Mid-term project report

Name of the project:

Development of the curriculum and distant learning program on control of communicable diseases for PHC professionals (CME courses) and general public. PHC 002.

Executive summary

According to the SIDA/SEEC/NPMP "St.Petersburg School of Public Health" agreement work on the project started April,2003. Project end - January, 2004. Work done so far:

- needs assessment performed

- goal of the course formulated

- objective stated

- reviewed more that 11700 pages of foreign-language literature

- translated 753 pages and converted to HTML

- prepared 401 pages of Russian-language material (found, assessed, converted to HTML/PDF)

- prepared 451 pages of Russian-language newspapers/ journals clippings (found, assessed, converted to HTML/PDF)

- Totally 1604 page of material prepared for inclusion in course materials

- Advance organizers for 2 submodules written

- Technology analyzed, reports prepared

- Analysis of workload perfomed, rules for workload calculation established

- Total course workload now is about 85 credit houres, or 2.7 ECTS credits.

Report

The financing of the project has been opened in the second half of December, 2002

Main source of financing - SIDA/ Swedish Eastern Europe Committee

(SEEC). Secondary sources of financing (indirect) Open Sciety Institute and STAKES (support of purchasing of books necessary for selection of materials). Owing to the indirect support activiy under project, which does not demand payments to the subcontractors (translators, Internet designers and internet providers) started May-June 2002.

2. The planned duration of the project

from April 2003

to January 2004

3. The responsible organization:

St.Petersburg School of Public Health (SPH)

Goal (overall objective):

Increasing access to the information on the modern methods of CCD, especially in remote areas.

To reach his goal distance eucation (DE) package is developed. The package is dedicated to the comprehensive planning of STD/HIV prevention efforts based on understanding politics and sociology of STD epidemics. Course is developing themes raised and discussed in DE-course DProf-01 "Barrier methods of contraception n prevention of STD". (developed in colloboration with Moscow Medical Academy and with expert support from CDC,Atlanta, USA and financial support from OSI). More specifically some questions important for comprehensive planning and interventions, namely, forecast of epidemics development, condoms: production technology, quality control, use, non-complience and effectiveness, as well as major STD diagnosis and treatment were discussed in depth in DProf-01(total size 246 pages for self-study, ECTS credit hours - 41, ECTS credits equivalents - 2) and not repeated in ongoing project.

Planned outputs as discussed in grant proposal:

1. Collection of the materials for the distance learning

Activity started May 2002 before formal financing.

1.1 Search and retrieval materials for education of PHC specialists in the field of CCD

Several approaches has been used in searching for materials:

A) subject matter experts information on those resources

B) dozens of searches on Inernet through Web-based search engines (mostly using Google) and specialized engines (PubMed)

C) Analysis of the content of HIV and STD prevention Web-sites both Russian (low-yeld) and foreign, ncluding site of UNAIDS, CDC, UNDP and ohers.

D) Analysis of books sold through Internet-bookshops Amazon and Barnes and Noble with subsequent purchase of books (funds rom STAKES for supporting the Schol of Public Health)

E) Analysis of books sold in several large bookshops in Finland and the USA

F) Analysis of periodic literature

It is difficult to estimate volume of materials shortly reviewed so we will report only data n relations between amount of materials thoroughfully reviewed (read by course developers) - from monographs and amount of it decided to be useful and underwent translation:

Total amount reviewed 11725 pages in 28 books. Hours necessary for reading was 1172 or 6.6 person-months of worktime. Of this amount selected for translation was 364 pages or 3.1 percent.

Amount of information retrieved in Russian language for the use during the course (in printed pages)

Core part - 408 pages. Major components of training materials include handbooks on dealing with marinalized popultion (drug users, commercial sex workers), participatory evaluation and using LFA for planning projects (abridged Tempus handbook)

Newspaper and magazines clippings (HIV/AIDS, STD and prostitution in mass media) published originally in Russian: 451 pages

It is interesting to note relative volume of materials which reflects relevance of original materials on corresponding theme in Russian mass-media. There is almost no publications on STD per se (one out of 51 assessed). One more claimed STD to be major theme, but discussed more STD in commercial sex workers. 13 were dedicated to HIV/AIDS (of them 3 were from foreign press translated by news service inosmi.ru) and 38 to commersial sex work, some of them looking more like brothel/street prostitution guides. This informal rating shows that CSW are center of attention in more than two-thirds of publications, HIV/AIDS in about one-third, whereas conventional STDdoes not grab media attention.

