---

IN THIS ISSUE:

• Snapshot – Knowledge Hub activities to date, in numbers
• Knowledge Hub Calendar – Find out about training workshops and other upcoming events
• Knowledge Hub in Review – Learn about recent activities
• Knowledge Hub Notebook – Read in-depth articles about our activities
• HIV/AIDS Resources – Links to useful information, evidence-based research, and more

---

Snapshot

These statistics reflect the Regional Knowledge Hub’s activities from its inception in March 2004 to November 2005

• Knowledge Hub courses held: 42
• Healthcare professionals trained: 1141
  • Ukraine: 636
  • Russia: 449
  • Kazakhstan: 29
  • Tajikistan: 18
  • Moldova: 9

Ukrainian physicians who have earned nationally recognized advanced professional certification in adult/adolescent or pediatric AIDS treatment through the Knowledge Hub: 57

---

Knowledge Hub Calendar

The following events are scheduled to take place at the Knowledge Hub or affiliated centers in the near future

---

 

Initiation of Antiretroviral Therapy (ART) for Adults
December 12-16, 2005 – Kiev, Ukraine

On the initiative of the World Health Organization (WHO) Regional Office for Europe and the principal Uzbek recipient of a grant from the Global Fund to fight AIDS, Tuberculosis and Malaria, 12 healthcare professionals from Uzbekistan and one administrator from the Uzbekistan National AIDS Center will participate in an ART course in Kiev in December 2005. Three WHO national HIV/AIDS coordinators from Central Asia will take part in the training as observers. The emphasis will be on care team composition; patient counseling; and ART goals, drugs, and protocols. The team of trainers consists of leading healthcare professionals from Ukraine, the United States, and Germany.

---

Knowledge Hub in Review

These events were hosted by the Knowledge Hub or affiliated centers during September – November 2005

---

TRAININGS:

 

UKRAINE

 

Initiation of Antiretroviral Therapy for Adults in Correctional Settings
September 12-16, 2005 – Kiev, Ukraine

Twenty-seven doctors from 13 medical units of Ukrainian correctional institutions took part in this training, held at the Lavra AIDS Clinic in Kiev. It was held on the initiative of the Ukrainian State Department of Prison Systems and was funded by the International HIV/AIDS Alliance in Ukraine, the principal recipient of the Global Fund grant for Ukraine. Plans call for the commencement of ART for Ukrainian inmates in December 2005 and the training was the first step to meet the goal.

Laboratory Monitoring of HIV Infection and Antiretroviral Therapy
September 12-16, 2005 – Odessa, Ukraine

Through this training, the Knowledge Hub broadened the scope of its training courses. The curriculum was developed by experts from the Knowledge Hub, the American International Health Alliance (AIHA), and the Association of Public Health Laboratories (APHL). The twenty-eight Ukrainian laboratory doctors participated in the training, which covered: quality assurance and quality control, validation and biosafety, monitoring of CD4 concentrations, analysis of mistakes, and other important topics. A central theme of the training was the value of effective communication between laboratories and those working in clinical settings. This theme was repeated throughout the course by emphasizing the importance of pre-analytical and post-analytical activities as well as the role of the laboratory in attaining reliable test results. The training was funded by the International HIV/AIDS Alliance and held at the Odessa Oblast AIDS Center.

Initiation of Pediatric Antiretroviral Therapy
September 26-30, 2005 – Odessa, Ukraine

The training was conducted in the framework of the joint UNICEF/Knowledge Hub initiative on human capacity building to support the Ukrainian pediatric service on ART. The training was conducted for eight pediatric care teams (25 participants from seven regions of Ukraine). During this five-day training at the South Ukrainian AIDS Education Center, the following topics were covered: components of HIV/AIDS care, the care team approach in HIV/AIDS care, principles of counseling, and ART goals and drug regimens for pediatric cases and for prevention of mother-to-child transmission of HIV. The training was the second course in a series of the Knowledge Hub’s pediatric ART trainings supported by UNICEF/Ukraine in 2005.

