV and STI ( EMIS )(Financed by EU, Russian arm financed by Finland, additional financing from ECDC for comparative analysis)

24 OT 2.2. Geographical and priority thematic areas, as well as key populations at higher riskin urgent need of further local or regional projects etc. (2) Empowering public health system and civil society to fight tuberculosis epidemic among vulnerable groups ( TUBIDU ). (Prevention of IDU-and HIV-related TB epidemic in the partner countries.) Project started in October Financing EU, budget 900,000 EUR Duration: Partners: Estonia (lead), Lithuania, Latvia, Romania, Bulgaria, Russia, Ukraine, Georgia, Bosnia-Herzegovina, Albania Subcontractors: Finnish Lung Health Association and National Institute for Health and Welfare (THL) Study tour to Finland in March

25 OT 2.2. Project idea on prevention and early detection of HIV among men having sex with men

26 Projects which have received NDPHS label OT 2.2. (3) 1. Controlling the spread of HIV/AIDS in the Barents and Northern Dimension Regions (Phase III); Technical Assistance and Coordination" ( ) Coordination of the Barents HIV/AIDS Programme and support to NDPHS EG on HIV/AIDS&AI. Coordination: National Institute for Health and Welfare (THL), Finland. Budget for ,000 EUR. Financier: Finland. 2. Strengthening of municipal anti-drug networking in the Murmansk Region( ) (aiming at prevention of HIV). Coordination THL (Finland) and Monchegorsk City Administration. Budget for ,600 EUR + local input. Financier: Finland. Application submitted for 2012.

27 Projects which have received NDPHS label OT 2.2. (4) 3. HIV prevention among reproductive-aged women in the Republic of Karelia( ). Coordination: National Institute for Health and Welfare (THL), Finland and the Republican AIDS Centre, the Republic of Karelia. Budget for ,600 EUR + local input. Financier: Finland. Application submitted for Development of low threshold services in Leningrad Region( ). Coordination THL and Leningrad regional AIDS centre. Budget for ,500 EUR. Financier: Finland. Application submitted for TB/HIV collaboration in Murmansk. Project planning phase Implementation Coordination FILHA, Finland. Budget for ,000 EUR. Financier: Finland. Terminated by the RF Ministry for Regional Development in autumn 2011.

28 OT 2.2. Geographical and priority thematic areas, as well as key populations at higher risk in urgent need of further local or regional projects etc. (5) Epidemiological review under preparation Barents region collaboration Evaluation of the Barents HIV/AIDS Programme by the former EG Chair (May-September 2011) Collaboration with the Steering Committee of the Barents Tuberculosis Programme

29 Progress Report: Operational projects aiming at achieving the Goal 2 (Prevention of HIV/AIDS and Associated Infections in the ND-area has improved) "As part of its efforts to contribute to the above-mentioned goal, the NDPHS will develop a project/projects which involve relevant stakeholders in the region and pay proper attention to the penitentiary system. - Proposal for improving services in the Kaliningrad Region prepared, submitted to EU Delegation in Russia, approved for financing, contract negotiations to be started

30 Progress Report: Operational projects aiming at achieving the Goal 2 (2) (Prevention of HIV/AIDS and Associated Infections in the ND-area has improved) Taking up the Challenge: Developing services to contain the spread of HIV and TB among injecting drug users in Kaliningrad Oblast Logical Framework Approach Workshop, Svetlogorsk, Kaliningrad Region (February 2011) Planning workshop, Sopot, Poland (May 2011) Lead organisation: NGO YLA, Kaliningrad Partners: Monar Association (Poland) Deutsche AIDS-Hilfe (Germany) The Ministry of Health of the Kaliningrad Oblast Information Office of the Nordic Council of Ministers in Kaliningrad The National AIDS Center (Poland) The Centre for Communicable Diseases and AIDS (Lithuania)

31 Overall objective: Prevention of HIV/AIDS and associated infections in the ND area has improved (Goal 2 of the NDPHS Strategy) Overall objective: Social and health care for HIV infected individuals in the ND area is integrated (Goal 3 of the NDPHS Strategy) Improved control of the spread of HIV and its consequences Overall objective of the Project (=Purpose of the NDPHS programme): Improvement of services in prevention and care of HIV and related diseases for vulnerable populations in the target area Overall objective of the Project: To contribute to the prevention of the spread of HIV and TB in Kaliningrad Oblast and neighboring areas Purpose of the Project: Services to contain HIV and TB among IDUs are developed 1. Integrated service chain developed ACTIVITIES FOR RESULT ETC. 2. Low threshold service point established ACTIVITIES FOR RESULT ETC. 3. Drug treatment services improved ACTIVITIES FOR RESULTS ETC. 4. Enabling political and legislative environment created ACTIVITIES FOR RESULT ETC.

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33 Revised proposed targets and indicators for the Priority Area 12 EG HIV/AIDS & AI / GOAL 3 Baseline Value/Situation Most countries provide separate social and health care services for HIV-infected individuals in the ND area. A big amount of HIV-infected people belong to vulnerable groups as drug users, sex workers, migrants, men having sex with men etc. These groups are very difficult to reach by traditional separate services.

34 Target Value/Situation Several countries in the region will have in place programmes on integration of health and social services for people living with HIV/AIDS by 2020.

35 Proposed Indicator Name and Description Indicator 2.1: Policy recommendations aimed at integration of health and social services have been developed and implemented through international programmes. Indicator 2.2: Number of cooperation programmes focusing on strengthening the integration and capacity of social and health care systems. Indicator 2.3: Number of countries that have integrated social and health care services for people living with HIV/AIDS.