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PHCM9143 z5033917 Internship Report – 2016

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Internship Report

PHCM 9143

Prepared by Ashfaq Chauhan


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Overview and layout of Report This report reflects on events and work completed during internship at Australasian Society of Human Immunodeficiency Virus (HIV), Viral Hepatitis and Sexual Health Medicine (ASHM) located in Surry Hills, NSW. This internship was completed as a part of summer school. I was working with International team at ASHM, particularly assisting with expansion of the Regional Network across Asia and the Pacific and assisting with delivery of the first Assembly of the Regional Network. This is a project-‐focused report where following will be discussed:

• Introduction…………………………………………………………………………………………..Pg. 03 • A brief description of ASHM………………………………………..…………………………..Pg. 03 • Current trends in HIV, Viral hepatitis and STIs in Asia-‐pacific…………………..Pg. 04 • A brief description of Regional Network and rational behind formation and

expansion of Regional Network……………………………………………………………….Pg. 07 • Report from the 1st Assembly of Regional Network………………………………......Pg. 08 • Roles and responsibilities of the intern. ………………………………..………………... Pg. 09 • Regional Network: Reflection and Learning experiences………..…………………Pg. 10 • 1st Assembly: Reflection and Learning experiences……….…………………….…….Pg. 12 • Reflection and Learning experience in general………………………………………….Pg. 14 • Conclusion…………………………………………………………………………………….……..….Pg. 16 • References………………………………………………………………………………………………Pg. 17

Acknowledgement Some information in this report is used from concise report of the 1st Assembly of the Regional Network, Handbook of the 1st Assembly of the Regional Network, ASHM International Newsletters, ASHM website and Aids Data Hub website. Permission was obtained from workplace supervisor at ASHM to use resources relevant to ASHM.


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Introduction This paper is reflection of activities completed as part of my internship at ASHM. Activities related to internship are described below in detail. This report aims to justify need of the Regional Network in the Asia-‐Pacific region between the organisations working in the field of HIV, viral hepatitis and STIs to develop strategies and build health workforce capacities. By doing so it hopes to develop a regional collaborative approach in the filed of HIV, viral hepatitis and STIs. Literature review for HIV, Viral Hepatitis and STIs included in this paper is relevant to Asia-‐Pacific region. Funding for response to HIV discussed in this paper is related to Asia-‐Pacific region. This report is focused primarily around HIV in Asia-‐Pacific.

Australasian Society of HIV, Viral Hepatitis and Sexual Health Medicine (ASHM)*

ASHM is a non-‐government organisation (NGO) working in the field of HIV, Viral Hepatitis and Sexual Health. It aims to see eradication of HIV, Viral Hepatitis and sexual health by supporting health workforce in Australia, New Zealand and Asia-‐Pacific through education and training; direct action and leadership; policy and advocacy (ASHM, 2015). ASHM support members and sector partners to generate knowledge and action in clinical management, research, policy and education (ASHM, 2015). In field of HIV, ASHM has developed national guidelines for testing and management of HIV. It runs HIV prescriber programs for general practitioners and nurses along with providing clinical training, education and resources to support all levels of HIV workforce including non-‐medical professionals (ASHM, 2015). ASHM manages HIV General Practice Community Prescriber Program, which sets the National Curriculum and Continuing Professional Development (CPD) for HIV s100 prescribers (ASHM, 2015). ASHM does similar work in field of viral hepatitis and sexual health. It has developed guidelines for management and treatment of Hep B and Hep C, run education and training program for medical and non-‐medical staff and develops information materials like booklets and patient information guides (ASHM, 2015). ASHM runs many international programs in collaboration with other international professional societies e.g. it ran a leadership program called ‘the Twinning Project’. This project was run to strengthen and increase collaboration between health professionals and Institutions working in the filed of HIV and sexual health (ASHM, 2015). Participating members from Indonesia, Malaysia, Thailand and the Philippines were teamed with the HIV and sexual health practitioners in Australia to enhance clinical capacity and knowledge transfer between Australian practitioners and regional clinicians (ASHM, 2015). In addition to this ASHM also has Education and Policy division along with Conference division.

