GENDER RELATED BARRIERS AMONG HIV INFECTED INDIVIDUALS.

Late detection of HIV infection still remains serious problem for Georgia. During the last years prevalence and late detection of HIV infection is increasing among females and therefore, attempts to implement services adapted to female needs have significantly increased. It is essential to conduct research to create a basis for country's national response of HIV infection to become more gender sensitive. The goal of our study was to conduct survey among HIV-positive individuals to identify potential gender-based barriers and contributing factors that might influence timely diagnosis and treatment of HIV infection. Cross sectional study design was used. Target population included HIV-infected persons. Study subjects were selected by simple random sampling. Study participants were sampled from the registry of HIV infected patients. Quantitative data were collected through individual, face-to-face interviews, using specially designed questionnaire for this study. In total 182 HIV-infected individuals participated in survey, of whom 74 (40.6%) were females and 108 (59.6) were males. The level of awareness and knowledge on HIV/AIDS was similar in both male and female HIV positive individuals, although a higher proportion of men than women have heard of HIV/AIDS before their diagnosis. HIV infection is more stigmatizing for women than men. Fear of being abandoned by both community and family due to HIV/AIDS diagnosis was higher among female respondents. Higher proportion of male respondents than women reported an illness-related unemployment. Women were more likely to hide their diagnosis from other people compared to men. Higher proportion of female compared to male respondents reported notifying family members about their HIV status. Significantly higher proportion of female HIV-infected individuals have been accompanied by a family member on visit to physician due to HIV/AIDS compared to male HIV-infected respondents. A higher proportion of men than women reported an interruption/discontinuation of treatment regimen. Georgia has ensured free and unrestricted access to HIV service for all HIV infected individuals in the country. However, the stigma related to HIV still creates barriers to service utilization. Therefore, HIV national program should continue implementation of focused and concerted interventions to improve HIV awareness among gender populations.

GENDER RELATED BARRIERS TO TUBERCULOSIS IN GEORGIA.

The morbidity and mortality burden of tuberculosis (TB) remains high in Georgia, including drug-resistant TB. A survey was conducted to identify potential gender-based barriers and contributing factors that might influence the timely diagnosis and treatment of TB among active and former TB patients. To assess TB-related stigma and discrimination, a quantitative study was conducted to identify gender-based barriers to the diagnosis and treatment of TB among current and former patients. The study subjects were selected by a simple random sampling method with a 1:1 gender ratio. Participation in the study was voluntary. Data were collected by individual, face-to-face interviews. The patients' registry of the National Center for Tuberculosis and Lung Disease was used as the sampling frame to select patients either currently on anti-tuberculous treatment as well as former TB patients, who completed or discontinued treatment. A total of 230 patients on current anti-tuberculosis treatment or former patients who have been treated for tuberculosis participated in the study. Half of the participants (115, 50%) were male. No significant gender difference was detected with respect to awareness and knowledge about tuberculosis. Stigma associated with TB was found to be higher among women than men. Compared to men, more female respondents than males reported a negative change in attitude from other people after their TB diagnosis (14.8% vs 8.7%, respectively). A higher proportion of women than men notified a family member upon deciding to visit a doctor due to TB symptoms and, similarly, more women were accompanied by a family member for the first physician visit related to tuberculosis. In Georgia, as in other countries around the world, men are more likely to be infected with TB than women. However, the stigma related to TB introduces barriers to service utilization. Barrier reduction programs should consider more comprehensive gender assessment and in-depth analysis of the epidemiological situation by economic status, living conditions, regions, employment status, and ethnicities. Effective interventions may reduce barriers and contribute to the timely diagnosis and treatment of TB.

Cost of TB services in the public and private sectors in Georgia (No 2).

BACKGROUND: Patient-centred care along with optimal financing of inpatient and outpatient services are the main priorities of the Georgia National TB Programme (NTP). This paper presents TB diagnostics and treatment unit cost, their comparison with NTP tariffs and how the study findings informed TB financing policy.METHODS: Top-down (TD) and bottom-up (BU) mean unit costs for TB interventions by episode of care were calculated. TD costs were compared with NTP tariffs, and variations in these and the unit costs cost composition between public and private facilities was assessed.RESULTS: Outpatient interventions costs exceeded NTP tariffs. Unit costs in private facilities were higher compared with public providers. There was very little difference between per-day costs for drug-susceptible treatment and NTP tariffs in case of inpatient services. Treatment day financing exceeded actual costs in the capital (public facility) for drug-resistant TB, and this was lower in the regions.CONCLUSION: Use of reliable unit costs for TB services at policy discussions led to a shift from per-day payment to a diagnosis-related group model in TB inpatient financing in 2020. A next step will be informing policy decisions on outpatient TB care financing to reduce the existing gap between funding and costs.