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1.  Methadone and buprenorphine-naloxone are effective in reducing illicit buprenorphine and other opioid use, and reducing HIV risk behavior – Outcomes of a Randomized Trial 
Drug and alcohol dependence  2013;133(2):10.1016/j.drugalcdep.2013.06.024.
Aims
Determine the extent to which buprenorphine injectors continue treatment with buprenorphine-naloxone or methadone, and the impact of these treatments on substance use and HIV risk in the Republic of Georgia.
Methods
Randomized controlled 12-week trial of daily-observed methadone or buprenorphine-naloxone followed by a dose taper, referral to ongoing treatment, and follow-up at week 20 at the Uranti Clinic in Tbilisi, Republic of Georgia. Eighty consenting treatment-seeking individuals (40/group) aged 25 and above who met ICD-10 criteria for opioid dependence with physiologic features and reported injecting buprenorphine 10 or more times in the past 30 days. Opioid use according to urine tests and self-reports, treatment retention, and HIV risk behavior as determined by the Risk Assessment Battery.
Results
Mean age of participants was 33.7 (SD5.7), 4 were female, mean history of opioid injection use was 5.8 years (SD4.6), none were HIV+ at intake or at the 12-week assessment and 73.4% were HCV+. Sixty-eight participants (85%) completed the 12-week medication phase (33 from methadone and 35 from buprenorphine/naloxone group); 37 (46%) were in treatment at the 20-week follow-up (21 from methadone and 16 from the buprenorphine/naloxone group). In both study arms, treatment resulted in a marked reduction in unprescribed buprenorphine, other opioid use, and HIV injecting risk behavior with no clinically significant differences between the two treatment arms.
Conclusions
Daily observed methadone or buprenorphine-naloxone are effective treatments for non-medical buprenorphine and other opioid use in the Republic of Georgia and likely to be useful for preventing HIV infection.
doi:10.1016/j.drugalcdep.2013.06.024
PMCID: PMC3818507  PMID: 23916321
buprenorphine abuse; treatment; Republic of Georgia
2.  Factors Associated with HIV Testing History among Pregnant Women and Their Partners in Georgia: The ANRS 12127 Prenahtest Trial 
AIDS Research and Treatment  2014;2014:356090.
Despite the benefits of timely diagnosis of HIV infection and the wide availability of VCT services, the acceptance of HIV testing and counseling still remains a challenge in Georgia. The goal of our study was to assess the history of HIV testing and associated factors among pregnant women. The recruitment of study participants took place during routine antenatal care visits at one of the large Maternity Hospitals in Tbilisi, capital of Georgia. A total of 491 pregnant women were included in the sample. More than a third of women (38.5%) reported that they were tested for HIV before the current pregnancy and almost all of them (91.5%) were tested during previous pregnancies. Bivariate analysis revealed statistically significant association of women's history of HIV testing with age, education level, remunerated activity, history of STI, and multiparity. In multivariate analysis, the only independent predictor of being HIV tested was ever being pregnant. In conclusion, HIV testing history among women at reproductive age was poor in Georgia. Women mostly received HIV testing at prenatal centers. Efforts should be made to promote HIV testing in primary care settings, which would increase its acceptability and overall testing rate in the population.
doi:10.1155/2014/356090
PMCID: PMC4195251  PMID: 25328692
3.  Attitudes and knowledge of Georgian physicians regarding cervical cancer prevention, 2010 
Objective
To document Georgian physician’s knowledge, attitudes, and practices concerning HPV, Pap smear testing, and HPV vaccination, and to assess whether physician practice might change with additional education and training.
Methods
A cross-sectional study was conducted using a self-administered written survey of 288 physicians practicing in 7 healthcare institutions in Tbilisi, Rustavi, and Batumi, Georgia. Data were collected on demographics, conduct of and perceived barriers to Pap smear testing, knowledge about HPV and HPV vaccination, and willingness to receive education and training about HPV and cervical cancer. Univariate counts and proportions were calculated. Pap smear testing and barriers were compared across demographics using bivariate and Poisson regression with robust error variance methods.
Results
Overall, 54% of physicians never performed Pap smears; most reported testing was not their responsibility. Most (88%) obstetricians/gynecologists performed Pap smears. Younger physicians were more likely to perform Pap smears. Approximately 48% of physicians actively offered the HPV vaccine. Most physicians were receptive to increased education and training about HPV and cervical cancer.