• Source – ASHM, http://www.ashm.org.au


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Current Trends in Asia and the Pacific HIV Significant success has been achieved in preventing HIV infections in Asia and the Pacific in last decade or so. According to UNAIDS (2013) report, 350,000(220,000 – 550,000) new HIV infections were estimated in 2012, which is 26% fewer than new infections in 2001. In year 2014, 340,000 new infections were estimated, slightly lower than 2012 (Aids Data Hub, 2015) If we look at the trends in new infections there has been a decline in rate of new infections from 1997 to 2008 followed by almost same rate of infections until current times in Asia-‐Pacific region (Aids Data Hub, 2015). However there are increasing trends in rate of new infections in countries like Indonesia, Pakistan, Malaysia and the Philippines (UNAIDS, 2013) as compared to Australia and Cambodia where the rate of new infections are declining (UNAIDS, 2013, Aids Data Hub, 2015). However this increase can be related to increase uptake of testing. Number of people accessing antiretroviral therapy (ART) is increasing. Treatment coverage, according to World health Organisation (WHO) guidelines (2010), was 51% (43%-‐63%) in Asia and the Pacific which is 46% more than 2009.It is estimated that roughly 5 million people are living with HIV and AIDS (PLWHA) and about 1.8 million people are receiving ART as of the end of 2014. Uptake of ART is expanding but still considered below global trends (Aids Data Hub, 2015). Women consist almost one third of population living with HIV at 36% of the total in 2012 (UNAIDS, 2013). Estimated number of children living with HIV in the Asia-‐Pacific region was 210,000 by the end of 2012, with a decline in the rate of new infections among children by 28% since 2001 (UNAIDS, 2013). Of all the people living with HIV and AIDS in Asia and the Pacific, more than 90% of these are estimated to be living in 12 countries: Cambodia, China, India, Indonesia, Malaysia, Myanmar, Nepal, Pakistan, Paua New Guinea, the Philippines, Thailand and Viet Nam (UNAIDS, 2013). Response to HIV among these countries and other counties in Asia and the Pacific varies. E.g. Cambodia is poised to become first low income country to achieve elimination of HIV transmission by 2020 by maintaining high level of ART coverage among PLHIV (People living with HIV) and continued effective interventions for prevention and uptake of testing among target group (Cambodia GARPR, 2015). However coverage of people on ART in India and PNG is approximately 50%, in Nepal ART coverage among PLHIV is 27% and in Philippines it is 24% (Aids Data Hub, 2015). This disparity in response to HIV will warrant country specific programs for uptake of diagnosis and treatment. Despite the diversity in specific countries, some similarities are apparent (Godwin & Dickinson, 2012). The HIV epidemic in Asia and the Pacific is concentrated among key population of men who have sex with men (MSM), people who inject drugs (PWID), sex workers, transgender people and intimate partners of these key population (Godwin &


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Dickinson, 2012; UNAIDS, 2013) requiring special attention for prevention and treatment services. Estimated 10.5 – 27 million people in Asia-‐Pacific consist of MSM according to country estimates with HIV prevalence of more than 10% among MSM in major cities (UNAIDS, 2013) e.g. in Bangkok prevalence of HIV among MSM is greater than 24% as compared to national prevalence of 7.1% (UNGASS, 2010; UNAIDS, 2013). Approximately 3-‐4 million PWID live in Asia, rate of HIV prevalence in PWID in different in countries of Asia and the Pacific: Pakistan (27.2%), Indonesia (36.4%) and Philippines (13.6%) (UNAIDS, 2013; Philippines National Aids Council, 2012). This will further warrant target specific programs to reach this key population group. According to UNAIDS report (2013), female sex workers in Asia-‐Pacific are 13.5 times more likely to acquire HIV as compared to other adult females. A systemic review conducted in low-‐ and middle-‐ income countries of the world showed consistent evidence of higher level of HIV prevalence among female sex workers with highest level of prevalence in Asia (Baral et al, 2012). However disparities exist for HIV prevalence among female sex workers within countries of Asia, e.g. India, Indonesia and Thailand have high HIV prevalence among female sex workers when compared to Pakistan and Mongolia (Baral et al, 2012). Transgender population in Asia-‐Pacific region is estimated to be around 9-‐9.5 million people (Winter, 2012; UNAIDS, 2013). However this numbers are estimations rather than actual population. Number of male sex workers is unknown and research into prevalence of HIV among transgender and male sex workers is scarce (UNAIDS, 2013; Winter, 2012). HIV prevalence among trans community is generally higher than that of HIV prevalence among MSM in Asia (Godwin, 2010; Winter 2012) and limited country specific research available indicates high prevalence among this population group (UNAIDS, 2013). Most of the research is focused on trans-‐women and HIV prevalence among trans-‐men is under-‐researched (Winter, 2012). Often transgender people are stigmatised and considered vector of HIV transmission rather than victims (Winter, 2012), this can act as a barrier to seek treatment or prevention measures within the community and their participation in research.

