1. 1 Arsen Kubataev, MD, MBA, Regional Director, Russian Federation American 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

2. 2 HIV/AIDS Capacity Building Needs Background  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

3. 3 HIV Infection, newly diagnosed Europe, 1996 – 2007* * Data from WHO/EURO http://data.euro.who.int

4. 4 HIV Infection, newly diagnosed Europe, 1996 – 2007* * Data from WHO/EURO http://data.euro.who.int Russia

5. 5 ARV treatment needs and coverage Eastern Europe and Central Asia* * Data from UNAIDS factsheets reports, 2005, 2006, 2007 and www.globalhealthreporting.orgwww.globalhealthreporting.org YearNeed ARV Treatmenton ART 2003n/a<1,000 2004n/a~9,000 2005160,00021,000 2006190,00024,000 2007295,30039,500

6. 6 HIV/AIDS Capacity Building Needs Background 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

7. 7 HIV/AIDS Knowledge Hubs Background 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

8. 8 Regional Knowledge Hub for Capacity Building in HIV Surveillance HIV/AIDS Knowledge Hub Network Implementing 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

9. 9 HIV/AIDS Treatment and Care Knowledge Hub American 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

10. 10 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

11. 11 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)

12. 12 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

13. 13  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

14. 14 HIV/AIDS Treatment and Care Knowledge Hub Types of Care Providers Trained (2004 to 2007)

15. 15 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

16. 16 HIV/AIDS Treatment and Care Knowledge Hub Number of Care Providers Trained

17. 17 HIV/AIDS Treatment and Care Knowledge Hub Number of Trainers Trained* * 2008 data are only for the first six months of 2008

18. 18 HIV/AIDS Treatment and Care Knowledge Hub Involvement of National and International Trainers

19. 19 HIV/AIDS Treatment and Care Knowledge Hub Countries Assisted

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23. 23  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

24. 24  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

25. 25 For more information about the Regional Knowledge Hub www.aidsknowledgehub.org www.aiha.com www.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