AFEW Works Towards Ending Tuberculosis in the EECA region

World Tuberculosis Day is being recognized on the 24th of March in the whole world. This annual event commemorates the date in 1882 when Dr. Robert Koch announced his discovery of Mycobacterium tuberculosis, the bacillus that causes TB.

The theme of World TB Day 2017 is “Unite to End TB.” AFEW International‘s activities are also aimed on ending tuberculosis in Eastern Europe and Central Asia. In Kazakhstan, KNCV and AFEW-Kazakhstan are developing a model for structural collaboration between public health (TB, HIV, primary health care) and non-public sector through the DGIS-funded project in Almaty. AFEW International is coordinating this project. In March of 2016, a stakeholders meeting was organised to establish a Stop TB Partnership for Kazakhstan. This partnership reflects a close collaboration between different stakeholders, patients form an important group, working in the field of TB and HIV. 31 participants from NGOs, public TB and HIV services, and representatives of the Stop TB partnership of the Republic of Tajikistan took part in the meeting. The representatives from Tajikistan presented the value, successes and challenges of such partnership.

Kazakhstan is one of the three countries selected to develop a model to strengthen engagement with non-public sector for improved quality of TB/HIV services. Almaty was chosen for the implementation of the model because it is the largest urban area in the country. The project supports the establishment of a network of NGOs that have the capacity to provide TB and HIV care to the most vulnerable populations, and build a partnership between public and non-public sectors to improve access to TB and HIV care by the development of a referral mechanism.

Roman Dudnik: “People with HIV and Tuberculosis are the Same as We Are”

A photo exhibition dedicated to the World Tuberculosis Day will be opened in Almaty, Kazakhstan on March 18. The purpose of this exhibition is to show that people living with HIV or tuberculosis are the same as everyone else. This exhibition is one of the first important public events held by AFEW-Kazakhstan in 2017. We are talking about this and discussing other plans for this year with the executive director of AIDS Foundation East-West in Kazakhstan, Roman Dudnik.

– How was the year of 2016 for you? What were the new and exciting things that happened?

– Even though the year of 2016 was difficult, it was successful for us. We moved to a different office. Before, we were in the small office building. Now we are in the new building with much more space. The repairs were made based on our requirements, using our colours. There is a very good energy here, and it helps to work good.
In 2016 we finished the first part of the project HIV React that is financed by USAID/Central Asia, and we got the extension for the next three years. This is our main project. It is regional: we work in Kazakhstan, Kyrgyzstan and Tajikistan. Being the part of this project, we are working in preventing HIV among injecting drug users in prisons. We also work with people living with HIV who are getting ready to be released, and those who are already released. With specially developed START plus program, we prepare a person for his release two months before it happens, and then continue to work with a person for another four months after the release. Additionally, we train medical and non-medical staff of correctional facilities and employees of non-governmental organizations. This program is unique and does not work in many countries of the world. All efforts are aimed at preventing HIV infection and supporting those who live with HIV. The main goal, of course, is to encourage a person to get tested for HIV. If the test is positive, then we send a person to the AIDS centre, and we motivate him to start treatment with antiretroviral medicine, if necessary. We also help to restore needed documents, find jobs, renew social connections. This program is unique because it has a human face. We are aimed at a specific person, at solving of his or her problems. We also try to form skills so that people can solve their problems in the future themselves.

– Working in three countries in Central Asia with the same groups of population in HIV React project, can you observe the common tendencies?

– The general trends in all three countries are that HIV in places of detention exists, and the number of new cases of HIV transmission is increasing. Convicts is the group that requires intense attention and constant work. There is a very high level of stigma from prison staff. Of course, the reason for this is a lack of information, and this is what we are trying to correct through the trainings. The most successful project is implemented in Kyrgyzstan, where the criminal executive system is more open and sympathetic to such activities. In Kazakhstan and Tajikistan it is a little more difficult, but despite this, we manage to work and implement all planned activities within the framework of the project.

– Besides this, what were other projects that you worked on in 2016? 

