STAGE 2.1 PROJECTS
The WEEPI Foundation has awarded a new round of stage 1 project grants (stage 2.1). Five stage 1 projects (of 12 months’ duration) covering a range of clinical and implementation research topics across HIV, viral hepatitis and TB were selected following the Foundation’s second call for stage 1 proposals. Brief project summaries are available below.
- Reviewing Screening Practices and Management of Latent Tuberculosis Infection in HIV patients from Central and Eastern Europe
- Introducing HIV self-testing in Latvia – pilot for key groups
- Promotion of HBV vaccination among people who inject drugs in Georgia
- DCRs as facilitators for testing, prevention and treatment for HCV for PWID in the Czech Republic
- Identifying barriers to HIV and TB testing among key population groups in Azerbaijan: a mixed methods study
Reviewing Screening Practices and Management of Latent Tuberculosis Infection in HIV patients from Central and Eastern Europe
Grantee: Euroguidelines in Central and Eastern Europe (ECEE) Network Group
Project start: April 2023
Main applicant and principal investigator: Justyna Kowalska, Prof, President for the ECEE Network Group
Deputy applicant: Dominik Bursa, MD, Secretary of the ECEE Network Group
Background: Tuberculosis (TB) remains a top killer among people living with HIV. Active TB develops mainly through re-activation of latent TB infection (LTBI) and is, thus, preventable. Risk of LTBI re-activation in people living with HIV is 20-30-fold higher than in the background population. Antiretroviral therapy (ART) significantly decreases this risk but not to the level of the background population. TB preventive treatment (TPT) decreases the risk of TB re-activation in people living with HIV by approximately 30%, regardless of ART. WHO estimates that one fourth of the world’s population has LTBI and that less than 5% of those infected are diagnosed and treated to prevent active TB. Central and eastern Europe (CEE) have the highest rates of TB/HIV coinfection and the largest reservoir of LTBI in Europe. Management of LTBI is a key component of the Global End TB Strategy. Strategies for LTBI screening and management in CEE have not been assessed.
Objective: The overall long-term aim of the project is to improve management of LTBI in people living with HIV and, thus, to contribute to the reduction of TB-morbidity and mortality and achievement of the End TB Strategy goals. The specific project objectives are to: 1) perform a baseline assessment of current national policies and practices on screening and management of LTBI in people living with HIV across countries of Eastern and Central Europe; 2) identify challenges and opportunities to scale up programmatic management of LTBI and 3) establish an international platform for future LTBI research by setting-up a cohort of people living with LTBI.
Methods: The study will be conducted within the Euroguidelines in Central and Eastern Europe (ECEE) Network Group which brings together experts in the field of infectious diseases from 24 countries across the CEE region, representing both high and low TB, MDR-TB and HIV prevalence and incidence settings. Objectives 1-2 will be addressed through a survey conducted among members of the ECEE Network. The survey will include questions related to national policies and existing practices on LTBI management in people living with HIV and related challenges. Clinical and epidemiological data on LTBI, TB and HIV in a particular clinic and country will also be collected. A workshop dedicated to LTBI management in Europe will be proposed for the EACS 2023 conference where the survey results will be presented, and a facilitated discussion take place. In preparation for a larger stage 2 WEEPI proposal, a prospective cohort study of LTBI/HIV patients will be designed, aiming to evaluate TB incidence, risk factors for active TB in LTBI patients, and follow-up implementation of recommended interventions to improve the continuum of care.
Output/impact: This will be the first study to assess current policies and practice for the management of LTBI in the CEE region, providing the basis for building a sustainable LTBI care model and ultimately facilitating progress toward TB elimination. The direct outcome of the study will be an improved understanding of LTBI epidemiology and management in people living with HIV in CEE and identification of areas for improvement at both local and national levels. The best results will be set as a benchmark for LTBI-care at clinic and national levels in the CEE region. The study will also provide a baseline assessment that can be used for monitoring and evaluating future progress toward the targets of the WHO End TB Strategy (90% reduction of TB mortality and 80% reduction in TB incidence by 2030.). The results of the study will be applicable for similar settings elsewhere. The research scope and framework for future research will be discussed during the planned workshop which will be open for attendance by all main international stakeholders (including WHO and ECDC) and will have both clinical, public health and political impact. The project is seen as preparatory for the establishment of a larger international collaboration to address unanswered clinical, epidemiological, and public health related questions on LTBI management and risks for progression to active-TB among people living with HIV. The ECEE Network has potential to be expanded and include additional eastern European and Central Asia countries as well as clinics/countries from Western Europe.
