IntroductionAn accurate estimation of the population size of men who have sex with men (MSM) is critical to the success of HIV program planning and to monitoring of the response to epidemic as a whole, but is quite often missing. In this study, our aim was to estimate the population size of MSM in Tbilisi, Georgia and compare it with other estimates in the region.MethodsIn the absence of a gold standard for estimating the population size of MSM, this study reports a range of methods, including network scale-up, mobile/web apps multiplier, service and unique object multiplier, network-based capture-recapture, Handcock RDS-based and Wisdom of Crowds methods. To apply all these methods, two surveys were conducted: first, a household survey among 1,015 adults from the general population, and second, a respondent driven sample of 210 MSM. We also conducted a literature review of MSM size estimation in Eastern European and Central Asian countries.ResultsThe median population size of MSM generated from all previously mentioned methods was estimated to be 5,100 (95% Confidence Interval (CI): 3,243 ~ 9,088). This corresponds to 1.42% (95%CI: 0.9% ~ 2.53%) of the adult male population in Tbilisi.ConclusionOur size estimates of the MSM population (1.42% (95%CI: 0.9% ~ 2.53%) of the adult male population in Tbilisi) fall within ranges reported in other Eastern European and Central Asian countries. These estimates can provide valuable information for country level HIV prevention program planning and evaluation. Furthermore, we believe, that our results will narrow the gap in data availability on the estimates of the population size of MSM in the region.

Marginal changes in access to services and the geographically diverse impact of the MIP on service utilization points to other factors affecting health-seeking behaviour of the insured. These other factors include private insurer behaviour that may have used strategies for reducing claims and managing utilization. Equity impact of the MIP and improved financial protection, especially for the poor, are benefits to be retained by government policies when universal health coverage is rolled out nationwide and all citizens will be covered. The role of private insurance companies as financial intermediaries of the publicly funded programme needs further evaluation before moving forward.

BackgroundThe HIV epidemic in Georgia is increasing. Data shows that compared to previous years, Georgia has increasingly more HIV-infected individuals than previous assessments. Select client groups remain hard to reach by harm reduction programs. The need for innovative strategies to involve these individuals is imperative.MethodsThe following study examines demographics and risk factors of participants, previously known and not known to harm reduction services, for HIV and other infectious disease in towns across Georgia in 2015 and compares risk among different groups, while also assessing the rationale for implementing Peer-Driven Interventions in Georgian Harm Reduction activities. Important differences in demographics and risk profile are thought to exist between those exposed, and those unexposed, to harm reduction activity.ResultsImportant and striking differences between previously known and unknown participants, including demographic background and risk profile and behaviours exist in the drug using community. These differences can potentially explain some of the rise of HIV prevalence in Georgia.ConclusionSignificant differences exist between known and unknown drug users in Georgia, the differences between which are crucial for planning future and holistic harm reduction activities in Georgia, regionally and globally. The research advocates for smarter harm reduction activity, adds to the global evidence for the utility of Peer-Driven Intervention, and encourages sustained global effort for reduction of blood-borne disease burden globally.

ObjectivesThe aim of the study was to investigate HIV testing practice among female sex workers (FSWs) and men who have sex with men (MSM) in Tbilisi, Georgia and to identify determinants of never testing behaviour among MSM. MethodsData obtained in two rounds of bio-behavioural surveys among FSWs (2006and 2009) and MSM (2007 were analysed. Determinants of never testing behaviour among MSM were investigated among 278 respondents recruited in 2010 through respondent-driven sampling. ResultsKnowledge about the availability of HIV testing and never testing behaviour did not show changes among FSWs and MSM. Every third FSW and every second MSM had never been tested for HIV according to the latest surveys in 2010. In bivariate analysis among MSM, consistent condom use during anal intercourse with a male partner in the last year, awareness of HIV testing locations and preventive programme coverage were negatively associated with never testing behaviour, while those who considered themselves at no risk of HIV transmission were more likely to have never been tested. In multivariate analysis, lower odds of never testing for HIV remained for those who were aware of HIV testing locations [adjusted odds ratio (AOR) 0.12; 95% confidence interval (CI) 0.04-0.32] and who reported being covered by HIV prevention programmes (AOR 0.26; 95% CI 0.12-0.56). ConclusionsIn view of the concentrated HIV epidemic among MSM in Georgia and the low rate of HIV testing uptake, interventions in this key population should take into consideration the factors associated with testing behaviour. The barriers to HIV testing and counselling uptake should be further investigated. SHORT COMMUNICATION 29Our research aimed to evaluate HIV testing and to identify determinants of never testing practice based on two rounds of Bio-BSSs conducted among FSWs (2006and 2009) and MSM (2007 in Tbilisi, Georgia. MethodsFSWs were recruited through time-location sampling (TLS), with a sample size of 160 for each round of the survey. TLS is a probabilistic method where recruitment of respondents from a hidden population is carried out at specific times in set venues. Recruitment of MSM was carried out through respondent-driven sampling (RDS). RDS is a modified form of snowball sampling, where the sample is weighted to compensate for not being randomly selected. RDS allows networks of study participants to be identified. This method is based on the assumption that peers are better able than researchers to recruit members of a hidden population. In the 2007 and 2010 surveys, 140 and 278 MSM were recruited, respectively.Inclusion criteria for FSWs were age ≥ 18 years and involvement in commercial sex in Tbilisi. Inclusion criteria for MSM were age ≥ 18 years, homosexual contact with a male partner during the last 12 months and Tbilisi residency. Anonymous face-to-face interviews were conducted using standardized behaviour questionnaires. Data were analysed with SPSS (18.0; IBM Software Group, Somers, NY). The study protocols and questionnaires were approved by the E...

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.