According to UNAIDS (2013), 0.5% to 15% of men bought sex in year 2011 in Asia-‐Pacific region, however research into sex behaviour and prevalence of HIV among clients of sex workers is sparse. Further to this, intimate partners of the clients’ remains at high risk but programmes to reach them are limited (UNAIDS, 2013).

Hepatitis C (Hep C/HCV) and Sexually Transmitted Infections (STIs) Estimated prevalence of hepatitis C in Asia-‐Pacific in general population is considered to be <1.5% (Mohd Hanafiah, Groeger, Flaxman & Wiersma, 2013), however this picture is different in different countries. For example in countries of Asia prevalence of HCV infection in adult population is estimated to be 2.0% with countries such as Pakistan and


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Taiwan having prevalence of over 4% (Sievert et al, 2011). There is lack of research in low-‐ and middle-‐income countries about prevalence of hepatitis C as most of the research conducted in these countries took place in urban centres and participants were mostly adult blood donors and older population limiting its generalizability (Mohd Hanafiah et al, 2013). Research in STIs is country specific however reliable data from several countries of Asia-‐Pacific is not readily available due to lack of national STI notifications body and regular data collection (Chan, 2011). According to WHO report into selected STIs, in year 2005 there were 7.39 million cases of chlamydia in South-‐East Asia and 32.69 in Western pacific; 8.37 million and 9.43 million cases of gonorrhoea in South-‐East Asia and Western Pacific respectively and that of syphilis were estimated to be 11.77 and 2.54 million cases respectively in South-‐East Asia and Western Pacific respectively (Chan, 2011; WHO, 2011). Some countries such as India uses ad hoc surveillance based on convenience sampling to measure STIs which can make results less generalizable (Chan, 2011) and hard to establish or infer change in rate of infections over time. Also in Thailand, estimates are made based on notifications from public hospitals only (Chan, 2011), which further threatens the generalizability of such estimates.

Funding for HIV response in Asia-‐Pacific Governments in Asia and the Pacific need multilateral and bilateral official development assistance (ODA) to respond to respective HIV epidemics and achieve epidemiological targets (Stuart, Lief, Donald, Wilson & Wilson, 2015; Godwin & Dickinson, 2012; UNAIDS, 2013). However a large gap exists between current funding available for HIV and the funding required achieving targets to reduce HIV related mortality and incidence in Asia (Stuart et al, 2015; Godwin & Dickinson, 2012). In addition to this according to Stuart et al (2015), this gap in widening. Australia is the largest provider of HIV funding to countries in Asia and the Pacific, and over the last few years this funding has increased however due to change in government and change in financial policy this funding is expected to remain stagnant or reduce over next few years (Stuart et al, 2015; ACFID, 2014). Also some other large providers of HIV funding to Asia and the Pacific are expected to decrease their funding (Stuart et al, 2015). Figure 1 below shows that funds through ODA available for HIV response to Asia and the Pacific have reduced over last decade.


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Fig 1. Bilateral funding through ODA for HIV response to Asia-‐Pacific from 2004-‐2013, Source: Stuart et al, 2015, Pg. 5.

Regional Network* Regional network is an initiative by ASHM to expand collaboration between professional societies and organisations working in HIV, viral hepatitis and sexual health in Asia and the Pacific. Initially this network, known as APRSN (Asia Pacific Regional Societies Network), was a network between five other regional societies. At 2014 AIDS conference in Melbourne, then member agreed to expand the network to other professional societies and organisations. To this date (as at February 2016) 42 different organisations from Asia-‐Pacific region have signed up as member of the Regional Network. ASHM has worked in capacity development with members of APRSN successfully in the past and this success enabled to expand the network more broadly and boldly with aim to develop long term, sustainable, collaborative projects with other high-‐, low-‐ and middle income countries in Asia-‐Pacific region (ASHM, 2015). The root for this collaboration or cooperation between organisations is based on principle proposed by United Nations as “South-‐South cooperation” and “Triangular cooperation” (United Nations Office of South-‐South Cooperation, 2016). South-‐South cooperation provides a broad framework between developing countries of the global south to share knowledge, skills, resources and technical knowledge to attain their development goals, both millennial development goals and sustainable development goals (UNOSSC, 2016). Triangular cooperation refers to a collaboration between donor country and/or multilateral organisation with developing countries to foster south-‐south cooperation by providing training, funding, management support, technical support as well as other forms of support (UNOSSC, 2016).


