Around the world, the long distances that stand between remote communities and health facilities hinder many people from accessing the lifesaving health services they need. Millions of people globally cannot reach health care within one hour by motorized transport and billions cannot reach a health facility by foot within one hour.

In East Kazakhstan, which is predominately mountainous and rural, ICAP at Columbia University is helping close the gaps that limit access to health care by decentralizing HIV services offered by health care providers located within remote areas.

Many communities in the East Kazakhstan region are several miles from the closest AIDS center, which provides antiretroviral treatment (ART) for people living with HIV. Without initiation and adherence to ART, there is a much greater risk of a person living with HIV becoming seriously ill or infecting a partner with the virus. Not only does the long distance to the AIDS center impede a person living with HIV from adhering to ART, but it also hinders those with new infections from initiating the HIV treatment, not to mention doing so early enough to prevent the disease from progressing.

In November 2022, in collaboration with the East Kazakhstan AIDS Center, and with support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC), ICAP conducted a training for primary health care workers from remote areas in the East Kazakhstan region on how to provide early initiation of ART. With the aim of decentralizing HIV services in the cities of Altai, Shemonaikha, and Glubokoe, ICAP’s trainers have shown these local health care providers how to counsel patients under online supervision from specialists at the East Kazakhstan AIDS Center. Following these initial consultations, the providers are available to support people living with HIV to initiate ART within seven days of diagnosis at the health facility in their own community.

“Decentralization of HIV services is vital for ensuring that people living with HIV can receive the treatment they need as early in their diagnosis as possible,” said Anna Deryabina, MD, DrPH, MScIH, regional director of ICAP in Eurasia. “The trainings we are providing are giving health care workers the tools and knowledge they need to make that possible. In addition to the obvious health benefits this will give patients, early initiation of ART at local health facilities limits the constant travel back and forth from people’s communities to the East Kazakhstan AIDS Center, which will save patients time and money in the long-term.”

During the training, health care providers learned about post-test HIV counseling, HIV treatment and adherence, and other HIV health concepts, such as the UNAIDS 95-95-95 targets, and alongside experts from the AIDS center. While the training focused on practical steps for quickly initiating a person living with HIV on ART, it also emphasized the importance of health care worker sensitivity around an HIV-positive status. Stigma surrounding HIV continues to pervade East Kazakhstan, especially in rural areas. People newly diagnosed with HIV often postpone visiting local physician’s offices for fear of their HIV status becoming public knowledge and being ostracized by their local community. For this reason, topics such as identifying confidentiality issues with patients and building trust between provider and patient also figured into the training.

“It is important to work with patients in a way that makes them feel supported by health care workers, especially when we inform them about their diagnosis,” said Natalia Korotkova, infectious disease specialist at a health care organization in Altai who attended the training. “The training gave me confidence that I was doing my post-test counseling correctly. A patient’s psychological comfort is the first step to consistent adherence to antiretroviral therapy.”

Health care providers who attended the training

Following the training in November, physicians in East Kazakhstan began prescribing ART within the first seven days of diagnosis at patient primary health care facilities under the supervision of physicians from the East Kazakhstan AIDS Center.

“Now we are providing monitoring and necessary mentoring assistance that will help to address any problems that otherwise would arise in the future,” said Yelena Kudussova, deputy clinical director of ICAP in Central Asia.

In addition to Kazakhstan, ICAP is also working to improve early initiation of ART for people living with HIV in other parts of Central Asia, including Tajikistan. Recently, ICAP collaborated with the Republican AIDS Center in Tajikistan and local partners to execute revisions to national guidelines outlining that people living with HIV should be initiated on ART within seven days of diagnosis.

About ICAP

A major global health organization that has been improving public health in countries around the world for two decades, ICAP works to transform the health of populations through innovation, science, and global collaboration. Based at Columbia Mailman School of Public Health, ICAP has projects in more than 40 countries, working side-by-side with ministries of health and local governmental, non-governmental, academic, and community partners to confront some of the world’s greatest health challenges. Through evidence-informed programs, meaningful research, tailored technical assistance, effective training and education programs, and rigorous surveillance to measure and evaluate the impact of public health interventions, ICAP aims to realize a global vision of healthy people, empowered communities, and thriving societies. Online at icap.columbia.edu

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