1.2 Translation of the foreign-language material

Total amount of pages translated (at 3500 characters per page - average textbook page) - 387. Equivalent to the 753 printed pages (at 1800 characters per page). Including:

L.Garrett. The coming plague, 1994

J.Goudsmit Viral Sex, 1997

S.Watts. Epidemics and History, 1997

A.Karlen. Man and Microbes, 1995

P.Ewlad. Plague Time, 2002

P.Ewald, Evolution of Infectious Diseases, 1994

P.Duisberg, Infectious AIDS, 1995

Cochrane Library , 2001

R.Brookmayer, in Quantitative Evaluation of HIV prevention, 2002

Greenberg, et. al Medical Epidemiology

E. Pisani. Estimating the Size of Populations at Risk for HIV

EMCDDA Estimating the Prevalence of Drug Misuse

H.Schauffler Policy Development

R.Kurz. Quality Assurance and Improvement

T.Rundall. Evaluation.

Baker, Bellis. Human Sperm Competition

Chaulk. The Public Health Paradigm

S.Aral Social Organization of CSW in Moscow

S.Aral Determinants of STD epidemics

1.3 Assessment of the evidences on which aforementioned materials are based

Was done by subject matter experts and specialists in evidence-based medicine. Because majority of materials were dedicated to social and political processes it was difficut to employ standard tools of EBM, which was used during discussion of evaluation of intervention effectiveness. Evidence base of "soft" data was checked by triangulation methods (comparing several sources against each other). With exclusion of articles in Russian newspapers trinaglation was used for decididng whether to translate parts of the informaton materials or not. For the former newspaper status and personalities of those mentioned, cited and data sources indication was primary sources of evidence judgement. Some sources were excluded from translation because failing triangulation test.

For other peridic sources indication of materials and methods was necessary and several key sources, like Cochrane library was systematically searched for information relevant for the course.

1.4 Conversion of the existing Russian-language materials into electronic form

Done for some journal articales (i.e. Report from journal "Roundtable" and article on sociology and history of plague from Russian edition of "Scientific American")

1.5 Search for the updateable Web-resources on CCD

Search for updatable resources identified several Web-sites but majority of them undergo constant changes very seldom, especially if to exclude short news clippings. Most of identified resources were in English, updatable Russian resources included almost exclusevly HIV Web-sites. Some of them are Ukrainian sites. Unfortunately, majority of Russian site carried outdated epidemiological data. Presently list of the resources is being prepared.

2. Improved methodology of distance learning

The following resources for distance learning at the end-user level were analyzed: content delivery by internet with rich multimedia, delivery by internet mostly HTML-based text, WAP-oriented delivery. Also different modes of access were studied: dial-up connections, leased line access, HSCSD mobile access, GPRS mobile access and CSD mobile access. All methods of access are available inside metropolitan St.Petersburg. To test adequacy of WAP access a WAP-site with conscise information on STD treatment was setted up. It was found that WAP access functioned well with English-language information but there were grave problems with cyrillic. GPRS and HSCSD performed well under conditions of download of test materials but relatively poorly in case of HTML Web-pages access with frequent comunication break-down or stalling.

As for content multimedia-rich pages usually had lower added value comparing with essentialy paper-equivalent Web-pages which became mainstream of created course.

Additional accent has been made in searching for formats allowing download of the course content in compressed form for off-line viewing and reference. Two major formats has been selected: Adobe PDF and iSilo proprietary format. First emerged as format mostly suitable for conserving page layout and good quality illustrations, whereas the second provided high level of compression and was usable on pocket and palm-sized computers. Owing to the high compression rate it is the format suitable for distribution of the content over the internet for offline viewing. Unfortunately, all formats have problems with cyrillic alphabeth. Some need additional proceeding for getting software work under MS Windows (iSilo), some have had problems on palm-sized computers (MobiPocket), some have almost random problems with cyrillic (PDF) especially when converting fro HTML.

Report on mobile technologies has been prepared and published on the Web together with data of text formats analysis (http://stphs.narod.ru/Handheld)

The pedagogical model underlying distance learning has been extensivel studied. Analysis of Russian legislation has been undertaken.Basing on current laws and regulations proposals for introducing credit system at SPb MAPS were formulated and now are under review. Those proposals together with proposal for Ministery of Health could be found (in Russian) at http://stphs.narod.ru/Handheld

3. Web-site dedicated to general public education

Will be developed after completng training site creation as a subset of information colleted for DProf-1 and DProf-2. Due to changed timing of financing, resource problems and other questions, financial support of social marketing campaign was not included in final proposal to SIDA and SEEC and so will include mostly submitting data to search engines.