– Since January we started with the new City Health project with the financial support of the Global Fund, where the main grant recipient is the International Charitable Foundation “Alliance for Public Health”. The project works in five cities of the EECA region. We are responsible for work in Almaty. Implementing this project, we will involve the city administration in the prevention of HIV infection among vulnerable groups: injecting drug users, men who have sex with men, and sex workers. We plan to create a city council on HIV/AIDS. We know that the project is not simple, but it is interesting for us. For Almaty, the project is very important, since it is the most populated city in the country, and the problem of HIV infection is especially relevant here. It will be important for us to make this a successful model and to duplicate this experience to other cities and countries.

– A year ago you had a school of tolerance, the goal of which was to reduce stigma on the part of health care providers. Please, tell us if you can see the results of this school?

– It is difficult and too early to talk about the results. Stigma and discrimination are big problems for Kazakhstan and whole Central Asia, and this is one of our main areas of work. One school of tolerance cannot solve this issue. Without any doubt, there is a big difference in how people come to the training, and what they think after three or five days of the training. In our training, we focus on the personal qualities of a person, perform the situations when the participant himself acts as a client or the representative of a vulnerable group, and is experiencing everything what the client is experiencing by himself. Human intolerance was formed long ago, and one year of work cannot change it. Nevertheless, there is already some progress in this field.

– On the 18th of March you will have the photo exhibition dedicated to the World Tuberculosis Day. Please, tell us more about it.

– The exhibition is intersecting with the topic of stigma and discrimination. We invite everybody to come and see it. It will be held from 18 to 31 of March in the gallery June 24. During the exhibition, there will be master classes, lectures, and talks with people who are depicted on the photos. On the photos, there are 15 Kazakhstani people who live with HIV, or who were cured of tuberculosis. The name of the exhibition Life in the Shadow speaks for itself, because due to the human ignorance, the heroes of our photos should hide their diagnosis from others and live with their problem alone in fear. Now they have opened their faces for the exhibition and they are not afraid to share their experiences. By each photo, there is a written piece with the story of the person: what he was going through, what he was thinking about. The purpose of the exhibition is to shed light on everyday life of people affected by HIV and tuberculosis. They are just like us. The only difference is that they know their diagnosis and they have to fight for their health. Myths and prejudices about HIV and tuberculosis make them hide this part of their lives. Although, the understanding and support of others is what helps them to defeat the disease. The exhibition is positive; people are smiling on the photos. We made only colour photos that show people in everyday life: in the flower shop, in the metro, during painting. During the exhibition, we will tell the visitors about HIV and tuberculosis, tolerance. We will also distribute flyers with the information about where you can bring, for example, bags with clothes that are no longer needed and help people who live with HIV in such a way.

– Even though it is almost the end of the first quarter of 2017, I still would like to ask you about the plans of AFEW-Kazakhstan for this year.

– We plan to work with our projects further. In April, we will be having big regional training about gender violence. We already invited a very good professional in this field to be our trainer. This is a new topic for us, and everything new is interesting for us.

Looking for the Consultant for the Cities TB/HIV Regional Project

LogoAFEW3Consultant for the development of a situation assessment tool in the framework of the Cities TB/HIV Regional project, funded by the Global Fund

It is well known, that the HIV/AIDS epidemic in Eastern Europe and Central-Asia is still driven by most affected key populations, which are concentrated in urban areas. On average, the share of representatives of key population among all PLHA is assumed to be up to 70 percent, while the majority of them are PWID (about 80% of all HIV-infected representatives of key populations). Despite the paramount role of key populations in the development of HIV epidemics in the region, reaching them with key services remains low. The overall coverage of essential HIV prevention services of PWID, sex workers (SW) and men having sex with men (MSM) in Bulgaria, Georgia, Kazakhstan, Moldova, and Ukraine is around 40% (at the level of 50% for PWID and SWs and 16% for MSM).

