The countries that comprise the Central Asia Region (CAR) have diverse economies, ethnicities and geographies, but they share a rapidly expanding HIV epidemic fueled by injecting drug use. In the three countries of CAR, Kazakhstan, the Kyrgyz Republic and Tajikistan, there are an estimated 176,400 people who inject drugs (PWID). Throughout the region, it is estimated that HIV prevalence is significantly higher among PWID than the general population. HIV prevalence among the general population is approximately 0.20% compared to an average prevalence of 7.95% among PWID in Kazakhstan, 12.4% in the Kyrgyz Republic, and 13% in Tajikistan. Official PWID size estimates are 127,800 in Kazakhstan, 25,500 in Kyrgyz Republic in and 23,100 in Tajikistan.
PSI/Central Asia began implementing HIV prevention and drug demand reduction programs in 2002 in Kazakhstan, the Kyrgyz Republic, Tajikistan and Uzbekistan. Under those programs, PSI promoted healthier behaviors to more than 217,000 at-risk youth and thousands of PWID and sex workers (SWs) in high-risk sites along major opiate trafficking routes. PSI expanded its work in the region in 2007 to include family planning projects to priority populations in Tajikistan and the Kyrgyz Republic.
In 2009, PSI/Central Asia embarked on a five-year USAID Dialogue HIV and TB Project aimed at reducing the HIV and tuberculosis (TB) epidemics by improving health behaviors among key populations (KPs) throughout Central Asia. To achieve this goal, the project provided outreach services for PWID, SWs, men who have sex with men (MSMs), prisoners, and migrants. These included educational sessions and referrals to medical and social services, as well as HIV and TB testing. For each key population, the project developed targeted outreach packages based on behavioral and epidemiological specifics, such as unprotected sexual behavior and drug using practices. As a result, 178,224 KPs were reached, over 23,000 KPs were tested for TB, and almost 30,000 were tested for HIV. For those who started a TB treatment, the project provided case management services aimed to build treatment adherence and overcome social and personal barriers. A total of 1,438 clients benefited from these case management services. To increase the capacity of local non-governmental organizations (NGOs) to provide effective services to KPs, the project provided intensive training and technical assistance on outreach services, and integration of TB-focused activities into HIV programs. Outreach and social workers built their counseling and motivational skills to help people start TB treatment and support their adherence. The project also helped the local NGOs build effective partnerships with medical facilities. Overall, 41 NGOs were trained and strengthened their capacity to serve key populations.
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PSI/Central Asia estimates that in 2015, its products and services helped avert 165 DALYs across Kazakhstan, Tajikistan, and Kyrgyzstan.
Its family planning programs in Kazakhstan and Kyrgyzstan also provided 255 couple-years of protection.
In December 2015, USAID/Central Asia and PSI signed a contract to implement the five-year USAID Central Asia HIV Flagship Activity. This was in response to the recent increase of HIV cases primarily among key populations (KPs) in the Central Asia Region (CAR).
The goal of the project is to reduce new HIV infections and HIV-related deaths in the Central Asian countries. The project aims to increase the use of high-quality HIV prevention, testing, treatment, adherence and care services among key populations. In contribution to the overall project goal, the project focuses on the following results:
Result 1: Increased access to HIV prevention, care and treatment services for KPs.
Result 2: Improved quality of HIV prevention, care and treatment services for KPs.
Result 3: Expanded mechanisms for social partnerships with HIV/AIDS NGOs.
The project broadly follows the UNAIDS ambitious 90-90-90 strategy, aiming to ensure that 90% of people with HIV are diagnosed, 90% of those are on anti-retroviral therapy (ART), and 90% of those are virally suppressed by 2020. Within this broad strategy, the project follows the President’s Emergency Plan for AIDS Relief (PEPFAR) 3.0 Impact Action Agenda. This prioritizes the sustainable control of the HIV epidemic by ensuring that resources are focused on doing the right things, in the right places, at the right times. The emphasis also falls on funding core activities, especially care and treatment for priority populations, and by leveraging additional resources to scale-up quality interventions to address their most urgent needs.
To contribute to achieving the 90-90-90 goals in CAR, the project focuses its efforts on two key components: rapid case detection (RCD) to find undiagnosed HIV cases, and case management for ART initiation and adherence.
Implemented in Kazakhstan, the Kyrgyz Republic and Tajikistan, the project targets people who are most at risk of contracting HIV:
- PWIDs: the largest key population group experiencing the highest rates of HIV in the region.
- People living with HIV (PLHIV): within the PLHIV group, the project focuses on those who know their status but did not yet start ART, those who may or may not have started but were subsequently lost-to-follow-up (LTFU), and those who are on treatment but have low adherence.
The main driving force of the project are teams of peer navigators who are representatives from communities of PWID and PLHIV.
To increase its contribution towards the first 90-90-90 goal, the project implemented the (RCD) approach which engages community members to recruit their peers and bring them for HIV testing. The project clients who show negative results are referred to prevention services and medication assisted treatment. Those who received their first positive results are escorted to confirmatory testing and, if their HIV status is confirmed, are linked to the project’s case management program.
The case management component is aimed at providing community-based support for PLHIV to ensure their linkage to care, timely ART initiation and adherence. In addition, peer navigators conduct oral screenings of TB symptoms, refer clients to diagnostics and treatment of STI, medication-assisted therapy, reproductive health and family planning services, support groups for victims of gender-based violence, and motivate PLHIV to engage their sexual partners in HIV testing.
By the end of the first project year, the project tested 6,700 key populations and identified 130 cases of HIV. In the Kyrgyz Republic, the project found 25% of all cases registered in the country in 2016. 74 people newly found were linked to care, and 43 of them have initiated treatment.
Using their social networks or through close collaboration with local AIDS centers, peer navigators found 327 HIV positive people who were LTFU and relinked them to care. By the end of the first year, 86 LTFU clients have received treatment.
The project has significantly contributed to strengthening the national HIV testing policies, and developing methodological guidelines on community-based rapid testing in the region. As such, in Kazakhstan and Tajikistan the project pioneered the launch of the saliva-based tests, an approach that had not been implemented in these countries before. In the Kyrgyz Republic as well, the project launched rapid blood-based testing through local NGOs for the first time. Community-based testing brings services closer to clients, attracts clients who were reluctant to visit medical facilities, and decreases the number of those who could be lost on their way to health facilities.
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria
- Local NGOs
- Republican AIDS Centers in Kazakhstan, Kyrgyz Republic, and Tajikistan
- Local medical facilities
- The Effectiveness of PSI Outreach Activities Among MSM Regarding Condom Use and HIV HTC in Central Asia
The goal of this project is to use social networking and education to create a social norm that promotes safe sexual practices among men who have sex with men (MSM). This presentation was created for 2014 International AIDS Conference in Melbourne, Australia.
- Using Data Stored in Management Information System (MIS) to Improve Tuberculosis Treatment Adherence Among People Living with HIV (PLHIV) in Central Asia
PSI/Central Asia implements the USAID Dialogue on HIV and TB Project to improve TB treatment adherence among people living with HIV (PLWH) through comprehensive case management and social support. We use a management information system (MIS) to evaluate the effectiveness of adherence support. The MIS tracks referrals to TB testing and new cases detected through the use of vouchers. Clients are assigned a unique identifier, and social workers track client activities, including treatment completion and reasons for default. Unlike past systems that just tracked number of visits or people reached, this MIS enables follow-up of individual clients over time and identification of treatment defaults. After one year, MIS data showed 43.8% of defaulters (48) lost contact with the project in the last month – highlighting the need for improved PLWH retention strategies. The project is reviewing PLWH records and meeting with clients to identify steps to improve retention.
- Central asia (2008): Knowledge, Attitudes and Practices of At-Risk Youth Relating to Injecting Drug Use and Sexual Behavior in Four Countries of Central asia. Third Round
- Youth Perspectives on Drug Use, Heroin, and Risk for HIV/AIDS in Tajikistan and Uzbekistan, Central Asia
This study of youth in Tajikistan and Uzbekistan identifies factors that render them vulnerable to drug use. It explores youth’s definitions of and attitudes toward drug use and examines how substances other than heroin and opiates influence higher risk behaviors, especially injecting drug use.