Within the research project “Expanding Access to Medication-Assisted Treatment in Ukraine” (ExMAT) implemented in close collaboration with Yale University School of Medicine, on Janгфкн 29-30 Module 4 of learning collaboratives on expanding access to OAT in Ukraine took place. The goal of the meeting was to assess the scale-up of OAT program in Ukraine during 2018. The country managed to scale up by 15%!

Module 4 of learning collaboratives was attended by Chief Narcologists of all regions of Ukraine and over 70 representatives of 75 OAT sites; coaching was provided by certified NiATx trainers from the Alliance for Public Health and Ukrainian Institute for Public Health Policy under thorough mentoring of Yale University specialists. Next module (Module No.5) of learning collaboratives is scheduled for April 2019.

2018 was marked with innovations, greater scale and remarkable results in fighting HIV, tuberculosis and hepatitis. Next year, Ukraine will be challenged with transition of most of the services from donor to state funding. We celebrate key achievements of the outgoing year, which set a solid ground for successful 2019:

1. Nation-wide HIV prevention efforts focusing on Key Populations has brought the epidemic under control. In 2018, 200 000 PWID, 38 000 SWs, 43 000 MSM have accessed HIV prevention services. We run the largest harm reduction program funded by the Global Fund globally. Next year we will pass this successful program to the government for continued funding and management. The Alliance for Public Health (APH) will continue assisting with program oversight, monitoring and technical support to ensure consistently high quality and coverage.

2. Effective innovations including PrEP, HIV oral and blood self-testing, tailored programs for transgenders and young people, and new technologies in HIV and TB case finding have strengthened the national response to epidemics. Successful PrEP pilot for 100 MSM in Kyiv with support of CDC became a ground for scaling up PrEP up to 2 800 MSM all over Ukraine next year. The resource selftest.org.ua allowed to confidentially deliver self-tests to rural and remote areas. Optimized Case Finding model, based on active contact tracing and recruitment of the extended risk/social networks of HIV-positive participants, was included into Compendium of good practices in the health sector response to HIV in the WHO European Region. Innovative services and community mobilization efforts among transgender people and experimenting youth (Drugstore project supported by Elton John AIDS Foundation) have also been highlighted as international best practice.

3. APH brings new effective approaches in finding missing TB cases and TB treatment. Index screening scaled up through Results-Based Financing (RBF) allowed for a 4 times increase in the number of identified TB patients in 2018 compared to 2017! Ukrainian novel approach was acknowledged by the Global Fund Observer: people-oriented models of care that include social support for patients allowed to double TB treatment success rate from 40% up to 80%! Active engagement in the policy work including support and collaboration with TB Europe Coalition, Stop TB Partnership, WHO, Global TB Caucus, Partnership STOP TB Ukraine, 100% Life, Ministry of Health and Public Health Center brought Ukraine as a strong actor at the UN High Level Meeting on TB in September 2018 and in the post-UN HLM accountability processes on fulfilment of the commitments of the Political Declaration.

4. Hepatitis C is no more a neglected disease in Ukraine. APH pioneered Hepatitis C DAA treatment with sofosbuvir and ledipasvir/sofosbuvir making it accessible free of charge for the most marginalized patients. To date 2 162 patients from all over Ukraine have been treated with 95% success rate. These achievements stimulated the Ministry of Health and other international organizations such as MSF to support generic competition and further scale up of Hep C treatment. This year APH in partnership with the Ministry of Justice provided Hepatitis C diagnostic and treatment with DAAs in the penitentiary system to the patients who never received it before – prison population. 50 inmates were treated with 98% treatment success rate!

5. In 2018, APH continued pursuing its ambitious goals in sustaining epidemic control in Non-Government controlled areas (NGCA) of Donbas. Continued support of partner organizations in the area, regular supplies of health products, equipment, as well as maintenance of TB laboratories, help effectively reach TB and HIV affected populations there. As of the end of the year, APH efforts ensured high quality MDR-TB treatment for 585 patients (over 95% of all MDR-TB patients on treatment) those and provision of HIV-prevention services for 16 042 people there. The LANCET dedicated a special article to this APH unique experience of successful working in challenging operating environment.

