EG on HIV/AIDS and Associated Infections
Third Meeting
Kaliningrad, Russia
October 6-7, 2011
Reference / HIV/AIDS&AI 3Title / Minutes of the meeting
Submitted by / HIV/AIDS EG ITA
Annexes / Annex 1 - Proposal on revision of Goals 2 and 3 of the NDPHS strategy
Annex 2 - List of participants
Annex 3 - List of documents
Annex 4 - Revised work plan 2012
Summary / Note / For comments
1. Opening of the meeting
EG Chair opened the meeting, and Dr. Nikolay Cherkes, Chief Physician of the Kaliningrad Regional AIDS Centre, welcomed the participants to Kaliningrad.
NDPHS Secretariat told regards from the Russian chairmanship of NDPHS and Ms Yulia Bakonina who wished success for our meeting. The meeting was co-sponsored by Russia and EU.
2. Adoption of the agenda
The agenda was adopted.
Dr. Inga Upmace remarked that in the future, if we wish to describe developments also concerning associated infections (tuberculosis, hepatitis and syphilis), as well as HIV development - then 15 minutes reporting time per country will not be enough.
3. Presentation on latest developments of the HIV and TB situation in the Kaliningrad Region
Presentation was given by the Head Physician of the Kaliningrad Regional AIDS Centre. Dr. Cherkes concentrated in latest trends.
HIV incidence in the Kaliningrad Region is now close to Russian average - 43 per 100,000 in 2010 (average 41,3).
During 2011, ways of HIV transmission were the following:
- 67,5% through sexual contact
- 31,1% IDU
- 1.3% perinatal
Not even one MSM case has been detected during this year, probably due to stigma. This year a project among MSM will be started together with St. Petersburg.
Compared with 2010, new HIV cases have increased this year. The biggest amount of the new cases have been detected when tests have been carried out due to clinical symptoms (code 113; 33%). The second largest group is other examinations, meaning individuals who have presented themselves for testing (code 118; 26%). Drug users make 15% of the new cases.
Approximately 12% of the whole population is tested on HIV each year. The infection has already spread among general population; and it is no more connected with unemployment - there are 40 different professions among infected people.
The epidemic is "getting older", as only 3,7% of new cases are detected among youth under 20 years old and more than 10% among people over 50. The share of women is increasing (47%).
During 2011, six cases of MTCT have been detected when 60 HIV-infected mothers gave birth. These six infants got the infection due to the fact that their mothers did not visit health care services during pregnancy (due to alcohol, drug use etc.). Full course of prophylactic treatment is given to 90% of pregnant HIV+ women.
Mortality both among HIV-infected and those in the AIDS phase has decreased. This year 133 HIV-infected people have died, while during the last year by this period, the number was 170. Approx. 50% of deaths among HIV+ are connected with overdose, suicide, alcohol etc.
Tuberculosis
TB morbidity is continuously higher in the Kaliningrad Region than in Russia in average. Nevertheless, TB mortality is lower here. During 2011, 43 people have died of co-infection of HIV+TB.
There is some decrease concerning HIV-infected who caught tuberculosis: 2324 per 100,000 HIV-infected in 2010 compared with 3014 in 2008. Active case-finding of TB among HIV-infected has increased; fewer co-infections are found when patients actively seek medical care. TB is now detected at a later phase than earlier.
In 2010, HIV-positive people who have been diagnosed with a new case of TB came mostly from the following groups: alcoholics, homeless or prisoners.
During this year already 1975 HIV-positive people have been screened on TB with the result of 19 detected cases. In the register of the dispensary there are now 373 patients with co-infection of HIV and TB. Among bacteriologically confirmed TB cases, 64% are drug-resistent (from these 5,3% XDR).
Adherence is a big problem especially among asocial groups. This year already 125 patients have interrupted ARV treatment. At the moment 1400 patients receive ARV treatment.
HIV prevention gets hardly any financing. Most of the preventive activities concentrate on the World AIDS day (1 December).
Collaboration with NGOs is going well in Kaliningrad. Anyhow, when financing for low-threshold services was finished, the AIDS centre was forced to ask the NGO to move out from their premises. Improvement for this situation is foreseen in the frames of the future EU project.
