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Russia is home to more than 142 million people, including, according to UNAIDS, an estimated 1.1 million people who are living with HIV or AIDS. According to the Russian government, there have been 907,607 officially registered cases of HIV between 1987 and December 2014, with 85,252 new cases registered in 2014. There are some 9,004 children among these reported cases.
Injecting drug use has long been the primary driver of HIV infection in Russia, accounting for 57.3 percent of all cases; heterosexual transmission accounts for another 40.3 percent of reported HIV infections.
AIHA began working in Russia in 1992 with support from the U.S. Agency for International Development (USAID) and concluded operations in country at the end of 2012. From 2008 to March 2012, AIHA managed a highly successful Twinning Center initiative in Russia focusing on strengthening HIV/AIDS treatment, care, and support services in Orenburg and St. Petersburg. This project was supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID / Russia.
Russia HIV/AIDS Treatment, Care, and Support Initiative
(2008 – 2012)
Building on the efforts of four successful USAID-funded HIV/AIDS partnerships, AIHA implemented this initiative, which concluded in March 2012, in the PEPFAR target regions of St. Petersburg and Orenburg Oblast. Technical assistance focused on strengthening education and training of health and allied professionals on a broad range of HIV-related clinical care and social support.
In early 2012, when AIHA’s Russia HIV/AIDS Treatment, Care, and Support Initiative was concluding, WHO estimated that some 1 million people in the country were living with HIV — the equivalent of about 1 percent of the total population. At that time, roughly one-third of the people who inject drugs (PWID) in Russia were living with HIV or AIDS.
According to Russian government records for the same time period, there were 664,976 officially registered people living with HIV (PLHIV). The Federal AIDS Center reported that 565,074 of those individuals were alive and roughly 102,000 had initiated ART. Although there was controversy over how many people needed ART but were not yet receiving it, there was no doubt that Russia was — and still is — facing a maturing HIV epidemic.
With the support from PEPFAR and USAID / Russia, AIHA’s Russia HIV/AIDS Treatment, Care, and Support Initiative provided technical assistance to Russian partner institutions and healthcare providers in an effort to implement an integrated approach to HIV/AIDS treatment, care, and support, as well as a viable and innovative public health approach to scaling up ART provision.
The Russia HIV/AIDS Treatment, Care, and Support Initiative had its roots in AIHA’s very first HIV/AIDS partnerships, which were made possible when USAID / Russia granted AIHA a five-year extension to a previous cooperative agreement that ended in September 2003. This extension covered fiscal years 2004 through 2008 and was designed to help create comprehensive models of integrated care and treatment for PLHIV that could be replicated throughout Russia.
During the first half of the award period, the core of AIHA’s programming focused on building replicable models for HIV/AIDS treatment, care, and support at pilot sites in high-burden regions across Russia.
In July 2004, AIHA launched four partnerships linking:
- Orenburg with New York City;
- Samara Oblast with Providence, Rhode Island;
- Saratov with Bemidji, Minnesota; and
- St. Petersburg with New Haven, Connecticut.
These four partnerships linked U.S. and Russian care providers in a concerted effort to build the requisite institutional and human resource capacity needed to provide integrated, comprehensive treatment, care, and support to PLHIV in targeted regions of Russia.
Beginning in October 2006, AIHA’s USAID-supported HIV/AIDS program in Russia concentrated on the St. Petersburg and Orenburg partnerships in accordance with recommendations from USAID / Russia.
Both sites were looking to rapidly expand access to HIV/AIDS care and treatment through programs supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), as well as national and regional administrative bodies within Russia.
Starting in 2009, technical assistance from the U.S. partners and other experts focused on strengthening the capacity of target institutions in St. Petersburg and Orenburg related to:
- Simplified treatment regimens;
- Improved adherence to treatment;
- Quality Improvement through chart monitoring; and
- Management of opportunistic infections, including TB.
Sustainability of programs developed through the partnerships and local ownership were fostered through the increasing role in practitioner education and training played by Russian experts at the AIDS Training and Education Centers (ATECs) in St. Petersburg and Orenburg, which were established by AIHA in collaboration with the Government of Russia.
The medical curricula on AIDS treatment and care used at the ATECs were approved by the Ministry of Health and Social Development (MOHSD) and, when the project concluded in early 2012, were being used for postgraduate medical education at 15 institutions nationwide, with more expected to adopt the material during the subsequent months.