Dispatch from Lithuania

Knowledge Hubs: radiating expertise for HIV prevention, care and treatment across eastern Europe and beyond

1 February 2010

In Belarus, doctors, fresh from training at a pioneering clinic in Lithuania, have opened three new opioid substitution therapy programmes for people dependent on heroin and other opioids. By decreasing patients' craving for and use of these drugs, the programmes have reduced HIV transmission and other risks of injecting drug use; they have also boosted adherence to HIV treatment.

In Ukraine, hundreds of epidemiologists, health officials and representatives of nongovernmental organizations (NGOs), who have undergone training on second generation HIV surveillance developed by practitioners based in Croatia, are now conducting HIV surveillance of the highest standard.

In the Russian Federation, Ukraine, and Uzbekistan, thousands of doctors, nurses and social workers who complete courses in HIV care and treatment provided by the Knowledge Hub on HIV/AIDS treatment and care will now have their qualifications recognized by national institutions—a big step towards ensuring that all people in need of quality HIV care will get it, and for years to come.

These examples illustrate how three Knowledge Hubs in central and eastern Europe, conceived and supported by WHO, the German BACKUP Initiative—a programme of the German Technical Cooperation (GTZ)—and other partners, are accelerating the scale-up of quality HIV services across eastern Europe, central Asia and beyond.

Like other WHO Knowledge Hubs in Africa and the Middle East, the three Knowledge Hubs in central and eastern Europe are nuclei of regional and international experts that provide technical assistance, training and networking for comprehensive responses to HIV across whole regions. This includes helping countries adapt and implement WHO and UNAIDS tools and guidelines.

Knowledge Hubs complement each other by focusing on distinct HIV services—surveillance, prevention, care and treatment. They use technical experts from the region—rather than relying exclusively on international consultants—and tailor training and assistance to the specific demands and needs of different countries and regions. This fosters regional exchange of best practice and helps to develop the capacity needed for effective and sustainable HIV services.

In eastern Europe and central Asia the need is urgent. These regions are home to some of the world’s fastest growing HIV epidemics, burdening the health systems of large countries such as Ukraine and the Russian Federation.

Injecting drug use remains the primary route of transmission in these regions and in many countries drug users frequently engage in sex work, magnifying the risk of transmission. However, prevention services for drug users and sex workers are often inadequate, and while countries have expanded antiretroviral therapy, only an estimated 23% of adults in need in eastern Europe and central Asia were receiving this treatment at the end of 2008.1

The Harm Reduction Knowledge Hub for Eastern Europe and Central Asia, based in Vilnius, Lithuania, has only one full time staff member, but it exerts considerable influence through its strong network of trainers, advocacy and technical support.

In 2005, for example, the Vilnius Hub asked psychiatrists and social workers at the Vilnius Centre for Addictive Disorders to develop a training module on opioid substitution therapy. (The Centre was known for its research and had pioneered harm reduction and drug treatment programmes, informed by WHO guidelines, for a decade. Many observers believe it deserves much of the credit for Lithuania’s low rates of HIV).

The Vilnius Hub used the course developed by the Vilnius Centre for Addictive Disorders to train physicians in Estonia, Kyrgyzstan, Latvia, Moldova, Tajikistan and Uzbekistan, among other countries—and, as noted in the example of Belarus, to good effect. By early 2009, the Hub had provided 35 training courses, reaching more than 600 participants in 19 countries.

The ripple effects of the Knowledge Hub for Capacity Development in HIV Surveillance, in Zagreb, Croatia, have been even more widespread. Based at the Andrija Stampar School of Public Health, a WHO Collaborating Centre, the Hub draws on distinguished Croatian trainers and experts, while working closely with the London School of Hygiene and Tropical Medicine, the University of California (San Francisco) and WHO, among others. This Hub has contributed to the marked improvement of HIV surveillance in eastern Europe, and has conducted important research on most-at-risk populations throughout the region.2

The 32 Ukrainians who have completed courses in Zagreb have adapted Hub curricula to train 200 other Ukrainian health professionals in second-generation HIV surveillance, the WHO gold standard. (Second-generation surveillance supplements HIV epidemiological data with information on key behaviours and sexually transmitted infections). As a result, Ukraine has experienced what an evaluation called a “shift in ideology”: researchers now merge biological and behavioural data on HIV in most-at-risk populations.

Additionally, in its first five years, the Zagreb Hub has trained more than 200 professionals from North Africa and the Middle East, building human resources to establish HIV surveillance systems across these vast regions. Since 2004, the Zagreb Hub has provided 38 courses for 829 participants from 60 countries.

The Regional Knowledge Hub for Care and Treatment of HIV/AIDS in Eurasia is based in St Petersburg. Its core staff is small (a five-person, part-time team), but its impact is not. Since 2004, this Hub has developed 40 courses, most on the provision of antiretroviral therapy. It has also mobilized regional consultants and clinical training centres to provide 201 courses for more than 5000 participants from ten countries of eastern Europe and central Asia. This training has helped to extend antiretroviral therapy to an estimated 50 000 people with HIV.

Perhaps as important, training institutions in the Russian Federation and Ukraine are now recognizing the qualifications of health workers who complete specific courses developed and conducted by the Hub. Uzbekistan will do the same in 2010—institutionalizing the Hub training—for the benefit of HIV care and treatment in these countries for years to come.

Article written by James Boothroyd.