4. Presentation of the results of the Porvoo meeting in June. Continuation of the analysis of objectives of the Expert Group
EG Chair presented the results of the informal small-group meeting organized in June 13-14 in Porvoo, Finland. The meeting was organized as a modified Logical Framework Approach workshop; and the first draft of problem tree was distributed to the participants before this meeting.
The essential questions are: what do we expect from ourselves in the future? What is expected by others from us? We do have NDPHS goals and operative targets, but we need also our own long-term plan.
In the previous EG meeting in Riga, it was mentioned that the process of preparing the Barents HIV/AIDS Programme could be used as a model. It was a kind of extended Logical Framework Approach process, based on interviews of all relevant stakeholders in the Barents Region. The interviews were done by Dr. Zaza Tsereteli, and the planning process was guided by Ali Arsalo. The interview results were analysed and combined into a draft problem tree. This was followed by a big seminar/workshop in Petrozavodsk, to collect comments to the problem tree and to define objectives. After the workshop another round of interviews was carried out to finalise the analysis of problems and objectives. As the result, 6 working areas, which should be tackled with projects, were defined as the core of the Barents HIV/AIDS Programme. In the Riga meeting this model was seen as an interesting example to be applied in our Expert Group.
The planning process was started at the Porvoo meeting, and now it can be continued. After this meeting the next version of the problem tree will be distributed to the participants; and country representatives will be asked to collect comments and input from other experts in their own countries. If the EG will get financing to organize a NGO forum in 2012, it can also be used as a tool to collect more information from a wider range of stakeholders into the analysis.
A vivid discussion followed concerning contents of the problem tree. The following additions were proposed:
o Success of drug policy is essential; we should speak generally about drug policy, before speaking of harm reduction
o We don’t have evidence-based prevention programmes. If we wish to change any policy we have to prove that some method or programme works. Russian decision makers wish to have Russian research results before they believe in any methods or programmes.
o Bridging populations are missing from the table – they need more attention, partners of IDUs and others
o According to the analysis by NGO Stellit, 85% of research done in Russia, has not been published in Russia
o There is a good model how to involve MSM for testing – can it be replicated in other places? Will results of studies carried out in some other place be accepted in another place?
o Gay-friendly services needed or “men-friendly"
o There are many reports by ECDC – what works among which group. But if it is needed to be done in Russia to be credible in Russia, then it should be done there. Russian studies are needed to convince Russian decision makers.
o Some methods are more simply international, e.g. skills building on condom use. Of course the message should be culturally appropriate, but technical instructions on condom use are general.
o International standards should be applied in prevention activities.
o Combined methods are needed to stop the epidemic. Structures of the society need to be taken into account, and possibly even changed. Social aspects are important.
o Practical-minded research is necessary. E. g. more understanding is needed about post-exposure prophylaxis (PEP).
o Co-infection of HIV+TB is increasing. The need for early case finding of TB especially among HIV+
o Drug-resistant tuberculosis, especially MDR-tuberculosis is increasing
o TB infection control in settings for HIV services is extremely important
o Quality of counselling services varies quite a lot within countries and between countries. Counsellors need to be trained in methods known to work. Training of counsellors. Insufficient use of evidence-based methods in counselling.
o GPs should start small-scale counselling (in some countries GPs are involved already.)
o Strengthening of the operational research is needed in order to improve quality of service provision
o Monitoring and evaluation of programmes is necessary
o There is too little focus on prevention among HIV-positives
o integrating HIV surveillance with STI surveillance is necessary, as well as with TB surveillance
This analytical process will produce a group-level strategy which partly responds to the NDPHS strategy but goes further than that. The group strategy will, among other things, give guidelines for our annual planning.
Revision of NDPHS Operational Targets
The Expert Group proposes some changes into Operational Targets and their indicators under the Goal 2 of the NDPHS strategy (see document HIV/AIDS&AI 3/4/1). After discussion some more revisions were proposed - see Annex 1 of the Minutes.