Introducing HIV self-testing in Latvia – pilot for key groups
Grantee: Riga Stradins University, Institute of Public Health
Project start: April 2023
Main applicant and principal investigator: Anda Kivite-Urtane, PHD, MPH, Assoc Prof; Director, Institute of Public Health, Riga Stradins University
Deputy applicant: Evija Dompalma-Linuza, MSc, MPH; researcher, Institute of Public Health, Riga Stradins University; board member, NGO Baltic HIV Association
Collaborators: Inga Upmace, MD, researcher, Institute of Public Health, Riga Stradins University; chairwoman of the board, NGO Baltic HIV Association.
Santa Ansone, MD, Riga East University Hospital and Children’s Clinical University hospital, Latvia; researcher, Institute of Public Health, Riga Stradins University.
Background: Latvia has the second highest rate of annually diagnosed HIV cases in the EU, combined with one of the lowest testing rates and an estimated 30% of HIV cases being undiagnosed. There is an urgent need to increase access to testing and linkage to care. HIV self-testing has so far not been available in Latvia.
Objective: The overall aim is to increase HIV testing and linkage to care in the country. The specific project objective is to assess the feasibility and acceptability of HIV self-testing as a novel approach to increase testing in the country. This will be done by piloting self-testing among five key and vulnerable groups (people who inject drugs, men who have sex with men, sex workers, survivors of violence and clients of social services), evaluating feasibility and acceptability of HIV self-testing (both among the five groups and among relevant stakeholders), and disseminating study results within the scientific community, among stakeholders and in the general population.
Method: Written guidelines for performing an HIV self-test will be developed and included in the self-test kits. 10 employees of selected low-threshold services (reaching the selected target groups) will be trained in providing counselling in connection with distributing the self-testing kits. 250 people from the five key groups will be recruited for the study through convenience sampling. The trained staff will distribute a test kit for each of the 250 people, along with a printed anonymous questionnaire (which can also be filled in online) and a pre-paid envelope for returning the questionnaire. This quantitative part of the study will be carried out as a cross-sectional study, aimed at assessing acceptability of HIV self-testing. The qualitative part of the study will assess feasibility of introducing HIV self-testing as well as the acceptability. This part of the study will be based on semi-structured in-depth interviews with 10-15 members of the key groups recruited to the piloting of self-tests, as well as 7-12 stakeholders (policy makers, public health administrators, healthcare professionals, social workers and NGO representatives). Participants of qualitative interviews will be recruited through maximum variation sampling.
Output/impact: This will be the first study to assess the feasibility and acceptability of HIV self-testing in Latvia. The project will pilot HIV self-testing as a new testing technology in the country, train staff from different low threshold facilities in providing counseling for HIV self-testing and establish a network of organizations for distribution of self-tests. The project aims to generate scientific evidence (in the form of a study report, two conference abstracts, a peer-reviewed publication, a media briefing and press releases), which will be disseminated to the scientific community, stakeholders and lay society in various ways and used to advocate for HIV self-testing to be included in national testing policies.
