1

Translating Research into Action in a Challenged Region: Programs to Stem the

Tide of HIV in Eastern Europe and Central Asia

Jack A. DeHovitz, MD, MPHDistinguished Service Professor, Department of Medicine

Director, New York State International Training and Research ProgramSUNY Downstate Medical Center

Brooklyn, NY

March 16, 2018

Consortium of Universities for Global Health

http://www.downstate.edu/gallery/logos/DMSLogo-Final-cmyk.eps

Antecedents of Estonian EpidemicIncidence of HBV/HCV Infections and Absolute Number of

HIV Infections in Estonia, 1988-2002

Uuskula, A. et al Int J Inf Dis. 2002; 6(1): 23-7.

Source: David Guttenfelder/Associated Press, 2005

Source:

Major Drug Trafficking Routes

Russia

Map: GoogleEarth

China

Afghanistan

Almaty

UNODC, 2008

Reported routes of HIV transmission*, byEuropean sub-region, 2015

7

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

Region West Centre* Among those with known route of transmission

East

Source: ECDC/WHO (2016). HIV/AIDS Surveillance in Europe, 2015

Heterosexual

Sex betweenmen

Injecting druguse

Mother to child

Estimated new HIV infections are decreasing globally

1,400,000

1,600,000

1,800,000

2,000,000

2,200,000

2,400,000

2,600,000

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Num

bero

fnew

diag

nose

s(gl

obal

)

Year of diagnosis

Source: ECDC/WHO (2016). HIV/AIDS Surveillance in Europe, 2015. UNAIDS/WHO global estimates.

GlobalGlobal

Estimated new HIV infections are decreasing globally, but increasing in the WHO European Region

0

40,000

1,600,00020,000

60,000

80,000

120,000

2,200,000

100,000

140,000

160,000

180,000

1,400,000

1,800,000

2,000,000

2,400,000

2,600,000

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Num

bern

ewdi

agno

ses(

Euro

pean

regi

on)

Num

bero

fnew

diag

nose

s(gl

obal

)

Year of diagnosis

Global

WHOEuropean Region

Source: ECDC/WHO (2016). HIV/AIDS Surveillance in Europe, 2015. UNAIDS/WHO global estimates.

Estimated new HIV infections are decreasing globally, but increasing in the WHO European Region

0

20,000

40,000

60,000

80,000

120,000

2,200,000

100,000

140,000

160,000

180,000

1,400,000

1,600,000

1,800,000

2,000,000

2,400,000

2,600,000

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

WHOEuropean Region

Global

East

West

Centre

Source: ECDC/WHO (2016). HIV/AIDS Surveillance in Europe, 2015. UNAIDS/WHO global estimates.

Global Progress Towards 90-90-90

Progress Towards 90-90-90 in Eastern Europe and Central Asia

Availability of Needle & Syringe Exchange Programmes (NSP) and Opioid Substitution Therapy (OST) in EECA

Both NSP and OST

NSP only

HRI. The Global State of Harm Reduction 2016

Number of Needles/Syringes Distributed per Person per Year in EECA

Number of needles/syringes distributed per PWID

UNAIDS AIDSInfo. http://aidsinfo.unaids.org/

Recommended Level

http://aidsinfo.unaids.org/Chart1

Tajikistan

Estonia

Kyrgyzstan

Kazakhstan

Lithuania

Georgia

Moldova

Latvia

Armenia

Ukraine

Uzbekistan

Belarus

Azerbaijan

Series 1

345.4

230

152.8

119.7

101.8

90.9

87.5

84.4

72.1

71.3

62.3

41.1

34.4

Sheet1

Series 1Series 2Series 3

Tajikistan345.42.42

Estonia2301.83

Kyrgyzstan152.84.42

Kazakhstan119.72.85

Lithuania101.8

Georgia90.9

Moldova87.5

Latvia84.4

Armenia72.1

Ukraine71.3

Uzbekistan62.3

Belarus41.1

Azerbaijan34.4

Percentage of People with Opioid Dependence Use Receiving OST,

2015

UNAIDS Prevention Gap Report, 2016

New York State International Training and Research Program 25 year Fogarty HIV Research Training focused

on Eastern Europe and Central Asia Linked closely with multiple NY State based

training efforts Over 110 graduates with a 93% return rate Over 1100 publications subsequent to training

with >50 extramural grants Currently focused on implementation science

training14

Translating Research into Action in a Challenged Region: Programs to Stem the Tide of HIV in Eastern Europe and Central AsiaAntecedents of Estonian EpidemicSlide Number 3Slide Number 4Reported routes of HIV transmission*, by�European sub-region, 2015Estimated new HIV infections are decreasing globallySlide Number 7Slide Number 8Global Progress Towards 90-90-90Progress Towards 90-90-90 in Eastern Europe and Central AsiaAvailability of Needle & Syringe Exchange Programmes (NSP) and Opioid Substitution Therapy (OST) in EECANumber of Needles/Syringes Distributed per Person per Year in EECAPercentage of People with Opioid Dependence Use Receiving OST, 2015New York State International Training and Research Program