6. APH continues to strengthen its contribution to the development of programs in Eastern Europe and Central Asia through its partnership with CSO’s and regional projects. As a key implementation partner of TBEC and PAS (Moldova) APH completed a 3-year TB-REP project focused on advocacy and civil society support in 11 countries of the region. Acknowledging Ukraine’s successful experience, the Global Fund has supported a new HIV regional project with a consortium of organizations led by APH. This new regional HIV project focusing on 14 countries will start from January 2019 with the focus on sustainability of services for key populations.

7. Transition of the largest in Eastern Europe and Central Asia opioid substitution therapy program from donor funding to the domestic one is nearly successfully completed with the sufficient budget allocation for further scaling up to over 13 000 patients in 2019:

*allocated budgets/available from different sources for medicine purchase

Alliance congratulates all partners and colleagues on the coming New Year and Merry Christmas!

Alliance for Public Health is announcing an open Call for Proposals to support sustainability of HIV responses in the five countries of Southeastern Europe: Bosnia and Herzegovina, Macedonia, Montenegro, Romania and Serbia.

Please find Call for Proposals here

Please find recording of the webinar from 10^th January here

Questions and Answers here

On December 5-7, 2018, the Regional meeting on strategic priorities for operational and drug-related advocacy for quality people-centered TB care in the region of the Eastern Europe and Central Asia was held in Tbilisi.
The meeting was organized by TB Europe Coalition and Centrul PAS under the technical partnership of WHO Regional Office for Europe, Stop TB Partnership, Global TB Caucus and Global Fund Communities, Rights and Gender Strategic Initiative. The Alliance jointly with the MSF / Access Campaign was a co-organizer of this meeting.
The main goal of the meeting was to launch the development and consequent implementation of the combined EECA advocacy strategy on three diseases TB/HIV/HCV.
Zahedul Islam, Director: Treatment, Procurement and Supply Management, ICF “Alliance for Public Health”, during a session devoted to sense of urgency for action in light of GF transition, presented health systems strengthening approach combined EECA advocacy strategy on three diseases TB/HIV/HCV.
Also, during the discussion about challenges and opportunities in transition to people-centered TB care, the Alliance results of active finding of TB among key and vulnerable populations and the Alliance experience of Advocacy campaign for registration of HCV treatment in Ukraine were presented.

On November 30, 2018, the Alliance for Public Health (the Alliance), together with partner organizations in Kyiv, held an informational and educational campaign “Test under the Clouds” on the occasion of the 30-th anniversary of the World AIDS Day observed all over the world on December 1.

That is why for the first time in Ukraine, the Alliance carried out HIV testing at the altitude of 43 m – right at the top of the “Observation Wheel”. All interested persons had an opportunity not only to get tested for HIV and receive professional advice from the doctor directly in Observation Wheel cab, but at the same time enjoy the magnificent views of Kyiv from the bird’s eye.

Moreover, within the framework of the “Test under the Clouds” campaign, a short press briefing was held with the participation of representatives of charities and non-governmental organizations, leading infectious diseases doctors and HIV-positive people.

“This year, HIV testing was the priority of the World AIDS Day. Indeed, at the moment, 37 million people worldwide are living with HIV and about 9.4 million people are unaware of their status. Within the framework of the Alliance’s prevention programs, only 220,000 people were tested free of charge in Ukraine this year, 6,800 positive results (3%) were found. Today, we are not only testing at the bird’s eye altitude for the first time, but also are pioneering oral (saliva) HIV tests in Ukraine, having used more than 100 tests along with traditional rapid blood tests, which allowed to considerably simplify the procedure of testing and to reach more people”, – said Pavlo Skala, Associate Director for Policy and Partnership of the Alliance for Public Health”.