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Along with this, report by Department of Foreign Affairs and Trade (2012) indicates that strong policy and programming change needs to happen to tackle HIV epidemic in key populations and encourage regional or global framework to manage such problems more effectively. It will be difficult to achieve success at country level without changing regional framework. This report further elaborates on strategic option to develop a regional partnership with common strategic vision for the region helping to think and work together and support each other. It can be said that principles of South-‐South cooperation and Triangular cooperation are embedded within the philosophy of Regional Network as they are explicitly mentioned as role of Regional Network. ASHM and Regional Network aims to provide: leadership and governance capacity development; administrative and secretariat support (including human resources, technical infrastructure, database, communication strategies); information exchange and networking between organisations including sharing of ideas and experiences and exploration of collaborative research, education and workforce development opportunities; training and professional development opportunities for health workforce; guideline development and clinical laboratory support groups beside others (ASHM International, 2015). Regional Network thus aims to establish collaboration between developing countries within Asia-‐Pacific region to plan new strategies and foster capacities to attain development goals within current challenges and opportunities. *Source – ASHM International, Regional Network.

1st Assembly of the Regional Network * First assembly of the Regional Network was held back to back with HIV-‐NAT symposium in Bangkok from 15th – 17th of January. It was held with a view to get all the members of the Regional Network together. It was first in an ongoing process of strengthening collaboration, sharing knowledge and developing foundation for future meetings and work of Regional Network. 53 delegates from 42 different organisations and societies from 16 countries participated in the 1st Assembly of Regional Network. Proposed aims of the 1st assembly were: identify key points of collaboration among participating societies; strengthening skills and competencies in clinical field and service delivery; strengthening the constitution of Regional Network and provide support to new societies. One of the themes of the Assembly was to focus on translating clinical skills and research findings into applied practise. It was an interactive event with workshops, presentations and discussions for sharing ideas and practice across HIV, viral hepatitis and sexual health along with exploring role of professional societies in national response to these issues. Discussions included learning from experiences, sharing of technical knowledge, education, best practice dissemination, collaboration between organisations and advocacy. Limitations and challenges such as limited resources and funding, inadequate


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government response with lack of political commitment and leadership were explored. Panels and workshops discussed means of strengthening organisations’ responses within constraints in light of collaboration through Regional Network (extract from report which I wrote for ASHM after the 1st Assembly: included with permission from workplace supervisor). Workshops were conducted during the Assembly to allow participating members and organisations to develop negotiated SMART$ ($ sign was added to capture the estimated cost of proposed activities) goals in the fields of guidelines and professional standards, research, developing clinical capacity and role of laboratory in strengthening our response to HIV, Viral Hepatitis and Sexual Health Medicine. Next steps of the Regional Network were discussed on the last day of the Assembly with delegates and members further acknowledging the need of the Regional Network to strengthen collaborative approach (extract from report which I wrote for ASHM after the 1st Assembly: included with permission from workplace supervisor). *Source – ASHM International, Regional Network, 1st Assembly Report.

Goals, roles and responsibilities of Intern At the beginning of internship goals and role of the intern was negotiated with workplace supervisor. Broadly speaking my placements goals were to assist with the expansion of the Regional Network and assist with the delivery of the inaugural assembly of the Regional Network in Bangkok, which was held in January’16. Following table identifies planned learning outcomes and workplace activities associated with them. Planned Learning outcomes Workplace activities 1. Coordinate information

gathering from Regional Network members to facilitate Regional Network expansion and Assembly delivery

-‐ Contact Network members to gather information for Assembly handbook

-‐ Update Central Management Records (CRM) and ASHM website with members details

2. Produce country specific epidemiological fact sheet

-‐ Research the epidemiology of HIV, HCV, HBV and STIs for member countries

-‐ Create country specific fact sheets

3. Organise Assembly logistics -‐ Assist with speaker logistics -‐ Assist with delegate logistics -‐ Assist with event logistics -‐ Assist with onsite logistics


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4. Prepare an evaluation of Regional Network Assembly

-‐ Compile survey response -‐ Develop an evaluation report outline -‐ Populate evaluation report with

available Assembly feedback -‐ Analyse Assembly feedback provided to

determine the impact of the Assembly

Along with these activities, I also got to attend various meetings in preparation for the Assembly, networking with delegates at the Assembly, compiling handbook for the Assembly and drafting full evaluation report post Assembly. I also gained insight into structure of organisation and attended staff monthly meeting once. Below are some reflections on my learning experience at ASHM