City level data reveals that from about 18,000 PLHA 5,665 are receiving ART, which corresponds with 20% coverage in Almaty, 22% in Beltsi, 29% in Odesa, 54% in Sofia and 82% in Tbilisi. Given the overall low access to ART, access of key populations is assumed to be even lower, but data is largely unavailable. Out of 5 project cities only Almaty and Odesa could provide disaggregated data on ART access by key population.  Similarly, the results of TB and MDR treatment in the 5 project targeted cities are poor, with low treatment success even for new TB cases and relapses, not reaching the targeted 90% (highest in Almaty – 85.4%, lowest in Odessa – 54.2%), while the MDR TB treatment outcome is even worse, from extremely low in Odesa (47.5%) to 69.9% in Almaty.

Three main areas of programmatic/other gaps have been identified as handles for strategy development and interventions in the proposed regional project for selected cities:

  • Programmatic and data gaps: reaching key populations, HIV and TB treatment cascade gaps; low treatment efficiency and effectiveness, increase of MR-TB and repeated treatment cases; slow transition to the patient-oriented model of health care delivery and to out-patient ambulatory care; weak integration between HIV and TB services; gaps in essential city level data.
  • Political, governance, partnership gaps: lack of political will to address health issues in key populations and promote human rights and access to services by these key groups.
  • Financial gaps: sustainability of the HIV/TB responses is a major threat to programs for key populations in EECA.

Aims and objectives of the Cities TB/HIV Regional project

The goal of the project is to develop models of sustainable city responses to HIV and TB in key populations in EECA that significantly contribute to achieving 90-90-90 HIV/TB targets for key populations. The goal is supported by the following four objectives:

  1. Development and implementation of a model for key populations for the ’90-90-90’ targets of the HIV and TB response in selected cities of the EECA region.
  2. Establishing effective partnerships between municipalities and NGOs/CSOs in selected EECA cities.
  3. Ensuring sustainable allocations of municipal funding for key population programs in project cities.
  4. To increase knowledge management and popularize city responses on HIV and TB in cities of the EECA region and globally.

Project will be implemented in 5 cities in 5 countries: Almaty (Kazakhstan), Beltsi (Moldova), Odesa (Ukraine), Sofia (Bulgaria) and Tbilisi (Georgia).

The project is implemented by the Alliance for Public Health (APH) as lead agency, together with AFEW International and Licit.

One of the planned activities is:

Situation Assessment tool development and training on its use

At the beginning of the project, a needs or situation assessment will be carried out in 5 project cities aiming at identifying particular HIV/TB key populations needs, services, data gaps, barriers to access and sustainability of services resourcing.

Terms of Reference:

Job Location:

  • In Europe, Eastern Europe and Central-Asia

Period and duration:

  • Starting date 13 March 2017
  • A first outline of the tool should be ready by 30 March 2017
  • Provide an update of data every 1 week
  • The final version of the tool should be ready by mid-April 2017
  • A training in how to use the assessment tool in the second part of April 2017
  • A workload of 20 working days is expected

Overall Job Objective:

The development of instruments for the assessment with broad consultations with the project partnership and a training provided to implementers on how to use it. Specifically, the assessment addresses improvements in city data systems, availability of population size estimates and their mapping, improvements in city cascade information, HIV, TB, prevention, treatment, health and social integration, human rights of key populations, legal issues, city and country drug policy, accessibility to existing services, existing coordinating bodies and city governance, role and practice of law enforcement, attitudes of media, programs and their resourcing and potential areas for cost optimization.

Description of core responsibilities and tasks:

– collect information and results from assessments done by ECUO’s regional EECA project looking at challenges in transitioning from one stage of cascade to the other
– collect information and results from the situation assessment methodologies on the combinations of services available and the level of funding for interventions within the EHRN regional project
– identify relevant sources for HIV and TB data at national and city level
– consult with the project partners about the relevant topics, the sources and how to do the assessment
–  identify software to be used for mapping the data
– write a comprehensive tool to conduct the assessment
– train contact persons on how to use the assessment tool

Requirements

– Epidemiology and/or research background at university level
– Knowledge about HIV and TB in Eastern Europe and Central-Asia
– Familiar with the governmental and non-governmental landscape in EECA
– Speaking and writing in English and Russian

Contacts/Key Relationships:

–            Project partners
–            AFEW International for reporting and updating

Please, send your application to Anke van Dam’s email: anke_van_dam@AFEW.nl. The deadline is 15 March.