Initiation of Pediatric Antiretroviral Therapy
October 24-28, 2005 – Kiev, Ukraine

This training was the last in the series of pediatric ART trainings funded by UNICEF/Ukraine. The course was conducted at the Kiev City Children’s Hospital No. 1 for 24 participants from six regions of Ukraine.

Through agreement with UNICEF/Ukraine and with its financial support, the Knowledge Hub has, in 2005, provided training for 72 pediatric ART caregivers from 24 Ukrainian AIDS Centers.

 

Pediatric Antiretroviral Therapy Onsite Mentoring
October 31 - November 5, 2005 – Ukraine

Onsite mentoring was conducted for eight pediatric teams, each consisting of a physician, a nurse, and a social worker, that had started their training in pediatric ART in June 2005 through a UNICEF/Ukraine-funded program. During the training the participants were able to present and analyze the clinical cases of their first ART patients. The training also allowed participants to consult with the experienced mentor, Dr. Svitlana Komar of the Ukrainian National AIDS Center, on different aspects of ART in pediatrics. The training took place at the Cherkassy, Donetsk, and Khmelnitsky Oblast AIDS Centers.

 

Advanced Pediatric ART and Opportunistic Infections Management
November 14-18, 2005 – Kiev, Ukraine

This training was the last in the series of the Knowledge Hub’s pediatric ART trainings conducted for care teams from the AIDS Centers of Cherkassy, Dnitropetrovsk, Donetsk, Kiev, Khmelnitsky, Krivoy Rog, Mariupol, and Odessa. The 24 participants were members of medical care teams, each consisting of a physician, a nurse and a social worker who had previously completed Initiation of Pediatric Antiretroviral Therapy in June 2005 and Pediatric Antiretroviral Therapy Onsite Mentoring in November 2005. The training was dedicated to advanced principles of medical and social care to children with HIV/AIDS on ART and addressed such issues as opportunistic infections, drug regimens and dosages, complications, side-effects and drug adherence, and post-exposure prophylaxis. Eight physicians who successfully completed the series of pediatric ART trainings received national certification in pediatric AIDS treatment from the Kiev Medial Academy of Post-Graduate Education. Funded by the International HIV/AIDS Alliance, the training took place at Kiev City Children’s Clinical Hospital No. 1.

Initiation of ART for Adults
November 21-25, 2005 – Kiev, Ukraine

The 28 training participants consisted of eight care teams from eight oblast AIDS Centers, two administrators from the Ukrainian National AIDS Center, and one ART care team from Tajikistan. ART was new to most of the participants. The training covered such topics as care team composition, patient counseling, goals of ART, ARV drugs, and protocols. This was the first training in the series of adult ART trainings for the teams from Khmelnitsky, Kirovograd, Rivne, Sumy, and VolynSumy, . Follow-up Adult ART Onsite Mentoring and the Advanced ART for Adults and Opportunistic Infections Management training for these teams will be conducted in 2006. This training was also funded by the International HIV/AIDS Alliance and took place at the Lavra AIDS Clinic.

 

---

RUSSIA

 

Adult Antiretroviral Therapy Onsite Mentoring
September 28-30, 2005 – Orenburg, Russia

This mentoring was the second phase of the ART training conducted for two care teams (a total of five participants) from Orenburg, Russia. One team of the participants had already taken the Initiation of ART for Adults and Adolescents course in Kiev, Ukraine, in June 2005. The other team had participated in a professional exchange trip to Elmhurst Hospital, New York, in May 2005 where they got initial training on ART. The participants received professional recommendations on treatment of ART patients. The mentoring was funded by USAID/Russia and conducted by experts from Elmhurst Hospital. The final phase of the ART training cycle for these participants will be conducted in Russia in early 2006.