Regional Network: Reflection and Professional learning experience Governance/Management Much was discussed during the meeting leading up to the assembly about the governance structure of the Regional Network. ASHM had proposed itself as a secretariat of the Network; however, options were explored to form a sustainable governance and management structure for the Network. This task can be difficult as the distribution of health risk and resources are different in different countries (Frenk & Moon, 2013). Further to this, it is possible that different organisations will have different vested interests, which they will push for, leading to differences in decision making and can hamper the success of such Network to effectively manage health problems (Frenk & Moon, 2013). One suggestion made during meetings at ASHM was to plan governance structure, which resembles an organisation without board members e.g. Associations Australia, which is a for profit organisation providing support to NGOs in Australia. Associations Australia provides support to the member organisations in the area of management and governance. At the time of my internship, this idea was explored to see if such structure could be translated to Regional Network. Another suggestion was to have a rotatory chair, whereby members of the Network have shared responsibilities. For a Network, to function, resources should be readily available. However, ASHM do not have resources for sustainability of the Network as it has to use its own staff time. I think the first thing to establish would be the constitution of the Regional Network in partnership with willing members and implemented after further approval from all members. Principles of accountability, roles of members, role of the secretariat and governing structure need to be established with the common consensus. At first, it was really hard for me to grasp the concept of the governance of a network, I believe it to be a subset o ASHM but I realised soon that it is not a subset of ASHM. This


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experience provided me with an in-‐depth understanding of challenges an organisation can face while working in the global health arena. Also, it provided me with insight into the importance of thinking laterally to mitigate these challenges. Finance/Funding 1st assembly became a reality as a result of funding from pharmaceutical companies (Gilead and Viiv) and collaborating with HIVNAT and King Chulalongkorn faculty of medicine. As an agreement 1/3rd of the grant was used for preparation for assembly and 2/3 is to be used for follow-‐up measures post assembly. I learned about effective management of funds while preparing for the assembly. Managing funds is an inherent part of management and effective management of funds is important for program delivery and accountability to funding providers. During meetings, I learned how important budgeting is to examine where the money is spent and how it is spend and look for opportunities to reduce spending where it is unnecessary. I think having a spreadsheet with expected spending’s on each item helps to critically look at them. I remember in my first meeting, the cost was cut down by few thousand dollars by omitting items, which were unnecessary. Assembly was held in Thailand as it was considered easier for people to fly in at lower rates and book accommodation at lower rates due to good dollar value (flights were booked using the Australian dollar for delegates who received the scholarships). If it were to be held in Australia, the cost would have been high. Also, Thailand is in the centre of Asia, so delegates don’t have to worry about lengthy fly-‐in and fly-‐out time. I also learned about criteria for scholarship provision to increasing attendance of delegates e.g. delegates from low-‐income countries were given priorities and initially one delegate from each organisation was given the scholarship. More scholarships were granted depending on available budget. As mentioned earlier, resources are limited for sustaining work of Regional Network. It is imperative to look for opportunities for funding or generating funds. One idea, which was discussed, was to have joining fees for new members. This can work well with organisations that can afford annual joining fees, however, it can act as a barrier for societies and organisations from low-‐income countries. Another solution could be to seek volunteers and interns to reduce cost. This will be a mutually beneficial contract between volunteer/intern and ASHM. There is a lot to learn from an established organisation like ASHM and in turn, ASHM can utilise skills and time of an intern for the development of future activities for Network. Learning opportunity, which I missed due to time constraints and lack of knowledge about financial management, was preparing a report for funders after the 1st assembly and learning a system of managing finances for the Assembly. I believe that it would have been a great addition to my skills.