The Union demands that TB be included in the WHO list of bacteria for which new antibiotics urgently needed

social-shareToday, 28 February, International Union Against Tuberculosis and Lung Desease stated that it is unacceptable that tuberculosis (TB) was excluded from the World Health Organization’s (WHO) published list of antibiotic-resistant ‘priority pathogens’, released yesterday.

The Union further added that the WHO must revise the list to include TB – the world’s leading infectious disease killer – with immediate effect and called upon the international community to support demands that TB be included in the catalogue of bacteria posing the greatest threat to human health – and for which new antibiotics are urgently needed.

The bacteria that cause TB kill more people than any other infectious pathogen. Latest WHO figures state that in 2015, 1.8 million people died, including 210,000 children. An estimated 580,000 people were reported to have drug resistant versions of TB – both multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) – while actual numbers affected could be even higher.

The only way of treating TB is with antibiotics. Current treatments for resistant forms of TB are arduous and are accompanied by side effects that include deafness and psychosis, as well as practical difficulties for families, communities, health systems and livelihoods.

TB R&D has been systematically underfunded during the previous decade. The current spending of $620 million on all TB R&D (vaccines, diagnostics and treatment) is only one third of the $2 billion annual funding target outlined in the 2011–2015 WHO Global Plan. Funding in TB drug R&D is only 28% of the $810 million called for in the Global Plan to End TB 2016-2020. This is counter to the global aim of accelerating progress against TB in order to reach the ‘End TB Strategy’ by 2030.

“It is outrageous to sideline TB from global antimicrobial resistance (AMR) efforts. The Union strongly urges WHO to include TB on its list of priority pathogens. Among the group of antimicrobial-resistant diseases, drug-resistant TB is a leading cause of sickness and death.

Failing to include TB on its list was a dramatic departure from the data, and it undermines efforts to find the new and better treatments that patients desperately need. This is particularly critical for those countries where drug-resistant TB is epidemic,” said José Luis Castro, Executive Director, The Union.

“As G20 leaders are set to meet and discuss an agenda for tackling antimicrobial resistance, The Union strongly urges them to follow the data. They should include TB in any G20 initiatives aimed at increasing R&D investments and piloting models to deliver new medicines used to treat antimicrobial-resistant disease,” said Dr Jeremiah Chakaya Muhwa, President of The Union.

Source: The Union

AIDS Foundation East-West becomes AFEW International

ImprimirAIDS Foundation East-West, an international network of civil society organisations that is dedicated to improving the health of key populations, has changed its name to AFEW International.

A new logo and communication strategy have been created, and now they are part of the organisation’s identity. “With this new name we keep the recognisability and our brand as many partners in the field already know us,” says the executive director of AFEW International Anke van Dam. “With the new name we also acknowledge that we do more than HIV and AIDS. AFEW has built a track record for projects on TB, viral hepatitis and sexual and reproductive health and rights as well. AFEW strives to social inclusion of the key populations at risk and a healthy future of Eastern Europe and Central Asia!”

AFEW is dedicated to improving the health of key populations in society. With a focus on Eastern Europe and Central Asia, AFEW strives to promote health and increase access to prevention, treatment and care for major public health concerns such as HIV, TB, viral hepatitis, and sexual and reproductive health.

AFEW International is an uniquely positioned organisation as one of the few HIV, TB, hepatitis and sexual and reproductive health and rights organisations working in Eastern Europe and Central Asia. This is a region where the work is critical, as HIV and sexually transmitted infections are on the rise, sexuality education is deficient and gender-based violence goes largely unrecognized. Further, cases of multidrug resistant and extensive drug resistant tuberculosis are increasing; and there is a very high prevalence of hepatitis C. The group with the highest risk for HIV and HIV related diseases are people who use drugs. However, transmission through sexual contact is increasing and the prevalence among women and men who have sex with men is increasing.

U.S. Government Introduces New Drug to Help Save Lives of TB Patients in Tajikistan

IMG_1729

Source: Asia-Plus

Acting Deputy Chief of Mission of the United States to Tajikistan Lucy Jilka on January, 31 joined the First Deputy Minister of Health and Social Protection of Population of Tajikistan Saida Umarzoda, national health leadership, physicians, TB doctors, and stakeholders to celebrate the introduction of bedaquiline to Tajikistan. This is the first new drug approved for the treatment of tuberculosis (TB) since the 1960s.

According to the U.S. Embassy in Dushanbe, U.S. company Janssen Pharmaceuticals, a subsidiary of Johnson & Johnson, created bedaquiline to treat drug-resistant tuberculosis and protect public health. Janssen is donating 30,000 courses of this life-saving new TB drug to qualified countries.  The United States, through USAID’s Office of Global Health, is partnering with Janssen to introduce bedaquiline in Tajikistan.

Tajikistan is on the list of countries with a high prevalence of multi-drug resistant TB, and has growing numbers of patients with extensively drug-resistant TB, for which there was no effective treatment available within the country.  Bedaquiline, also called by its brand name Sirturo, offers a better chance to cure patients with these forms of TB and will help reduce the transmission of drug-resistant tuberculosis in the community.

USAID is leading the free distribution of this lifesaving medication through its Bedaquiline Donation Program in collaboration with Tajikistan’s Republican Center for TB Control, the Ministry of Health and Social Protection of Population, and other partners to introduce the new drug, build capacity to expand treatment, and pilot new shorter treatment options for drug-resistant tuberculosis.  A key international partner in these efforts is the Challenge TB Project, which is implemented by the Dutch TB Foundation, KNCV.

IMG_1744

Source: Asia-Plus

Bedaquiline received accelerated approval for use in the United States in December 2012, and it is used to treat Americans with drug-resistant TB.  In Tajikistan, per World Health Organization recommendations, fifty patients were initially enrolled in treatment courses containing bedaquiline, with one hundred and fifty more to begin treatment during 2017. The progress of treatment will be monitored by trained specialists at designated treatment centers.

The Challenge TB Project is one of the many assistance projects made possible by the American people through USAID. Over the last 25 years, the U.S. Embassy in Dushanbe has provided more than $1.8 billion in programs that support Tajikistan’s security, democratic institutions, social sector, and economic growth.  In February, Tajikistan and America will celebrate 25 years of diplomatic relations.

Source: Asia-Plus 

Today We Celebrate 15 Years of AFEW!

15yearsafew_logo_proposal2Dear AFEW supporters and partners!

Today is a very important day for AFEW International. We are honouring World AIDS Day 2016, and also celebrating the 15th anniversary of our organisation. We are very grateful that we have spent these wonderful 15 years with your support and appreciation, and we would like to thank you for this!

We know that 15 years of our work would be not possible without you. We understand that together with you we are working towards a healthy future of our region. We realize the potential and current issues of Eastern Europe and Central Asia, and we are confident that we will be able to overcome them together with you. Thank you for being with us throughout our successes and challenges!

Having a leading position with expertise in HIV, TB and other related public health concerns in Eastern Europe and Central-Asia, AFEW will continue fighting stigma and discrimination, upholding the human rights, and improving the access to and quality of health services for key populations at risk for HIV, TB and viral hepatitis. This is still so much needed as the region where we work is still experiencing HIV growth, faces increased incidence of MDR-TB and has a high prevalence of Hepatitis C. Our activities help to change the future of the region and contribute to a healthy and comfortable life of people!

Thank you for being with us!

Happy World AIDS day and happy AFEW anniversary!

Sincerely,

AFEW International

AFEW Director is the Chair of TB/HIV Working Group

ankeAFEW executive director Anke van Dam became the chair of Wolfheze Working Group on TB/HIV collaborative activities. The group will document and promote the best models and identify research priorities of integrated TB/HIV care in the European region. Members of the group will also identify barriers in TB/HIV services and collaboration.