Over the course of the traditional informational and educational campaign on the occasion of the World AIDS Day, 300 people, mostly students, were tested on the Observation Wheel on the Kontraktova Square and in mobile clinics. All interested persons also had the opportunity to receive condoms, the key protection from HIV/AIDS, free of charge.

The event was organized by the Alliance for Public Health in partnership with the “Convictus Ukraine”, the Kyiv City Center for Social Services for Family, Children and Youth, the Drop-In Center, the CO “Club “Eney” and the CO “ALLIANCE.Global”.

As of the beginning of 2018, there are 141 371 HIV-positive people enrolled on dispensary records in Ukraine, although their estimated number exceeds 241,000 people. Almost half of the estimated number of people living with HIV does not know about their HIV-positive status. That is why testing is no less important in the fight against the spread of the HIV epidemic and the early achievement of 90-90-90 goals, as well as prevention and treatment. Thanks to the tested testing, the Alliance succeeded in reaching 2.4 times more people (235,266 people) in 2017 compared to 2014. 30% more positive results were found (3,577). Among new clients, the percentage of positive results is 5 times higher than among the “old” ones, which indicates the efficiency of preventive measures, as well as new challenges in the activities.

On December 1, the World AIDS Day is observed for the 30-th time around the world.

This year, this day is held under the slogan #Know your status (#ДізнайсяСвійСтатус), because the timely testing of HIV becomes increasingly important throughout the world. 37 million people live with HIV, but at least 9 million of them are not even aware of their HIV-positive status.

This trend is also characteristic for Ukraine – according to official data, as of October 2018, there are 144.6 thousand HIV-positive people enrolled in the dispensary record, although their estimated number exceeds 240 thousand. Thus, almost half of those living with HIV in Ukraine are unaware of their status and, therefore, cannot receive efficient treatment in a timely manner, maintain their health and prevent the transmission of HIV to other people. That is why it is important to popularize regular and timely HIV testing as widely as possible, both among most-at-risk populations and the general population.

The Alliance for Public Health has been testing MARPs for over 10 years, and more than 250,000 people get tested each year due to our activities. This has been made possible by one of the largest HIV prevention programs in the world, enabling 300,000 people who are most vulnerable to infection to receive the necessary prevention services. The next year will become a turning point for this program, which is in line with best international practices and has already made it possible to reduce the number of new HIV cases – the program funding is transferred from the Global Fund to Fight AIDS, Tuberculosis and Malaria to government budget. This is also a pivot point for the Alliance, as we share our experience and best practices. We support state policy on the availability of HIV testing at health facilities at all levels.

The Alliance, based on the recommendations of the World Health Organization, has been introducing the practice of HIV self-testing for several years now. Nowadays a wide range of high quality and accurate rapid tests are available, using both capillary blood and saliva. This test is very easy to do at home and find out the result in 15 minutes, one can just buy it at the pharmacy. To help people choose from among the tests of different manufacturers, the Alliance has prepared detailed guidance on various types of tests available in Ukraine. They can be found at www.selftest.org.ua. Here you can also obtain information on where to get quick tests, what to do in case of a positive result, how to receive free and effective treatment, if necessary.

Ukraine’s successful experience in implementing comprehensive HIV prevention and treatment programs has become exemplary for the entire region of Eastern Europe and Central Asia. This year, the Global Fund has supported a new project of consortia of organizations headed by the Alliance on working in 14 countries. This is the largest regional HIV project that will start on January 1 next year. The Alliance continues its active work on combating the epidemic!

From November, 12 to 16, the Alliance for Public Health had training for members of Harm Reduction Academy that arrived from different parts of the world. We exchanged about most effective solutions on HIV response among PWID, integration with other health agendas, financing interventions.

Our participants from Bosnia and Herzegovina, Ethiopia, India, Macedonia, Romania, Serbia, Tanzania, UK represent public health institutes, municipalities, international organizations with a richness of background and experience to help leverage global response to HIV among PWID.