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Technical assistance/communication: For a successful implementation of a program, communication is an important process between organisation members ((Workman, 1993; Noble, 1999). Communicating with 42 different organisations from 16 different countries can be very difficult. At the time of my internship, ASHM was using CRM system to records data of the delegates and organisation. Organisations, upon sign-‐up, has to fill out the surveys and that data was imported into CRM by staff at ASHM. I found it hard to enter data into CRM as some of the delegates were already in the system – only difference being a suffix of ‘Mr” or “Dr” or “Prof”. Also, it requires some form of experience and familiarity with the CRM system to use it efficiently. Having written guidelines about the use of such system can be helpful to a novice. Also, I believe, that it is important to have a common platform for members to communicate with each other and share information. At the time of my completion there, a new web platform was in progress to be made available, for the use of members of the Network. This platform will prove beneficial for sharing information, to keep records, to promulgate guidelines for adoption and can also serve as a blog post for discussion forums. We see such platforms highly used e.g. by external university students for learning and development as well as for discussion. Such platform can also be used to run web-‐based courses for members. During one of the meetings, I met with a representative from an organisation in Netherland who showed us the example of education material run via online web platform to their members for capacity development. Other professional bodies like Australian Physiotherapy Association also use such platforms to run continuous professional development courses. It requires effort and resources to build these platforms and due to limited funding, resource allocation can be difficult. Encouraging participation of volunteers and interns with technological/digital media background may help.

1st Assembly: Reflection and Professional learning experience Many great minds came together at this Assembly from different regions to explore ideas and foster collaborations. Much was discusses over these two and half day assembly. Some of the highlights and learning experiences for me as an intern are mentioned below. This assembly gave me deep understating of share responsibilities between different stakeholders and innovative ways to develop strategies to bring change. Further to this, I gained insight into the role of professional and clinical organisations in public health, which is often complex and far from just one. Often one organisation works at multiple levels and with different stakeholders. I believe that this experience can be translated into practice for not just sexual health but also for other areas of public health concern.


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• Moving forward as of this year, we have transitioned from an era of Millennial Development Goals (MDGs) to Sustainable Development Goals (SDGs), with health now forming only 1 of the broader 17 targets and many more indicators. Professional societies have opportunities to learn from what we have achieved in the era of MDGs through collaboration and partnerships and apply it to an era of SDGs. E.g. wide distribution of ART was possible by combined efforts of pharmaceutical companies, Governments, and NGOs to bring prices down by transforming strategies and facilitating change. Such initiatives and innovative strategies need to be implemented in the area of HCV and STIs. There were also concerns raised that in the new era of SDGs, support from UN and other global funds will not continue and hence professional societies need to strengthen their partnerships.

• A higher number of health workforce along with more effort in training and

capacity building need to happen to develop viral hepatitis health workforce. Keeping up to date with best practice and its dissemination will further help regional organisations to address health workforce development issues. Professional societies have a critical role in linking research findings to clinical service provision.

• Policy for better health and political commitment is necessary to develop a

national response. Professional organisations with the help of their political connections need to push for such issues. This will further aid to develop strategies and implement them as part of a national strategic plan.

• Financing is becoming scarce and finding different venues along with exploring

options for public-‐private partnerships is essential. Public-‐private partnership can be an ethical issue for regional network and proper consultation is required before entering such contract. One suggestion was to explore ideas of creating a social enterprise e.g. Blue D gay dating website which creates funding opportunities for sexual health clinics in China, Taiwan, and Thailand.

• Professional societies have a role in the development of professional standards

and ethical conduct. By incorporating them into a curriculum and building partnerships with statutory bodies e.g. councils, they can be implemented and maintained.

• Professional societies also have a role in developing guidelines for diagnosis and

treatment. In an absence of national guidelines, professional societies should encourage dissemination and adoption of WHO guidelines for diagnosis and treatment. This is often the case in low-‐ and middle-‐income countries.

• The Regional Network can provide a link between laboratories and community

by creating information for community testing, supporting laboratory staff with


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PoCT (point of care testing) policies and procedures. In an absence of a statutory body, Regional Network can promote standards and quality of the laboratory procedures.

• Engagement of clinical service providers with community sector is of utmost

importance for success. Often stigma and discrimination result in the lack of service uptake especially among key population groups who are at high risk. Professional societies with their partnerships with multiple sectors and other actors in public health need to address this issue and advocate for people.