“I am very honoured to be part of the group,” – Anke says. – “AFEW is implementing integrated HIV/TB activities in the EECA region for quite some years now. I will bring this experience into the group, and hope to contribute to collecting best models. There is still so much to gain in improving the care and health of people living with both HIV and TB.”

Wolfheze TB/HIV Working Group started a year ago in The Hague, The Netherlands. There, Wolfheze and WHO National TB Programme Managers’ meeting participants discussed the need for strengthening TB/HIV collaborative activities in the context of the WHO End TB Strategy. They agreed to create a Working Group on TB/HIV collaborative activities taking into account specific challenges and opportunities in the WHO European region.

AFEW Cooperates in Co-infection Prevention and Harm Reduction EU project

HA-REACT-logoAFEW became the collaborative partner of the Joint Action on HIV and Co-infection Prevention and Harm Reduction (HA-REACT) that addresses existing gaps in the prevention of HIV and other co-infections, especially tuberculosis and viral hepatitis, among people who inject drugs. This three-year project was launched in late 2015 with core funding from the European Union, and is being implemented by 23 partners in 18 EU Member States. Twelve collaborating partners are contributing additional expertise, among them the European Centre for Disease Prevention and Control and the European Monitoring Centre for Drugs and Drug Addiction.

“Collaboration with HA-REACT is important for AFEW because we would like to explore how we can use the tools developed by HA-REACT for countries in our EECA region,” – AFEW executive director Anke van Dam says.

HA-REACT focuses particularly on the EU member states where there are obvious gaps in effective and evidence-informed interventions, or where such interventions are not being implemented at a sufficient level. HA-REACT also encourages the implementation of comprehensive harm reduction programmes at sufficient scale in all EU member states as an essential strategy for improving the prevention and treatment of HIV, TB and viral hepatitis.

Community-based research: the key population small grants fund AIDS2018

FB AIDS 2018 coverAs the HIV epidemic continues to grow in Eastern Europe and Central Asia, new, more relevant, interventions are needed to address this public health concern. Before such interventions can be implemented, the needs of certain communities at higher risk for HIV, TB and Viral Hepatitis need to be understood. Involving members of key population communities in research gives an opportunity to identify needs that are currently not being met. Community based research captures the actual situation on the ground more clearly and such research can be used as a powerful advocacy tool. By equipping community based organisations and community members with the tools to conduct research and collect data, research capacity will increase, and research results will reflect an inside perspective on needs and priorities.

Fund for community based research

Towards the end of 2016, AIDS Foundation East-West (AFEW) will release a call for proposals for community-based organizations to conduct research to benefit key populations living in Eastern Europe and Central Asia (EECA). The proposals will be assessed by a steering committee. Activities proposed by grantees must contribute knowledge to improving the health of key population groups in EECA. The grantee must be a legally recognized community-based organization registered and operating in EECA. All awarded projects should be completed within 9 months.

Training and Guidance

Training and guidance on how to conduct the community-based research, write abstracts, and present and disseminate findings, will be provided to the grantees. We will be looking for participants with a keen interest, some experience, and familiarity with community based research. A first training, Tools for Change: conducting community based research, is being planned for October/November 2016, followed by a call for proposals, selection, and grant awards.

Monitoring

The awarded research projects will receive guidance and support from the AIDS2018 project team, with some logistical support provided by the AFEW secretariat.  The research report and other relevant materials will be shared via the websites of relevant parties (AFEW, GNP+, EHRN, and others), in other briefings, newsletters, and at meetings and workshops. We anticipate that you submit an abstract to AIDS2018, with the aim of presenting a poster, or an oral presentation.

If you would like to know more about, or be considered for, this unique opportunity to gather knowledge and raise the voice of key populations in research, and at AIDS2018, send us an email at research@AFEW.nl. We will send you the application form on request. Please feel free to get in touch with us with questions or remarks. AFEW is looking forward to implementing this project, with and for you!