This time we had several participants from Southeast Europe countries who are in the middle of transition of HIV programs from donor funding to national funding — the challenging path that Ukraine is making these days — and we learned from their experiences of successful and not so strategies.

In order to strengthen the partnership network with state institutions, namely, the Ministry of Youth and Sports of Ukraine and oblast state administrations, the ICF “Alliance of Public Health” on November 14-16, 2018, held a seminar for partners – public and youth and other institutions and organizations – in the Dnipro Children’s Recreation Camp in Kozyn town of Kyiv oblast.

The holding of this event is extremely important in the context of the transition of the program transition from Global Fund support to public funding and in the context of the reforms that are currently taking place in Ukraine.

During the seminar, the specialists got acquainted with the state program “Youth of Ukraine 2016-2020”, the study on the youth situation, the program “Youth worker” and the activities of the Association of Youth Centers.

The workshop was organized by the Alliance to engage its partners as active participants in state programs aimed at improving the health of young people. This activity includes prevention actions and ensuring rights of representatives of key populations, prevention and treatment of HIV/TB and other socially dangerous diseases.

The workshop reviewed the conditions and criteria for funding under the Youth of Ukraine 2016-2020 Program, the competition announcement and financing deadlines, established for each region of Ukraine.

The Alliance expresses its appreciation to all the partners involved in this event and the co-organizers of the event: the Department of Youth Policy of the Ministry of Youth and Sports of Ukraine and the team of the Kyiv Regional Youth Center.

On November 6, with the support of the ICF “Alliance of Public Health” a round table was held in the Ukrainian Parliament on the occasion of the first anniversary of the Parliament Platform to Fight Tuberculosis.

Representatives of the Ministry of Health of Ukraine, the Public Health Center, the ministries of Justice and Social Policy and other national institutions, international organizations, civil society and patients’ organizations together with parliamentarians discussed the most important issues dedicated to TB control in Ukraine. As well, the following topics were highlighted during the meeting: the state policy in fight against TB, development and implementation of a multi-sectoral accountability mechanism after UN High-Level Meeting on TB and Strategic Plan on advocacy, communication and social mobilization.

MP Sergiy Kiral, the Head of the Parliament Platform to Fight Tuberculosis told that the success achieved by the parliamentary association during the first year of activity was the result of a joint work. The role and importance of civil society organizations and their capacity in overcoming the epidemic in Ukraine were noted during the meeting.

Significant work in the area of TB control is carried out by the ICF “Alliance of Public Health”, which is the focal point of the civil society organizations to work with the Global TB Caucus in Ukraine.

Zahedul Islam. Director: Treatment, Procurement & Supply management, on behalf of civil society expressed gratitude to the Head of the Parliamentary Platform for the openness to cooperation and prominent results achieved during the year.

Opioid substitution therapy is the efficient method of opioid dependence treatment and one of the most efficient HIV/AIDS prevention ways. Currently the state takes leadership in OST program development and fully ensures the procurement of medicines.

To improve the quality and efficient treatment of opioid dependence, the ICF “Alliance of Public Health” in cooperation with the U.S. Centers for Disease Control and Prevention (СDС) and with the support of the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and by the technical support of the UNODC office in Ukraine translated into Ukrainian and published the «National Guidelines for Medication-Assisted Treatment of Opioid Dependence», of the Department of Health of Australia 2014).

Currently the printed copies are being delivered to HCFs, and the electronic version of the Guidelines is available at the link.

Thus, HCFs will be able to use this document on the facility level after its approval by the internal order of the HCF (according to the provisions of the Decree of the MoH of Ukraine No. 1422 dated 29.12.2016).

We express our gratitude to all partners contributing to the improvement of OST quality and sustainability in Ukraine – Public Health Center of the MoH of Ukraine, UIPHP, the Network of PLWH, UNODC, PEPFAR, civil society organizations and associations.