It was remarked that often policy recommendations and best practices can be the same thing. Marek Maciejowski replied that projects may produce policy recommendations and also our Expert Group can produce own policy recommendations, e.g. in form of thematic report. In a way the Group strategy which will be prepared in LF form, can be seen as a general policy recommendation that calls for further actions.
5. Information from the NDPHS Secretariat
Marek Maciejowski informed the participants about latest news concerning NDPHS:
· As most of the EU financing programmes do not mention health and social sector projects as any of their priorities, NDPHS has prepared a position paper on raising the profile of health and social well being in the period 2014-2020. The position paper will be presented for endorsement to the Committee of Senior Representatives meeting in the end of the month, and then submitted to Partnership Annual Conference for adoption. (See http://www.ndphs.org/?mtgs,csr_19__brussels document CSR 19/10.2/1.) Lobbying activities will commence thereafter.
· New financial possibilities in 2011-2012
o European Commission’s technical assistance for the EUSBSR implementation (DG Regio)
§ EUR 28,600 has been admitted for the HIV/AIDS&AI EG (consultant, travel, meetings)
§ ACTIVITY #1: Organization of a Logical Framework Approach (LFA) workshop and subsequent project planning meetings to elaborate projects to implement the above named cooperative action in the EUSBSR Action Plan.
§ ACTIVITY #2: Preparation of a review on best practices of integration of social and health care for HIV-infected individuals.
o New funding from the ENPI Regional East Indicative Programme 2010-2013
§ In 2011, the NDPHS received 100,000 EUR (among others this meeting got support from these funds).
§ In 2012, there might be available even 300,000 EUR (at least 100,000) for the NDPHS. The Secretariat invited the EGs to discuss how they would like to utilize this funding in 2012. The EG and TG leaders are asked to send their draft proposals to the Secretariat by mid-November, before the PAC. The Secretariat aims to have a final proposal in early January, so that the funds can be used starting with the meetings in spring 2012. It is important that the funding will be used for activities in line with the NDPHS Strategy.
o (i) Cooperation between the NDPHS and the Baltic Sea Network ESF and (ii) between the NDPHS and the ENPI CBC Karelia Programme
(i) There is a framework (albeit not fully developed yet) in the ESF, for transnational cooperation, and the EUSBSR could be a platform for cooperation between the NDPHS and the ESF network. Furthermore, it also provides an opportunity to reinforce the social dimension in the work of the NDPHS, which has been a goal for the Partnership. The Secretariat further suggested that, if there is general agreement, the EGs could participate in drafting the calls for the ESF proposals, which is in line with the position paper currently being developed by the NDPHS, which sets out the aim to influence funding decisions in this region.
(ii) There will be 6 calls for proposals, including a call in 2012 on Balanced Social and Economic Wellbeing, which is the particular area in which they would like to cooperate with the NDPHS in designing the objectives and indicators. The first stage of the selection process is the competition of ideas. In the second stage, the best ideas will be invited to submit full proposals.
· Request from EUSBSR to propose some indicators under the Baltic Sea Region strategy, e.g. concerning action: Health: “Contain the spread of HIV/AIDS and tuberculosis” through partnerships and international collaboration in prompt and quality care for all, focusing on Tuberculosis / HIV co-infection and ensuring early diagnosis of HIV infections, providing access to treatment and strengthening interventions to reduce vulnerability especially for Injecting Drug Users (IDU), prisoners, etc.
§ 1-2 targets and indicators should be proposed per thematic area by the end of this year – probably more like overall objectives or high-level indicators.
After brief discussion it was agreed that indicators will be discussed with Dr. Mika Salminen to see if some of UNGASS or other international indicators could be chosen. In the Finnish-Russian project on HIV and TB, a set of indicators were prepared after thorough discussions - some of these could be of use, too.
· Partnership Annual Conference and a side-event focusing on non-communicable diseases and alcohol will be organized in St. Petersburg on 24-25 November.
· Other issues
· Contributions to e-Newsletter
o The HIV/AIDS&AI EG is proposed to submit an article concerning the new EU project in Kaliningrad. Dead-line is mid-November.