4. Web-site for delivery of distance learning material content

Under construction. Offline version with materials already prepared. MCQ and advanced organizers for each module are currently prepared. Knowlege control system will be analogous to that used in DProf-01 based on proprietary off-line control software, Java-Script pages for self-assessment and VbScript self-administered exam pages. Software components for off-line control and self-administered exam has been developed under previous grants.

5. Training modules on prevention of STD and emerging communicable diseases

The modules ae being prepared. Development according top-down model with help of Designers Edge software. Background documents prepared, course structure analysed and agreed. After preparation they should be reviewed by subject matter experts. Passing curricular committee after completing the course.

Appendix. List of materials used in course

Русский язык

UNAIDS, Подход системы здравоохранения к проблеме контроля за ИППП, 1998

UNAIDS, Секс-бизнес и ВИЧ/СПИД

Л.Андреев, В тумане, 1904

К.Макэведи Бубонная чума, 1988

А.Бобков. Происхождение и эволюция ВИЧ, 2000

Диагностика и лечение ВИЧ-инфекции

В.Покровский, И.Савченко Пути передачи ВИЧ-инфекции и профилактика

Сбор поведенческой информации

Этические вопросы сборы информации

Оценка эффективности программ профилактики ВИЧ

FHI. Профилактика передачи ВИЧ

В случаях вертикальной трансмиссии

У мужчин, занимающихся сексом с мужчинами

В мобильной популяции

Среди инъекционных наркоманов

UNAIDS. Профилактика ИППП

TEMPUS. Руководство по LFA

Оценка программ с участием целевых групп

 

 

ПРОСТИТУЦИЯ

Исторические очерки и документы

Три века российской проституции, Коммерсантъ-Деньги, 2001

Быкова А.Г. О социальной сущности проституции, XIX- начало XX века

Быкова А.Г. "Древнейшая профессия" в истории сибирских городов

Проституция и общество - исторический очерк, реферат, 2000

О лице псковской проституции, 1937

Лебина Н.Б. Проституция в Петербурге (40-е гг. XIXв. - 40-е гг. XXв.).

Покровская М.И. Как женщины должны бороться с проституцией, 1908

Проститутция в России нашего времени

" Панель да любовь", (общий обзор пролемы), Коммерсантъ-Деньги, 2001

" Недетские шалости", (детская гомосексуальная проституция), АиФ, 2000

" Разгул бледной спирохеты в России", (сифилис и проституция), Независимая газета, 2002

" Россия становится центром детского секс-туризма", Утро.ru, 2002

Проституция в регионах РФ

Барнаул

Особенности секс-бизнеса в Барнауле, Алтайский центр СПИД, 1999-2000

Владивосток

"' Ласковые девушки' в жестких объятиях",Независимая газета, 2003

Волгоград

Социально-эпидемиологические наблюдения..., Круглый стол, 2003

Выборг.

"Девочки на жердочке", Парламентская газета, 2000

Кемерово

" Подорожницы", Медицинская газета, 2003

Красноярск

« Бетонный» секс под кайфом, 2002

Москва

" Проститутки Москвы", 1997

" Ночная армия рвется в бой"АиФ, 2000

" Куда улетели ночные бабочки?" АиФ, 2000

" Одна ночная бабочка на 30 мужиков"АиФ, 2001

" Интимная коррупция", Независимая газета, 2002

" Коммерческий секс: как с ним быть?", Медицинская газета, 2002

Мурманск.