Pediatric Antiretroviral Therapy Onsite Mentoring
October 31-November 1, 2005 – Orenburg, Russia

Two multidisciplinary teams from the Orenburg and Saratov AIDS Centers, Russia, who had previously completed the training course on Initiation of Pediatric Antiretroviral Therapy in St. Petersburg in June 2005, attended this practical clinical workshop designed to advance their knowledge and practical skills in care and treatment for children on ART. The faculty evaluated patients on treatment and the adequacy of their ART regimens and gave the participants recommendations and suggestions for future activities. The mentoring was funded by USAID/Russia.

 

Prevention of Mother-to-Child Transmission of HIV (PMTCT): General Knowledge
Series of Six Trainings
September-November 2005 – Russia

Knowledge Hub conducted six PMTCT trainings in September and November 2005 under its funding agreement with UNICEF/Russia. The goal of the PMTCT training program in Russia is to strengthen the human capacity of healthcare professionals in the sphere of PMTCT. The purpose of this general course was to give participants the understanding of the core elements of PMTCT based on World Health Organization/UNICEF/United Nations Population Fund strategy and national standards and know how to implement them in practice. A total of 164 participants took part in trainings in Chelyabinsk, Magnitogorsk, Novotroitsk, and Orenburg.

 

---

TAJIKISTAN

Adult Antiretroviral Therapy Onsite Mentoring
November 28-30, 2005 – Dushanbe, Tajikistan

The Knowledge Hub organized onsite mentoring for nine healthcare professionals from Tajikistan who had completed Initiation of ART for Adults and Adolescents courses in July 2005 and in November 2005 in Kiev. Leading German and Ukrainian specialists in HIV/AIDS medicine went to Tajikistan to assist local care teams there in selection of patients for ART. Knowledge Hub experts also provided technical assistance to the National AIDS Center to plan a program for initiating ART in the country. The United Nations Development Programme/Tajikistan provided funding.

 

---

For more information on this section please visit
www.aidsknowledhehub.org > What the Knowledge Hub does > Training Courses,
or follow the link:
www.aidsknowledgehub.org/eng/mastering/trainings/browse/ .

 

---

MEETINGS:

 

Human Capacity Building Strategy to Support ART Scale Up in Ukraine
September 26, 2005 – Kiev, Ukraine

The Regional Knowledge Hub for the Care and Treatment of HIV /AIDS in Eurasia and the Ukrainian National AIDS Center conducted this meeting to analyze and plan for human capacity building activities to support national ART scale up in Ukraine. Participants reviewed activities since June 2004, developed consensus on HIV/AIDS care and treatment human capacity building priorities and approaches, and discussed ways to improve the availability and quality of care in the coming year for people living with HIV/AIDS in Ukraine. The meeting was attended by 27 representatives of international and Ukrainian organizations involved into the planning and implementation of the HIV/AIDS care and treatment program in Ukraine. The meeting also provided a forum for review and discussion of the effectiveness of the Knowledge Hub capacity building programs since March 2004 from multiple perspectives and to examine lessons learned.

 

 

For more information on this meeting please visit
www.aidsknowledgehub.org > National Capacity Building Programs,
or follow the link:
www.aidsknowledgehub.org/eng/about/approaches/249/

 

WHO/Regional Office for Europe (EURO) Sub-regional Meetings to Accelerate Access to ART
September 2005 – Tbilisi, Georgia, and Almaty, Kazakhstan

Representatives from the Knowledge Hub and AIHA Caucasus and Central Asia regional offices participated in a series of WHO/EURO sub-regional meetings in Tbilisi and Almaty in September. The purpose of the meetings was to discuss current access to ART in these countries, progress made to date, and challenges in scaling up HIV/AIDS treatment, care, and prevention. Participants developed outlines of country action plans to accelerate access to ART and to promote in-country and sub-regional collaboration.