Conclusion
Age-related differences in the conduct of and attitudes toward Pap smear testing exist among Georgian physicians. There is an opportunity to increase Pap smear testing and provide evidence-based HPV vaccine counseling in Georgia.
doi:10.1016/j.ijgo.2013.01.016
PMCID: PMC3642210  PMID: 23497751
Cervical cytology; Human papillomavirus; Vaccine
4.  Associated factors for recommending HBV vaccination to children among Georgian health care workers 
BMC Infectious Diseases  2012;12:362.
Background
Most cases of hepatitis B virus (HBV) infection and subsequent liver diseases can be prevented with universal newborn HBV vaccination. The attitudes of health care workers about HBV vaccination and their willingness to recommend vaccine have been shown to impact HBV vaccination coverage and the prevention of vertical transmission of HBV. The purpose of this study was to ascertain the factors associated with health care worker recommendations regarding newborn HBV vaccination.
Methods
A cross-sectional study of prevalence and awareness of hepatitis B and hepatitis B vaccine was conducted among randomly selected physicians and nurses employed in seven hospitals in Georgia in 2006 and 2007. Self-administered questionnaires included a module on recommendations for HBV, HCV and HIV.
Results
Of the 1328 participants included in this analysis, 36% reported recommending against hepatitis B vaccination for children, including 33% of paediatricians. Among the 70.6% who provided a reason for not recommending HBV vaccine, the most common concern was an adverse vaccine event. Unvaccinated physicians and nurses were more likely to recommend against HBV vaccine (40.4% vs 11.4%, PR 3.54; 95% CI: 2.38, 5.29). Additionally, health care worker age was inversely correlated with recommendations for HBV vaccine with older workers less likely to recommend it.
Conclusion
Vaccinating health care workers against HBV may provide a dual benefit by boosting occupational safety as well as strengthening universal coverage programs for newborns.
doi:10.1186/1471-2334-12-362
PMCID: PMC3544730  PMID: 23256746
Hepatitis B; Vaccine; Safety; Health Care Worker; Newborns
5.  Descriptive epidemiology of Pap test results from women with gynecologic symptoms in Georgia 
Synopsis
With abnormal cervical cytology found in approximately 20% of Georgian women presenting with gynecologic complaints, widespread education is needed about Pap testing when symptoms are present.
doi:10.1016/j.ijgo.2010.11.003
PMCID: PMC3039132  PMID: 21272882
Cervical cytology; High risk; Pap test
7.  Couple-oriented prenatal HIV counseling for HIV primary prevention: an acceptability study 
BMC Public Health  2010;10:197.
Background
A large proportion of the 2.5 million new adult HIV infections that occurred worldwide in 2007 were in stable couples. Feasible and acceptable strategies to improve HIV prevention in a conjugal context are scarce. In the preparatory phase of the ANRS 12127 Prenahtest multi-site HIV prevention trial, we assessed the acceptability of couple-oriented post-test HIV counseling (COC) and men's involvement within prenatal care services, among pregnant women, male partners and health care workers in Cameroon, Dominican Republic, Georgia and India.
Methods
Quantitative and qualitative research methods were used: direct observations of health services; in-depth interviews with women, men and health care workers; monitoring of the COC intervention and exit interviews with COC participants.
Results
In-depth interviews conducted with 92 key informants across the four sites indicated that men rarely participated in antenatal care (ANC) services, mainly because these are traditionally and programmatically a woman's domain. However men's involvement was reported to be acceptable and needed in order to improve ANC and HIV prevention services. COC was considered by the respondents to be a feasible and acceptable strategy to actively encourage men to participate in prenatal HIV counseling and testing and overall in reproductive health services.
Conclusions
One of the keys to men's involvement within prenatal HIV counseling and testing is the better understanding of couple relationships, attitudes and communication patterns between men and women, in terms of HIV and sexual and reproductive health; this conjugal context should be taken into account in the provision of quality prenatal HIV counseling, which aims at integrated PMTCT and primary prevention of HIV.
doi:10.1186/1471-2458-10-197
PMCID: PMC2873579  PMID: 20403152

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