" Трудовые блудни", Норд-Вест Курьер, 2003

Набережные Челны

Особенности секс-бизнеса в г. Набережные Челны,2002

Пенза

" Бизнес ниже пояса"

Пермь

" Секс-оттенок пермской политики", Независимая газета, 2002

Санкт-Петербург

Уличная проституция Петербурга, 2002

Коммерческий секс и ВИЧ, Медицина Петербурга, 2002

Челябинск

" Чернорабочие панели", Челябинский рабочий, 2000

Проституция в странах бывшего СССР

Украина

Социологическое исследование, Сегодня, 2003

" Девочки упали в цене", Киевские ведомости, 2002

Секс-работницы чаще "цепляют" гонорею, 2003

Киргизия

Социологическое исследование

Белоруссия

" Колесованная любовь", Журнал АБС, 2001

Латвия

Как «Час» считал рижских проституток, Час, 2001

Проституция и ее последствия в приграничных регионах

Гонорея и сифилис - из России в Норвегию, ЭпиНорт, 2000

Российские проститутки завоевывают Юго-Восточную Азию, Известия, 2002

Русские проститутки за линией Маннергейма. ТВЦ, 2003

 

ВИЧ в России

18 мая. День памяти больных СПИДом, Институт демографии РАН

Число ВИЧ-инфицированных уменьшилось вдвое, Интервью Г.Онищенко, Независимая газета, 2002

СПИД меняет ориентацию, Интервью В.Покровского, Независимая газета, 2003

ВИЧ: почему мы терпим поражение, Интервью В.Покровского, Медициская газета, 2002

Друзья и враги Венеры, Огонек, 1997

России угрожает эпидемия СПИД'а, Лос-Анджелес Таймс, 2002

Скоро российская эпидемия СПИДа начнет распространяться на Европу, Гардиан, 2002

Россия остается парализованной перед лицом катастрофы, Ле Монд, 2002

Репортажи из регионов

Самара

Поколение ВИЧ, Независимая газета, 2002

Пермь

Донор смерти, Независимая газета, 2001

Екатеринбург

Смертельная операция, Независимая газета, 2000

Ростов-на-Дону

В списках инфицированных значатся, Независимая газета, 2001

Элиста-Санкт-Петербург

Элистинское проклятие, АиФ, 2001

 

Структура курса

Введение

История крупнейших эпидемий - влияние на общество

Задачи модуля

Материалы для изучения

Бубонная чума

История бубонной чумы (PDF)

Сифилис

Возникновение сифилиса

Секретная эпидемия: сифилис в Европе 1492-1965

Л.Андреев В тумане (сифилис в российской литературе)

ИППП и ВИЧ/СПИД

Раскаты далекого грома (ИППП в современном мире)

Hatari:Vinidogodogo ( История СПИД)

Теории ВИЧ и политика

Зачет

Социальные характеристики эпидемий

Задачи модуля

Предварительная информация

Материалы для изучения

ВИЧ-инфекция и ИППП в России. Взгляд средств массовой информации

Детерминанты эпидемии ИППП: стратегии профилактики соответствующие фазам эпидемии.

Группа риска ИППП и ВИЧ/СПИД: Проституция

Экология сексуальной работы и наркотики в Саратовской области

Социальная организация коммерческой секс-работы в Москве

Зачет

Биология возбудителя и эпидемии (0,25 ECTS)

Задачи модуля

Предварительная информация

Материалы для изучения

Эволюция вирулентности

Внутреннее оплодотворение и ИППП

Биология появления и распространения вируса

Возникновение эпидемии СПИДа на Западе

Расцвет и закат эпидемий ВИЧ

Африканские корни ВИЧ

История и эволюция ВИЧ, российский взгляд

Будущее СПИДа

Зачет

Комплексное планирование профилактических мероприятий

Задачи модуля

Материалы для изучения

Сбор материала для планирования

Введение в эпидемиологические методы

Методы оценки размеров популяции высокого риска заражения ВИЧ

Методы двойного охвата

Статистическая оценка профилактических программ

Сбор поведенческой информации

Этические вопросы сборы информации

Планирование проектов на основе логико-структурного подхода (PDF)

Качество и оценка программ общественного здоровья

Результат и успешность политики профилактики

Контроль качества и улучшение качества

Оценка программ

Парадигма общественного здоровья

Оценка эффективности программ профилактики ВИЧ

Оценка программ с участием целевых групп (PDF)

ВИЧ

ВИЧ-инфекция. Этиология, патогенез, клиника и лечение

Секс-бизнес и ВИЧ/СПИД

Пути передачи ВИЧ-инфекции и профилактика инфицирования

Подходы к профилактике ВИЧ

У мужчин, занимающихся сексом с мужчинами

В мобильной популяции

Среди инъекционных наркоманов

В случаях вертикальной трансмиссии

ИППП

Профилактика ИППП

Подход системы здравоохранения к проблеме контроля за ИППП

Эффективность лечения ИППП для профилактики ВИЧ

Зачет

Заключение

Экзамен