 

---

Knowledge Hub Notebook

Penitentiary Health Specialists Learn about Antiretroviral Therapy

The sound of the bells from Kiev-Pechersk Lavra’s Orthodox Monastery fills the crowded classroom of the AIDS clinic, intensifying the meaning of the words spoken at that moment. “After receiving a diagnosis of HIV, many prisoners realize the mistakes they made in the past. Some of these guys start cursing themselves. Some cry. And some retreat inside themselves and won’t even utter a word. So, each in his own way, these men express how upset they are about their previous drug addiction, which was the cause of their contracting an infection,” Alexander Shatalov says. Shatalov is chief of the medical section at Olshansky Correctional Colony No. 53 in Nikolayev Oblast, where almost 80 percent of inmates are former injection drug users (IDUs). More than 15 percent of these people have been diagnosed with HIV, but Shatalov is certain that the real number is much higher. HIV testing is voluntary in Ukrainian prisons, and many people prefer not to know.

In some Ukrainian prisons as many as 30 percent of all inmates are HIV-infected. This sad statistic was shared during a workshop on HIV/AIDS in correctional settings conducted September 12-16 by the Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia. Hosted by the AIDS clinic at the L.V. Gromashevskiy Institute of Epidemiology and Infectious Diseases in Kiev, the workshop brought together 28 doctors and nurses from six of the largest penitentiaries in the southern and eastern parts of Ukraine, which have the highest HIV/AIDS incidence in the country.

According to the participants, just a few years ago there would have been no point in holding such a meeting because there were no medications available for ordinary citizens, let alone people serving prison sentences. Now, however, the use of antiretroviral drugs has been initiated on a broad scale in Ukraine. Since August 2004, some 3,000 people have begun antiretroviral therapy and now it’s the prisoners’ turn. According to the Ukrainian Ministry of Health, a total of 3,798 inmates have been identified as HIV-positive as of April 1, 2005. Fifty prisoners have already developed AIDS and require ART but—given the fact that many HIV-infected individuals contracted the virus in 1997 or 1998—that number is growing every day. The prison health system must therefore increase its capacity to provide appropriate treatment for HIV-infected inmates while at the same time ensuring the safety of its care providers.

 

To read a full-length story, please visit
www.aiha.com > Publications > Connections,
or follow the link
http://www.aiha.com/index.jsp?sid=1&id=9279&pid=4177

Laboratory Services: A Critical Component in the Provision of Prompt, Effective HIV/AIDS Diagnosis and Treatment

Today, almost 10 years after the number of HIV cases in Ukraine began exploding into epidemic proportions, the country is experiencing a runaway growth in the number of patients whose HIV has progressed to AIDS. For these people, antiretroviral drugs are a matter of life or death. But life-extending medications are not a panacea for the AIDS pandemic facing Ukraine and many other countries across Eurasia. For these therapies to be effective, HIV/AIDS care systems must provide for the timely diagnosis of AIDS and its associated pathologies while at the same time setting forth appropriate guidelines for prescribing antiretroviral therapy and monitoring the efficacy of treatment regimens.

Alla Shcherbinskaya, director of the Ukrainian AIDS Prevention Center (UAPC), paints a grim picture of the nation’s evolving HIV epidemic, reporting that the number of AIDS patients increased by a factor of 4.5 during the first half of 2005 compared to last year. Furthermore, mortality from AIDS has quadrupled, she says, which is a clear indication that addressing this situation will take more than the ARV drugs that grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria made available in Ukraine as of August 2004. “Now that the number of AIDS patients in the country is growing by the day, there is an acute need for doing more complex tests that can determine a patient’s immune system impairment and viral load. These diagnostics are crucial in order to determine the need for prescribing ART and monitor the effectiveness of treatment,” she underscores.

New Knowledge Hub Course Helps Lab Workers Keep Pace with Growing Demands

As part of the national capacity-building efforts supported by the Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia, staff members of laboratories from all the oblast AIDS Centers in Ukraine gathered in Odessa September 12-16 to enhance their knowledge of lab procedures for monitoring AIDS and ART. The meeting provided participants with an opportunity to learn about the most advanced methods of laboratory diagnostics used to monitor HIV/AIDS, various co-infections, and ART. In addition, sessions focused on issues of quality control, equipment maintenance, and occupational health and safety. Leading Ukrainian and American experts on laboratory systems and monitoring served as trainers during the meeting.

