For over 15 years PSI Central Asia (CA) has been implementing various programs toward improvement of health in Tajikistan (population 8.7 million), the Kyrgyz Republic (population 6 million), and Kazakhstan (population 17.8 million).
Today PSI CA carries out a 5 year-long USAID Central Asia HIV Flagship Activity providing services to people living with HIV (PLHIV), people who inject drugs (PWID) and men who sex with men (MSM), linking HIV positive clients to care and treatment, as well as testing services to their partners and those at highest risk of HIV.
There were estimated over 47,000 PLHIV in 2015 living in the CA countries where PSI is present today. In all three countries, the regions and cities that align with international drug trafficking routes have higher numbers of PWID, and consequently PLHIV, with 60% of the cumulative HIV cases in this region reported among PWID. HIV prevalence among PWID ranges from 9.3% (KZ) to 12.4% and 13. 5% (KG and TJ respectively). Epidemiological data shows that other key populations (KPs) are also disproportionately affected by HIV/AIDS relative to the general population. HIV prevalence among female sex workers (SWs) ranges from 1.4% (KZ) to 3.5% (TJ) and prevalence among MSM ranges from 2.7% (TJ) to 13% (KG).
PSI CA 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 at-risk youth, PWID and SWs in high-risk sites along major opiate trafficking routes.
PSI expanded its work in the region in 2007 to include family planning (FP) projects to priority populations in Tajikistan and the Kyrgyz Republic. Between 2007-2009, PSI implemented the USAID-funded family planning program, “I Know”. The project’s overall goal was to improve the reproductive health of women of reproductive age (ages 15-44) in rural areas through improving access to FP services and products, and increasing informed demand for FP services. PSI CA employed social marketing techniques aimed at promoting modern contraceptive methods to be distributed through public and private retail outlets. PSI CA successfully implemented a national branded condom social marketing campaign that bear further partnerships.
PSI CA was implementing a USAID Dialogue HIV and TB project from 2009 to 2015 aimed at reducing the HIV and tuberculosis (TB) epidemics by improving health behaviors among KPs throughout Central Asia. To achieve this goal, the project provided outreach services for PWID, SWs, MSMs, prisoners and migrants. These included educational sessions and referrals to medical and social services, as well as HIV and TB testing. For each group, the project developed targeted outreach packages based on behavioral and epidemiological specifics, such as unprotected sexual behavior and drug-using practices.
 PEPFAR Regional Operational Plan 17
PSI Central Asia estimates that in 2017, its products and services helped avert 10,127 DALYS.
PSI Central Asia’s family planning programs also provided 1,688 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.
Community-Based HIV Express Testing
Starting from April 2017 under the USAID Central Asia HIV Flagship Activity Kazakhstan and Tajikistan were introduced with the new community-based saliva HIV rapid testing method. Medical staff and peer navigators from Non-Governmental Organizations (NGOs) in Kazakhstan and Tajikistan were educated and trained to conduct rapid testing and consultations as well as provided with methodological recommendations and other needed equipment, documentation, and the express tests itself “Oral-Quick HIV ½”.
One of the main achievements of USAID Central Asia HIV Flagship Activity in the Kyrgyz Republic is the implementation of community-based HIV testing by blood. Community-based saliva HIV testing in the Kyrgyz Republic was available since 2012. NGOs were provided with all necessary equipment and supplies, as well as fourth generation express tests “Alere Determine HIV 1/2 Ag/Ab Combo”. Through the joint efforts of the Republican AIDS Center and the Project, on December 23, 2016, 10 rapid HIV testing centers were opened and started operating on the basis of 5 NGOs that partner with USAID Central Asia HIV Flagship Activity.
The Project explores a set of peer-driven approaches using communities to bring KPs for testing (such as RDS-based recruitment and enhanced mapping for more traditional outreach activities) as well as introduced enhanced partner notification to bring more PLHIV partners for testing services.
PSI CA is never standing by and pursuing to never-ending vigorous development. Today the Project is stepping up the technological game introducing new technologies for data collection and data processing, also offering its partners modern platforms to upgrade the way of interaction and information exchange.
Starting from the second project year the PSI CA improved online database MIS (Management Information System) which was developed by the PSI CA team and includes various instrument for convenient and user-friendly data quality monitoring, automatic formation of more than 100 reports on tracking the number of tested, detected positive cases at each NGO site and by the regions, tracking if clients were provided education on adherence to the treatment, TB screening, and if were referred and received other medical care, self-help groups conduction and topics discusses, process of client’s transfer and many more. The database system operates for three CA countries: Kazakhstan, the Kyrgyz Republic, and Tajikistan. Algorithms are designed specifically for each country taking into account the specifics of work in each region.
Market Development Approach
PSI CA moves towards shaping health market for family planning and non-communicable diseases (NCDs) in the region which is reflected in most recent regional operational plan. The new strategy and operational plan will focus on FP, NCDs, and reproductive health to fulfill the unmet need for family planning and NCDs in the region. Holistic research on market failures, consumer and market behavior will enable PSI CA to approach new funders committed to supporting efforts of shaping FP, NCD market systems in Kazakhstan, the Kyrgyz Republic and Tajikistan for the ultimate vision of consumer empowered healthcare.
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria
- Local NGOs
- Republican AIDS Centers in Kazakhstan, Kyrgyz Republic, and Tajikistan
- Local medical facilities
- USAID Central Asia Flagship Project 2017 Results
PSI CA has recently completed year 2 out a 5-year long USAID Central Asia HIV Flagship Activity providing services to people living with HIV (PLHIV), people who inject drugs (PWID) and men who sex with men (MSM), linking HIV positive clients to care and treatment, as well as testing services to their partners and those at highest risk of HIV. This infographic serves to provide information on the results from year 2 of the Project.
- 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.