1Arsen Kubataev, MD, MBA, Regional Director, Russian FederationAmerican International Health Alliance, August 3, 2008

XII International AIDS Conference Mexico City, 3-8 August 2008

Satellite Session: Building Capacities in HIV/AIDS - The Concept of Knowledge Hubs

Experiences from HIV/AIDS Care and Treatment Knowledge Hub in Eastern Europe

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HIV/AIDS Capacity Building NeedsBackground

Effective methods for both HIV/AIDS prevention and treatment available to respond to the challenge

Funding for treatment and prevention increased from international and national sources (The Global Fund To Fight AIDS, TB and

Malaria, National Governments)

High level political commitments made by governments and international organizations to put the epidemic under control

Pressure increased to deliver interventions to fight HIV epidemic at a scale never previously experienced

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HIV Infection, newly diagnosed Europe, 1996 – 2007*

-

20,000

40,000

60,000

80,000

100,000

120,000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

West Central East

* Data from WHO/EURO http://data.euro.who.int

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HIV Infection, newly diagnosed Europe, 1996 – 2007*

-

20,000

40,000

60,000

80,000

100,000

120,000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

West Central East

* Data from WHO/EURO http://data.euro.who.int

Russia

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ARV treatment needs and coverage Eastern Europe and Central Asia*

* Data from UNAIDS factsheets reports, 2005, 2006, 2007 and www.globalhealthreporting.org

Year Need ARV Treatment on ART

2003 n/a <1,000

2004 n/a ~9,000

2005 160,000 21,000

2006 190,000 24,000

2007 295,300 39,500

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HIV/AIDS Capacity Building NeedsBackground

Challenges:

Care providers with limited experience with new methods of HIV prevention and treatment

Health systems need to adapt as new care models develop in countries to accomplish scale up of treatment and care Local expertise in HIV/AIDS program development and management is scarce New flexible mechanisms to utilize increasingly available funding

are lacking

System for continuous/postgraduate education lags behind the urgent needs to develop cadre and build treatment capacity

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HIV/AIDS Knowledge HubsBackground

In 2003 WHO EURO and GTZ BACKUP Initiative announced launch of three Regional Knowledge Hubs for Eastern Europe and Central Asia:

Goal: Develop regional framework and affiliated national training and technical assistance capacity to help ensure availability of high quality, sustainable HIV/AIDS programs throughout Eastern Europe and Central Asia, and support affiliated centres

HIV Surveillance and Monitoring/Evaluation HIV Prevention/Harm Reduction HIV/AIDS Care and Treatment

Tasks: Training and Training Capacity Development Direct Technical Assistance Networking Adaptation of Tools and Guidelines

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Regional Knowledge Hub for Capacity Building in HIV

Surveillance

HIV/AIDS Knowledge Hub NetworkImplementing Organizations

Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia

American International Health Alliance

Eurasian Harm Reduction Knowledge Hub

Andrija Stampar School of Public Health , Zagreb, Croatia

Eastern European Harm Reduction Network, Vilnus,

Lithuania

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HIV/AIDS Treatment and Care Knowledge HubAmerican International Health Alliance (AIHA)

Start-up and operational support provided by WHO EURO and German Technical Cooperation (GTZ – BACKUP Initiative); AIHA course materials development and adaptation supported by WHO, USAID and other strategic partners

Ukrainian Knowledge Hub: Established in January 2004 through memorandum of understanding with the Ukrainian Ministry of Health, National AIDS Centre and National Medical Academy for Post Graduate Education (NMAPE)

Russian Knowledge Hub: Established in July 2006, the AIDS Training and Education Center in St. Petersburg (ATEC), based at St. Petersburg Medical Academy for Post Graduate Studies (MAPS)

Russian Knowledge Hub Expansion: In November 2007 agreement reached with Russian Ministry of Health and Social Development to develop ATECs based in Moscow, Irkutsk, Orenburg and Volgograd

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HIV/AIDS Treatment and Care Knowledge Hub Strategy

Strategically designed in collaboration with regional and national partners and international experts to support an effective national HIV/AIDS care and treatment model, ART scale-up strategies; regular review of approach

Target audience: multidisciplinary teams drawn from both the health sector and relevant social services/NGO’s selected according to care model agreed upon by national stakeholders, including national Ministries of Health

Faculty: international and national multidisciplinary teams with proven records of clinical excellence and adult learning

