HIV/AIDS 4

MEETING OF THE HIV/AIDS EXPERT GROUP OF NDPHS

May 3-4, 2006, Helsinki, Finland

The following Programme Group Members were present:

Pauli Leinikki – Chaiman, Finland

Anna Marzec-Boguslawska, Poland

Zaza Tsereteli (Georgia), - ITA

Saulius Chaplinskas – Lithuania

Marius Domeika - Sweden

Kristi Ruutel – Estonia

Andris Ferdats - Latvia

Jean-Elie Malkin – France

Invited guest

Lucy Laitinen,International Organisation of Migrants, Helsinki

Francoise Hamers, EuropeanCenter for Disease Control and Prevention, Stockholm

Seija Saana, (observer) Ministry of Social Affairs and Health, Finland (only the 3rd of May)

Mikko Tawast , Ministry of Social Affairs and Health, Finland (only at dinner on the 3rd)

Mika Salminen (observer, KTL, Helsinki)

Anneli Milen (observer, STAKES, Helsinki)

Outi Karvonen (observer, STAKES, Helsinki)

The meeting started on 03/05/2006 at 12.30

The minutes were taken by Zaza Tsereteli.

Pauli Leinikki, National Public Health Institute (KTL), Finland, chaired the meeting. The agenda of the meeting is appended

1. Opening of meeting

The Chairman opened the meeting and expressed his appreciation to STAKES and Ministry of Social Affairs of Finland having organized this meeting. He introduced participants and welcomed Seija Saana from the Ministry of Social Affairsof Finland and Fracoise Hamers, from European Centre of Disease Control. Mrs. Hamers started to work at ECDC 1month ago and she will be responsible for HIV/AIDS prevention activities within ECDC.

Seija Saana had welcomed meting participants on behalf of Ministry of Health. She also informed on May 16-17 Finland will host the first meeting of newly created group on SIHLWA, which is chaired by Dr. Mikko Veinonen.

2. Adoption of Agenda

Leinikki presented the agenda of the meeting. He also proposed to discuss possible agenda for the next EG meeting, which is scheduled for the end of September, and will be held in France. The agenda was adopted

3. Adoption of minutes from Vilnius meeting, November 4-5, 2005

The minutes were distributed among the group members, and they had made changes and additions. Final version of the minutes was adopted. It will be placed on ND Partnership Web page. During the discussions chairman once again touched the issue connected to invite TB specialist to become the member of EG, since EG on TB was diminished after the closer of Task Force. The need of cooperation between the HIV and TB is evident, and group will need to consider having one member from that field. It was decided to contact new secretariat in that regard.

Leinikki has also informed group that together with ITA he hold a meeting with the Dutch Embassy in Finland. The possible participation of Netherlands in the wok of HIV/AIDS EG was the main topic of that meeting.

Tsereteli had informed that he is also discussing involvement of Spain in the work of EG.

4. Introduction to the new head of ND Secretariat, news from the last SC meeting

Unfortunately, due to the busy schedule Virginija Ambraavichiene, from the Lithuanian Ministry of health, could not manage to participate in EG meeting. She had sent draft minutes from the CSR meeting. Those minutes were presented by Zaza Tsereteli. He had informed the group members that during the last CSR meeting in Stockholm November 17th 2005, former Head of the NDPHS secretariat Mr. Lars Blad have announced his resignation. In the beginning of January 2006, the 2 vacancies and job descriptions for the Head of secretariat and senior advisor positions were published on the NDPHS website and were sent by email to all the NDPHS partners and other interested bodies. After the evaluation process of the received applications and some informal consultations, the Recruitment panel decided to shortlist for interview 2 applicants for the Head of the secretariat position and 3 - for the advisor position. All interviews took place at the Lithuanian Ministry of Health. Chairman informed that the Recruitment Panel has selected the following two candidates for the posts at the NDPHS secretariat: Mr. Marek Maciejowski from Poland for the position of the Head of Secretariat, and Ms. Assia Brandrup-Lukanow from Germany for the position of the Senior Advisor.

France has proposed to host the meeting of HIV/AIDS Expert group and CSR meeting later on. Germany considers to host CSR meeting next year. Among the other issues was discussed website and database. EG has decided to come to that issue later, within the special item on it in the agenda.

  1. Lithuanian Project Proposal for EU public Health Programme.

Saulius Chaplinskas and Pauli Leinikki had presented project proposal, which by request of the Lithuanian Ministry of Health was prepared in order to submit as an ND HIV/AIDS EG proposal for the EU Public Health program, for its possible financing. The proposal was drafted together with Zaza Tsereteli and several Lithuanian professionals and was preliminary distributed among the group members. The objective of this proposal is to collect international recommendations and guidelines for various parts of case management, evaluate their applicability for regional use and in some cases make initiatives for the development of new guidelines in areas not well covered. The project will also put an emphasis on the application of useful guidelines in the form of pilot training programmes and working seminars for professionals. For most of these issues internationally acknowledged guidelines and best practices exist, but their optimal implementation varies depending on the local situation, lack of resources. So the idea is to have a project that would produce a collection of such guidelines and an evaluation of their implementation including an analysis of the problems encountered in participating countries. The implementation of can be seen in following steps.

  • Collection of available guidelines and production of database-availability. Link to Northern Dimension Partnership database
  • Selected working groups assessing the usefulness of available guidelines for regional and national use.
  • Analysis of the overall situation by the group of NDP experts
  • Preparation of training modules: Possible target groups: Nurses, social workers, infectious disease doctors, decision makers. Etc

The end product of the project can be seen as some kind of evaluated tool kits which will be offered to the countries.

Jean-Elie Malkin underlined that the bases of that work needs to be WHO guidelines and final product would be then National Guidelines.

Marius Domeika mentioned that mostly WHO guidelines are very general, so idea can be to work on thier harmonisation in order to se the European added value.

Anna Marzec-Boguslawska underlined that in Poland issues regarding the guidelines are coordinated by National AIDS Society, which is a very independent Institution. So, itcan be little bit difficult to implement possible recommendations form that project into the Polish reality. Plus she asked to clarify if the end product of project will be just Lithuanian guideline, or that be more general one for all participant countries.

Marius Domeika explained that one possible solution for Poland can beusage of experince and methods implemented in Lithuania during that project, in order to carry out same kind of activites then back in their country.

Jean-Elie Malkin noticed that gudelines are just recommendations and that political will in order to make changes in health care services is also an important part of their implementation. That can help patients and people in need to improve their services and avoid waste of time and money.

Sualius Caplinskas presented 7 working packages which were ellaborated and are presented in the proposal. He had asked all participant to nominate possible institutions, which wil be inetersted to become an associated partners for the Lithuanian AIDS centre in that project.

Zaza Tsereteli emphasized that this proposal is seen as a joint Baltic proposal, which means that Estonian and Latvian Institutions needs to be actvely involved form the begining and that they need to be one of the main associated partners of the project.

Mika Salminen proposed that Workng package 2, whcih includes evaluation of national guideliness can be managed by EG. Group can be also responsible for overal monitoring the project implementation.

France, Svede, Finalnd and Estonia expressed their willingnes to participate in this project. It was agreed that all institutions and indiviuals will conatct Lithuanina AIDS Centre in order to fulfill al EU requirements and submitt proposal by May 19, which is the deadline.

  1. National priorities (tour-de-table)

Mika Salminen briefly described Epidemiological situation with HIV/AIDS in Finland. Finland is currently revising and establishing new country strategy on HIV/AIDS. In general situation has stabilized, but new cases are registered a.o. among immigrants and foreign nationalities. Most cases are registered among MSM. To get more precise data from this group, an anonymous study (postal survey and saliva analyzes) is currently carried out.

Kirsti Ruutel presented the situation in Estonia. Total number of reported HIV cases in Estonia is 5200. Most of the cases are still registered among the IDU’s. In some regions, especially at the border with Russia prevalence among IDUs is more than 90%. Estonia is now drafting a new strategy for 2006-2009, where the main priorities are IDUs, young people and PLWHA. The plan is to increase the number of needle exchange points (currently 30), people on substitution therapy (currently 400 persons on methadone) and enlarge possibilities for testing. In total 350 persons are on ARV treatment, and Estonia is working on establishment of case finding guidelines.

Marius Domeika informed the group on situation in Sweden. Main risk group is MSM, and most cases are registered among the immigrants. Some structural changes have taken part within the Ministry of Health, as 5 months ago the department of HIV and STI was reorganised, those issues will be covered by the Social Department within the Ministry. In total 150 Ml. Swedish croonersare allocated in the budget for HIV/AIDS activities.

The main priority for Latvia is implementation of ongoing National program on HIV/AIDS (2003-2008), and starting of preparation for new one. Andris Ferdats, reported that in total 3300 cases of HIV are registered in Latvia. The main trend is decreasing numbers of IDUs among the new cases. Special concern is the situation inprisons, as no clear information is available. Penitentiary authorities are also slow in implementing specific preventive activities. According the Infectiological Centre, 250 registered patients in Latviaare on ARV treatment.

Saulius Chaplinskas briefed on the situation in Lithuania. The total number of cases is 1100, from which 80% are among the IDUs. After well known outbreak in Alytus prison in 2003, prison authorities became more active in implementation of specific programs in prisons. National HIV/AIDS Program is approved by parliament, however the budget is not allocated yet and as a result implementation of concrete activities is delayed. In total 57 persons are on ARV treatment. Harm reduction activities are carried out by 9 centres in Lithuania. 300 persons are on maintenance therapy.

Jean-Ellie Malkin, make a general comment on treatment situation in Baltic countries, and expressed his concern regarding very low rate of people on treatment. The representatives form Baltic countries explained that as an outcome of unclear policy of treatment of IDUs, who are the main group of people in need of treatment. It was underlined by the EG thatall in need on medical grounds should get the treatment.

Anna Marzec-Boguslawska, presented situation in Poland. Since 1995 more then 10 000 HIV cases are registered in the country. The data is collected by National Institute of Hygiene. According to their statistics, 20% of new cases are registered in prisons, 37% of new cases are among MSM, 31% are infected by heterosexual contact and 10% among IDUs. The main age group (52%) of all cases is 20-29 years old people. In total 2680 persons are on ARV treatment. A pilot project on testing of pregnant women was carried out in cooperation with Mother and Child institute in Warsaw. In total 760pregnant women were tested on HIV, form which 6 were tested positive. Based on outcomes of that project, special program was elaborated and submitted to theNational Insurance Company in order to implement testing of pregnant women in all gynaecological institutions. Finally, she presented data from the regular moniotoring and centres for anonymous and free of charge testing, according to which 70% of Polish population has no information on their HIV status.

In France more then 110 000 HIV cases are registered. Within the last year an increase of cases has been observed among the immigrants from Sub-Saharan Africa. Heterosexual transmission is the leading mechanism for infections. 40 000 persons are on ARV treatment.

7. ECDC plans for HIV

Francoise Hamers, who has just been appointed as a focal point for HIV/AIDS at ECDC presented information on the ECDC plans for HIV/AIDS activities. According to EU Commission strategy to combat HIV in Europe (for 2006-2009) priority areas are the following: Leadership & advocacy; Involvement of civil society, Surveillance, Prevention of new HIV infections, Voluntary testing, treatment, care & support, HIV/AIDS research and Neighbourhood.

Based on that strategy ECDC has elaborated its own action areas, which among the many fields includes: Prevention of new infections,Treatment, care and support,Facilitating sentinel surveillance in high risk groups in countries with low-level epidemics, identifying possible practical problems related to data protection and circulation of data and facilitating Europe-wide surveillance on ARV resistance.

This action plan will be discussed with ECDC Advisory Forum and a parallel consultation with the European Commission. Then several meetings with national focal points will be arranged in order to review the situation and identify best practices and gaps. Finally European meeting will be held in autumn 2006 to decide on actions. In the meantime, launching of several activities under key action areas will be carried out in parallel.

Leinikki suggested that based on current development of epidemic in many European countries ECDC needs to look on possible outbreaks of HIV among the immigrant populations. He also proposed that the EG of NDPHS should be seen by ECDC as a channel to distribute their plans and ideas to the authorities in ND partner countries. It was agreed that close contacts between ECDC and ND EG will be established

  1. Possible sources of financing for HIV/AIDS projects

Anna Marzec-Boguslawska has presented project proposal which is prepared by Polish side for submission to the EU Public Health programme. The goal of proposal is strengthen of HIV prevention in Poland. The main activities of proposal are following: Cross border activities; research and analyses of best practices; activities within penitentiary system; preventive activities among youth and general population; work with local authorities and NGOs in order to strengthen their project management capacity. Approximate budget is 2 mln Euro. It was decided that proposal will be distributed among the group members, and then final version will be submitted, during the second call of proposals by EU.

  1. STAKES activities

Anneli Millen presented briefly the activities of STAKES(National Research and Development Centre for Welfare and Health) and International Development Collaboration at STAKES, as a host organization of the EG meeting.

International Development Collaboration at STAKES is a Finnish expert organization specializing in health and social sector development projects. Supporting development in social welfare and health, the unit plans, implements, monitors and evaluates development projects in transitional economies and developing countries. To this end, the unit provides expert services, such as technical assistance, training and other consulting services.

The top priority in many of the projects carried out by International Development Collaboration at STAKES is to improve the functioning of the target country's social welfare and health care system, programmes and funding systems. Staff training in the target country is also an essential part of project implementation.
Focus areas for the unit's projects include development of preventive health care and primary health care, prevention of communicable diseases and improvement of health and social welfare systems. In recent years, the focus has also been on HIV/AIDS, which has become a burning issue in social welfare and health care.

In the course of the last 15 years, the International Development Collaboration at STAKES has implemented over 100 projects in nearly 40 countries worldwide and has advised several national and international bodies on social and health policy.The unit's main focus areas include Finland's cross-border regions, the neighboring countries andRussia. Among developing countries, countries in sub-Saharan Africahave traditionally been at the centre of its activities. Central and Eastern Europeand Asian countries are also included in the unit's field of operations.