According to UAPC data, more than 2.5 million people are examined for HIV in Ukraine each year. Since 1987, some 83,300 cases have been officially registered. At the meeting, UAPC Chief Laboratory Diagnostics Specialist Olga Kravchenko noted that 2,700 people in Ukraine are currently receiving ARVs and—by the end of 2006—5,000 Ukrainians will be on ART. To satisfy the growing requirement for timely prescription of antiretrovirals, Ukraine plans to open five inter-regional laboratories that will be supplied with flow cytometers, as well as equipment to measure viral load and facilitate the early diagnosis of pediatric HIV. These laboratories will operate out of the regional AIDS Centers in Crimea, Dnipropetrovsk, Donetsk, L’viv, and Odessa and will handle the needs of the entire country.

Commenting that the participation of Ukrainian specialists from the laboratories at Ukrainian oblast AIDS Centers contributes to their professional development, Kravchenko emphasized how important such trainings are for ensuring high-quality HIV/AIDS diagnostics. For that reason, education on AIDS monitoring and ART issues was identified as a priority area in the plans projected for implementation. In addition, she noted that the many years of experience that the American instructors brought to the event greatly helped the Ukrainians to improve their own knowledge.

To read a full-length story, please visit www.aiha.com > Publications > Connections,
or follow the link
http://www.aiha.com/index.jsp?sid=1&id=9279&pid=4177 .

---

HIV/AIDS Resources

Useful links to HIV/AIDS-related information and evidence-based research

The EurasiaHealth AIDS Knowledge Network (EAKN) is a special initiative to identify key resources related to the care and treatment of HIV/AIDS and adapt and translate them for use by health professionals in the former Soviet Union and Eastern Europe. The EAKN Library consists of a core set of textbooks and guidelines that have been developed by the world's leading experts on HIV/AIDS. As these materials are updated in English, EAKN will be updating the Russian-language versions maintained on this Web site. In addition to the core set of key documents, the EAKN Library includes a variety of HIV/AIDS information resources, including patient education materials, articles, and abstracts.

Please visit

www.eurasiahealth.org > EurasiaHealth AIDS Knowledge Network Library

for more information on HIV/AIDS-related information and evidence-based research.

Among the most recently added or updated documents are:

• Twenty of 29 chapters from the newly edited HIV Medicine 2005, by B. S. Kamps. This comprehensive book is recommended for practicing healthcare workers from various specialties and for instructors at medical institutions of higher learning and advanced training faculties, as well as for all those providing health care to people living with HIV/AIDS. The rest of the book is to be translated by the end of 2005.
  http://www.eurasiahealth.org/index.jsp?sid=1&id=9270&pid=7101&lng=ru
• Twelve chapters from the Textbook of Pediatric HIV Care, by S. Zeichner and J. Read. This comprehensive textbook provides the definitive account of effective care for pediatric HIV patients. The rest of the book is to be translated by the end of 2006.
  http://www.eurasiahealth.org/index.jsp?sid=1&id=9281&pid=7101&lng=ru
• U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis. This report updates US Public Health Service recommendations for the management of health-care personnel who have occupational exposure to blood and other body fluids that might contain HIV
  http://www.eurasiahealth.org/index.jsp?sid=1&id=4941&pid=3542&lng=en

The EAKN Library is continuing to translate HIV Medicine 2005 and the Textbook of Pediatric HIV Care, as well as various other publications and recent abstracts from medical conferences. Two of the Global AIDS Learning and Evaluation Network (GALEN) modules – Management of Pediatric HIV Infection (No. 10) and HIV Prevention in the Clinical Setting (No. 1) – are in the final stages of translating and will be posted by mid-December, while the module Prevention/Treatment of Co-Infectious Diseases (No. 12) is due to be submitted for translation in early 2006. Another major translation that is planned to begin soon is Medical Management of HIV Infection 2005-2006, the English version of which is slated for release in December 2005.