Training materials: based on WHO and relevant national recommendations; evidence based but adapted to regional resource levels and organizational structures; active input and review by key international and national stakeholders; oriented towards professional competences, available on-line in Russian and English

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HIV/AIDS Treatment and Care Knowledge Hub Strategy

Teaching methods: based on adult learning techniques, combination of didactical and bed-side; emphasis on practical, results oriented training

Quality control system: knowledge assessment test during trainings (pre/post), on-site mentoring

Certification by post-graduate institutions

Funding: Knowledge Hub developed proposals for and successfully bid on and otherwise secured co-funding from GFATM, UNICEF, WHO, USAID, Clinton Foundation and others

Coordination efforts to align treatment capacity development with drug availability through Global Fund and other sources (worked well in Ukraine)

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HIV/AIDS Treatment and Care Knowledge Hub Key Results (since June 2004 to June 2008)

Knowledge Hub courses held: 178

Curricula developed: 26

Care providers and faculties trained 4,317

Countries covered 10

Scope of services for $ 3,054,790

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Adult and pediatric ART physicians Nurses Social workers Administrators Laboratory specialists Regional, oblast and city AIDS centers Infectious disease hospitals Penitentiary medical system MCH system caregivers People living with HIV/AIDS NGOs

HIV/AIDS Treatment and Care Knowledge Hub Beneficiaries of Trainings

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HIV/AIDS Treatment and Care Knowledge Hub Types of Care Providers Trained (2004 to 2007)

2777

589

416

Physicians Nurses Social Workers

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HIV/AIDS Treatment and Care Knowledge Hub Curricula Development

Prevention of Mother-to-Child Transmission of HIV

Adult ARV Introductory and Advanced Course

Pediatric ARV Introductory and Advanced Course

Palliative Care for PLWHA

Clinical Management of TB/HIV Co-infection

Laboratory Monitoring of HIV Infection and Antiretroviral Treatment

Adult Care and Treatment in Correctional Settings

Antiretroviral Therapy During Pregnancy

HIV/AIDS Nursing

HIV/AIDS Clinic Administration and Management

Adherence to Antiretroviral Therapy

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HIV/AIDS Treatment and Care Knowledge Hub Number of Care Providers Trained

64 46 32142

608

243140

991980

186122

1288

1125

114 122

1361

0

200

400

600

800

1000

1200

1400

1600

Physicians Nurses Social Workers Total

2004 2005 2006 2007

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HIV/AIDS Treatment and Care Knowledge Hub Number of Trainers Trained*

0

20

47

101

57

0

20

40

60

80

100

120

2004 2005 2006 2007 2008

Trainers Trained

* 2008 data are only for the first six months of 2008

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HIV/AIDS Treatment and Care Knowledge Hub Involvement of National and International Trainers

19

HIV/AIDS Treatment and Care Knowledge Hub Countries Assisted

20

21

22

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Curriculum development is crucial but needs to be supported by strengthening training institutions for effective implementation of new courses

Training centers have to have a pool of national trainers on various areas not just key experts

Dentists, surgeons, etc need to be trained as well

Continuing Involvement by International Experts: While national care providers are gaining experience, international clinicians and experts must play an important role for several more years

Funding: Knowledge Hub developed proposals for and successfully bid on and otherwise secured co-funding from the Global Fund, UNICEF, WHO, USAID, Clinton Foundation, National Projects and others

HIV/AIDS Treatment and Care Knowledge Hub Lessons Learned

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First, despite both the tremendous need and commitment to the importance of capacity building from countries and the international community, funds for capacity building are generally shortchanged relative to other HIV/AIDS related costs. As a result, the volume of training activity is much less than needed and often less than planned or predicted.

Second, despite singular training role in the region and support of the UN community and other international donors, the Knowledge Hub has not been able to develop a consistent source of predictable funding that is sufficient to cover its fixed operational costs. Rather it has had to constantly work to piece together its funding from many sources on an opportunistic basis.

Question for Discussion:

Why it is so difficult to sustain such needed structures?

HIV/AIDS Treatment and Care Knowledge Hub Funding Challenges

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For more information about theRegional Knowledge Hub

www.aidsknowledgehub.orgwww.aiha.comwww.eurasiahealth.org

Special thanks to GTZ BACKUP Initiative and to WHO EURO for their commitment and continued support to the Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia