Amiran Gamkrelidze – Director General of the National Centre for Disease Control and Public Health of Georgia – the lead institution in charge of prevention and control of communicable and non-communicable diseases.
According to Mr Gamkrelidze, Georgia will transition from the Global Fund funding to national funding without losses, and all proposals in this regard will be taken into account in the process of planning the budget for 2016-2019 and subsequent years.
– Georgia started to work with the Global Fund in 2003, when we received a grant for three areas: HIV/AIDS, tuberculosis and malaria. In total, since then we have received about 100 million dollars.
The cooperation has been very successful, and today Georgia is the only country in Eastern Europe and the former Soviet Union with the universal availability of antiretroviral drugs. Treatment is provided for all those who need it (and there are about 2,600 people). According to the international guiding documents, the availability of drugs should be about 80% of the estimated number of people in need of treatment. Our belief in the 100% availability is based on the fact that all registered patients receive treatment.
It should be noted that the HIV programs serve as a kind of bridge between us and Abkhazia, as via us and the Global Fund Abkhazian patients have access to antiretroviral therapy.
How is the tuberculosis control program implemented?
– In this area we have achieved good results as well: with the support of the Global Fund, we treat patients with multidrug-resistant (MDR) TB. It is about 5,000 patients. In addition, with the Global Fund support, we provided bonuses to those who actively collaborated with doctors on their treatment issues. Previously, we gave them food packages to such patients.
And what about prevention programs – are they just as successful?
– With regard to preventive measures, we cannot boast about similar results. The main route of transmission in Georgia is injections. And 7-8 years ago drug use was the cause of 70% of infections. Today the statistics of getting infection this way decreases, and, at the same time, heterosexual transmission and transmission among MSM (men having sex with men) increases. The ratio of injection transmission to sexual transmission is about 50:50. Therefore, prevention programs need to be further developed.
100% coverage with treatment, opioid substitution therapy for nearly 3,000 people, needle and syringe programs, counseling - will the government be able to cope with all of this without the Global Fund support?
– Current HIV/AIDS grants will end this year, TB grants will end in the middle of next year. We have already submitted a new application, and, I think – this grant will be approved. And with the new funding mechanism, we will continue receiving funding for another three years. But the share of the Global Fund's participation in the program overall will be gradually decreasing and the state's share will be increasing.
The government held a lengthy discussion on this issue, and our suggestions developed jointly with the Ministry of Health to increase the share of the state funding have already been included in the four-year budget planning cycle. Therefore, during 2017–2019 all programs in Georgia will transition to national funding. The state funded opioid substitution treatment program already provides treatment to about 2,400 patients that constitutes about 75% of all patients receiving this treatment, and beginning in 2017 we will take on funding of the substitution treatment programs that are currently funded by the Global Fund. Of course it is challenging, but we realize the importance of these programs. Good results were achieved with the Global Fund support and we should continue developing these programs.
Does this mean that you will scale-up these programs?
– Of course. As you probably know, this year we started a very ambitious program that aims to eradicate hepatitis C. This program intersects with the HIV/AIDS program and will be implemented simultaneously. In Georgia in 2011 hepatitis С treatment was first provided to patients with co-infections who were treated with interferon and ribavirin. Starting this year, Georgia receives new generation antiviral medications, which demonstrate 90%-95% treatment success. About 3,200 patients have already participated in this program and beginning next year we will provide this treatment to about 20,000 people annually.
Aren’t you expecting migrants? People from neighboring countries will come to you to seek treatment…
– This treatment is for Georgian citizens, including for those living in Abkhazia and Southern Ossetia. If those who come receive the Georgian citizenship, then they will receive treatment – yes, of course.
What does the Ministry of Finance of Georgia say about the support for all treatment and prevention programs? Do they advise to cut down anything?
– When in 2012 the new government of Georgia changed, healthcare was announced one of political priorities. In 2013 the Ministry of Finance doubled the healthcare budget and since then it has been gradually investing more and more into healthcare. The state realizes that the health and education of citizens are very important. The Ministry of Finance has a good ongoing cooperation with the Ministry of Health. We feel that they fully understand our goals.