Promotion of HBV vaccination among people who inject drugs in Georgia
Grantee: Health Research Union, Georgia
Project start: April 2023
Main applicant and principal investigator: Maia Kajaia, MD, Assoc Prof; Project Coordinator, Health Research Union
Deputy applicant and principal investigator: George Kamkamidze, MD, Prof; Head of Research, Health Research Union
Background: An estimated 296 million people were living with chronic Hepatitis B virus (HBV) in 2019 and an estimated 280 000 people died from HBV related liver cirrhosis or hepatocellular carcinoma. A recent systematic review and meta-analysis reported 6-9% prevalence of hepatitis B surface antigen (HBsAg) among people who inject drugs globally, with substantial geographic variation. In Georgia is a country with intermediate to high burden of hepatitis B: hepatitis B surface antigen (HBsAg) prevalence of 2.9% and hepatitis B core antibody (anti-HBc) prevalence of 25.9% in the general adult population. Among people who inject drugs, HBsAg and anti-HBc prevalence was 7.2% and 51.3%, respectively, in 2015. The estimated number of people who inject drugs in Georgia is high at 52.500 (50.000 – 56.000) and the estimated adult (18-64 years) national prevalence of injection drug use is 2.2% (2.1% - 2.4%). HBV vaccination has been included in Georgia’s national immunization programme since 2002. The estimated HBV immunization coverage among 1-year-olds has been >90% during 2012–2019 but declined to 85% in 2021. Vaccination coverage among people who inject drugs is very low at 7.5% and only 20% are willing to be vaccinated.
Objective: The overall goal of the project is to promote universal HBV vaccination among people who inject drugs in Georgia. The specific objectives are to assess and improve knowledge and attitudes toward HBV vaccination among people who inject drugs and improve offering of and referral to universal HBV vaccination for people who inject drugs.
Method: A knowledge, attitude and practice (KAP) survey related to hepatitis B and HBV vaccination will be conducted among 120 people who inject drugs, recruited through snowball sampling initiated at harm reduction centers in different parts of the country. Around 200 staff from the Georgian Harm Reduction Network (covering 26 non-governmental organizations/harm reduction centres) will receive training about HBV (covering epidemiology, clinical course and management, prevention and vaccination strategies), with specific focus on improving awareness and skills for promoting, offering and ensuring referral to HBV vaccination services. Printed information and education materials for people who inject drugs will be developed and distributed among the training participants at the end of each training session. Lastly, two-hour informational-educational sessions, guided by the KAP survey findings, will be offered to 50 volunteer people who inject drugs to enhance their knowledge, understanding, skills and motivation to receive HBV vaccination and promote it among their peers.
Output/impact: The study is expected to improve HBV vaccination coverage among people who inject drugs and thereby contribute to reducing the burden of HBV infection in this high-risk population. The KAP survey will provide valuable information about current gaps in awareness, knowledge, attitudes and practices about hepatitis B and HBV vaccination among people who inject drugs in Georgia and guide the development and implementation of targeted interventions to scale-up vaccination coverage. Increased awareness and knowledge about HBV vaccination among harm reduction staff will help fuel promotion and encouragement of vaccination services. In addition, education of voluntary users will help improve knowledge, attitudes and acceptability of HBV vaccination in their peer networks. The study coincides with current preparations for widescale national hepatitis B treatment and prevention activities and will generate information that can be used by policy makers for planning of the hepatitis B elimination program among key populations in Georgia.
DCRs as facilitators for testing, prevention and treatment for HCV for PWID in the Czech Republic
Grantee: Spolecnost Podane ruce o.p.s.
Project start: April 2023
Main applicant and principal investigator: Viktor Mravcik, MD, Assoc Prof, PhD; Head of Research and Education, Spolecnost Podane ruce o.p.s.
Deputy applicant: Barbara Janikova, BSc, MA, Head of Infections Research, Spolecnost Podane ruce o.p.s.
Background: An estimated 12,000 people who inject drugs are living with chronic hepatitis C (HCV) in the Czech Republic. Research has linked injection risk behaviour with transmission of blood-borne infections such as HCV, which continues to spread among people who inject drugs. A number of countries have implemented various harm reduction and prevention initiatives including drug consumption rooms (DCR), where people can inject drugs in a safe environment under the supervision of professional staff. In a study from 2016, two thirds of 49 DCRs which offered onsite HCV testing were able to test 80% of its clients, of whom 60% tested positive and were linked to treatment. In the Czech Republic, there are 100 low-threshold harm reduction programmes, but still no DCR.