Reflection and Professional learning experiences: Planning Programme for Assembly While planning for the 1st assembly, I get to know how to make a programme for the assembly. While starting with laying the foundation on the first day to doing workshops on the second day and discussing future steps for the network on last day. I think it is important to plan a well-‐organised programme to keep enthusiasm up and to get maximum participation from all the members. One reason for having workshops in the middle as explained to me by my supervisor was that as most participants may leave on last day to their respective country, it is important that they participate in workshops to get ideas about future activities of the Network. Workshops Prior to the assembly, a draft of ‘how workshop to be run’ was sent to the presenters. This draft helped to steer workshop in a particular direction. One of the objectives of the workshop was to plan SMART$ goal for particular activities. A $ sign was attached to SMART goal to capture the expected cost/funding requirement for such activity if to be implemented. I really find it interesting and think it was helpful as Network as such has to work in constraints of limited funding. Evaluation Evaluation forms an important part of the programme. It is done to see what are the intended outcomes or to see if predetermined goals were reached along and give us indications for future activities (Noble, 1999). An evaluation was conducted in the form of surveys after the assembly to get participants feedback. Evaluation forms either in surveys (questionnaires) or focus groups give us insight into what is working, what is not and also give us direction for future success. I was able to see direct application of evaluation process as learned at University. This evaluation is used by ASHM for guiding their future activities within the region. E.g. as per feedback from delegates to develop proper communication between the members, ASHM is in the process of making a member based internet platform for communication, education and resource sharing. There were also questions in the feedback form about what are the challenges for Regional Network to which response ranged from lack of motivation from members to lack of resources for low-‐ and middle-‐income countries to continue participation; this


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feedback will help Regional Network to devise strategies for keeping members interested and motivated. This evaluation can also be used in conjunction with tools such as word cloud to see what are most common themes e.g. Fig 2 below shows delegates perception about the role of Regional network as a word cloud.

Fig 2. Word cloud: delegates perceptions about role of Regional Network, Source: Report of the 1st Assembly of the Regional

Network, 2016, Pg. 4.

Time Management Time management is an important aspect of work. I was able to learn from examples set by team members about efficient time management techniques. For example booking flights at night so that one can get to work next morning. Or making a run sheet (very useful tool) prior to assembly with detailed information about contacts and schedules. This was helpful while organising a large event. Simple things like sharing calendars at work and sending invites for meeting helps to manage time effectively and efficiently. Meetings Meetings were held regularly in preparation for the assembly. As identified in the literature (O’Dea et al., 2006; Jalil et al., 2012) and as learned through course in program such as Clinical Governance and Health Management, I was able to see the importance of agenda, chairperson, minutes taking, allocation of duties and circulation of notes. These further aids time management and appropriate task allocations and avoid confusion between members (Pigeon & Khan, 2014). Handbook This was my first time contributing to prepare a handbook along with my workplace supervisor. It was tedious with much going back and forth however at the end it was quite satisfying as feedback from delegates attending Assembly regarding handbook was positive and wanting to circulate it within their organisation and with their colleagues. I learned few things related to this task, e.g. how to arrange information in a handbook


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and formatting handbook to make it user-‐friendly, what information needs to be included so that it is concise but still informative.

Conclusion This placement informed my perspectives about current situation on HIV, Viral Hepatitis and STIs in Asia-‐Pacific. Some countries in Asia-‐Pacific have been successful in achieving their MDG target for HIV but some other countries lag behind. Fight against HIV is not yet over and there are other emerging challenges especially for low-‐ and middle-‐income countries. But I have also seen that success is possible e.g. success of Cambodia and Australia in reducing new infections of HIV and increasing uptake of ART in PLHIV. Regional Network gave me opportunity to understand importance of collaboration and networking with other similar organisations to achieve success. I believe my Internship at ASHM was helpful to develop my professional skills, as I was able to implement things into practice, which I learned during my studies in this program. I also received mentoring from members of organisation who more than willing to help me develop and learn new skills and provide support. This opportunity provided me with experience that was relevant to health management and international public health. I understand now a broader role of the organisation such as ASHM in global health and challenges of working in global health.


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References Aids Data Hub, 2015. Retrieved from http://www.aidsdatahub.org/

ASHM, 2015, http://www.ashm.org.au ASHM International Program, 2015. Retrieved from http://www.ashm.org.au/international-‐programs/international ASHM International, Regional Network, 2015. Retrieved from http://www.ashm.org.au/international-‐programs/international/regional-‐network

ASHM Regional Network Newsletter, Edition 4, (2015). Retrieved from http://www.ashm.org.au/Documents/International%20Newsletter_Issue%204_WEB.pdf