Objective: The overall aim is to increase access to testing, prevention and treatment of HCV for people who inject drugs. The first DRC in the country will be established around mid-2023, offering sterile injection and other consumption materials, as well as testing for HIV, HCV and other blood-borne infections and linkage to treatment. The specific objective of this project is to conduct a study to assess the feasibility and effect of the DRC on achieving the overall aim of increasing testing, prevention and treatment of HCV. More specifically, the study will focus on the feasibility of setting up a DCR as well as the effect of the new DCR on injection risk behaviours, improvement of quality of life of the users, and the effect at community level.
Methods: The first part of the research will be to carry out a feasibility study, collecting information from both potential clients, community members and other stakeholders, before the DCR is set up. The feasibility study will cover: a suitable location, opening hours, client acceptance, community acceptance, needs and relevance of services offered, as well as legal barriers and how they can be overcome. To measure the effect of the DRC on the community, members of the general population will be randomly sampled. To measure the effect of the DRC on the target group, a total of 500 people who use drugs will be recruited using snowball sampling. Both quantitative and qualitative data will be collected through forms filled in by clients monthly when entering the DRC, and through interviews and focus group discussions. The data collected will cover the following topics: the type of services most used and accepted by clients, reasons for not seeking treatment, changes in risk behaviour of the clients, changes in physical and mental health of the clients, changes in social relations with peers and family members, changes in the quality of life of clients (incl. retention in treatment).
The study will provide country-specific evidence of the feasibility of establishing DCRs and of the effectiveness of DCRs in reducing transmission of HIV and HCV. It will also provide a better understanding of the needs, challenges and barriers for clients accessing testing and treatment services. Study results will be disseminated among key national and regional agencies with a view to revising national policies for management of HIV and co-infections among people who use drugs. The hope is to challenge existing views on tools to be included in national harm reduction programmes by demonstrating the effectiveness of DCRs. Expansion of DCRs is expected to have a considerable impact on reduction of the spread of HIV and HCV.
Identifying barriers to HIV and TB testing among key population groups in Azerbaijan: a mixed methods study
Grantee: NGO ‘Towards TB free Future Public Union’
Project start: August 2023
Main applicant and principal investigator: Parvana Valiyeva
Deputy applicant: Chingiz Ramazanli
Collaborators: Azerbaijan republican AIDS Center, Research Institute of Lung Diseases, WHO Collaborating Center on tuberculosis, TB Azerbaijan NGO Coalition, Harm Reduction Network.
Background: Key populations at higher risk of HIV and TB infection in Azerbaijan face multiple barriers for accessing essential HIV and TB services. Barriers are both structural, administrative, legislative and cultural and include challenges related to gender discrimination, human rights, stigmatization and fear of HIV/TB diagnosis disclosure. These barriers impede access to primary healthcare services, which is the main entry point for HIV and TB testing in the country, but also access to community-based testing services. In addition, testing and diagnosis rates have declined during and after the COVID-19 pandemic and should be restored and also improved.
Objective: The main aim of the project is to assess and describe the main barriers for HIV and TB testing faced by key population groups at higher risk of HIV and TB in Azerbaijan and develop an action plan with policy recommendations to address the identified barriers, ultimately aiming to improve the quality of HIV and TB care for the affected populations.
Method: This study will utilize both quantitative and qualitative methods. The quantitative part includes semi-structured questionnaire interviews with representatives of key populations for HIV (men who have sex with men, sex workers, transgender people, people with injecting drugs and people living with HIV and TB) and TB (ex-prisoners, migrants, refugee and internally displaced people, homeless people and TB patients and their household contacts). The qualitative part will consist of in depth-interviews and focus group discussions with health care workers, selected key population group members and community health workers. In addition, a desk review will map legislative/administrative barriers, national testing policies and good practice international experiences.
Output/impact: A key output from the study will an action plan with policy recommendations aiming at addressing the identified barriers. By mobilizing community members and engaging into dialogue with key stakeholders, the data generated through the study will be used in advocacy efforts with decision makers aimed at reducing the structural and human rights barriers to HIV/TB services for key populations. The project will also support research related capacity building through training of the involved project members, including training of interviewers in interview methods and recruitment procedures.