Australian Council for International Development (2014), ACFID federal budget analysis 2014–2015; Canberra: Retrieved from http://www.abmission.org/data/News/ACFID_2014-‐15_Federal_Budget_Analysis_Final-‐140514.pdf Baral, S., Beyrer, C., Muessig, K., Poteat, T., Wirtz, A. L., Decker, M. R., ... & Kerrigan, D. (2012). Burden of HIV among female sex workers in low-‐income and middle-‐income countries: a systematic review and meta-‐analysis. The Lancet infectious diseases, 12(7), 538-‐549. Chan, R. (2011). Sexually transmitted infections in Asia and the Pacific—an epidemiological snapshot. Sexually transmitted infections, 87(Suppl 2), ii14-‐ii15. Frenk, J., & Moon, S. (2013). Governance Challenges in Global Health. The New England Journal of Medicine.368(10), 936-‐942. Godwin, J. (2010). Legal environments, human rights and HIV responses among men who have sex with men and transgender people in Asia and the Pacific: An agenda for action. Bangkok, UNDP. Godwin. P. & Dickinson. C., (2012), HIV in Asia – Transforming the agenda for 2012 and beyond Report of a joint strategic assessment in ten countries, Final report, Department of Foreign Affairs and Trade, Australia. Retrieved from https://dfat.gov.au/about-‐us/publications/Documents/hiv-‐strategic-‐assessment-‐report.pdf


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HIV in Asia and Pacific. (2015), UNAIDS Report, Publisher by UNAIDS Retrieved from http://www.unaids.org/sites/default/files/media_asset/2013_HIV-‐Asia-‐Pacific_en_0.pdf Integrated Biological and Behavioral Survey. (2011)., Ministry of Health Republic of Indonesia., Jakarta. Retrieved from http://www.aidsdatahub.org/sites/default/files/documents/IBBS_2011_Report_Indonesia.pdf

Jalil R, Lamb B, Russ S, Sevdalis N & Green J (2012) The cancer multi-‐disciplinary team from the co-‐ordinators’ perspective: results from a national survey in the UK, BMC Health Services Research, 12:457 Mohd Hanafiah, K., Groeger, J., Flaxman, A. D., & Wiersma, S. T. (2013). Global epidemiology of hepatitis C virus infection: New estimates of age-‐specific antibody to HCV seroprevalence. Hepatology, 57(4), 1333-‐1342. Noble, C. H. (1999). The eclectic roots of strategy implementation research. Journal of business research, 45(2), 119-‐134. O’Dea, N. A., de Chazal, P., Saltman, D. C., & Kidd, M. R. (2006). Running effective meetings: a primer for doctors. Postgraduate medical journal, 82(969), 454-‐461. Perz, J. F., Armstrong, G. L., Farrington, L. A., Hutin, Y. J., & Bell, B. P. (2006). The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. Journal of hepatology, 45(4), 529-‐538. Philippines Global AIDS Response Progress Report. (2012)., Philippines National AIDS Council., Manila. Retrieved from http://www.unaids.org/sites/default/files/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/ce_PH_Narrative_Report.pdf

Pigeon, Y., & Khan, O. (2014). Leadership Lesson: Tools for Effective Team Meetings -‐ How I Learned to Stop Worrying and Love my Team. Association Of American Medical Colleges. Retrieved from https://www.aamc.org/members/gfa/faculty_vitae/148582/team_meetings.html Sievert, W., Altraif, I., Razavi, H. A., Abdo, A., Ahmed, E. A., AlOmair, A., ... & Elshazly, M. (2011). A systematic review of hepatitis C virus epidemiology in Asia, Australia and Egypt. Liver International, 31(s2), 61-‐80. Stuart, R. M., Lief, E., Donald, B., Wilson, D., & Wilson, D. P. (2015). The funding landscape for HIV in Asia and the Pacific. Journal of the International AIDS Society, 18. UNGASS Country Progress Report. (2010).,National AIDS Prevention and Alleviation


19

Committee., Bangkok. Retrieved from http://data.unaids.org/pub/Report/2010/thailand_2010_country_progress_report_en.pdf

United Nations Office for South-‐South Cooperation, 2016. Retrieved from http://ssc.undp.org/content/ssc/about/what_is_ssc.html

Winter, S. (2012). Lost in transition: transgender people, rights and HIV vulnerability in the Asia-‐Pacific Region. UNDP. Workman Jr, J. P. (1993). Marketing's limited role in new product development in one computer systems firm. Journal of Marketing Research, 405-‐421. World Health Organization. (2010). Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach-‐2010 revision. Retrieved from http://apps.who.int/iris/bitstream/10665/44379/1/9789241599764_eng.pdf

World Health Organization. (2011). Prevalence and incidence of selected sexually transmitted infections, Chlamydia trachomatis, Neisseria gonorrhoea, syphilis and Trichomonas vaginalis: methods and results used by WHO to generate 2005 estimates.


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