April 06, 2016

All-Ukrainian action “Unite to end TB!”

On 24 March 2016, activities dedicated to the World TB Day were held almost all over Ukraine with support of Alliance for Public Health, calling to Unite to End TB.

About 15 CSOs played an active role in the campaign. To draw public attention to the issues of TB, raise awareness in TB prevention and early detection, information materials were distributed thought mass media and awareness-raising classes were held, including lectures for students of professional and higher educational institutions, and individual counseling on early TB diagnostics was conducted.

About 3,500 copies of information materials “Tuberculosis” and “Tuberculosis is Curable” were distributed and about 2,500 people were screened with the help of special questionnaires for presence of tuberculosis symptoms. In case of detecting any people with tuberculosis-like symptoms, recommendations were given on the need to seek medical assistance in treatment facilities.

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April 05, 2016

Advancing combination prevention horizontally – from Ukraine to Kenya

Alliance for Public Health was featured in a case study included in a new advocacy brief for community-led organisations ‘Advancing combination HIV prevention’, produced by the International HIV/AIDS Alliance and UNAIDS. The publication aims to support community-led organisations make the case for greater investment in HIV combination prevention at national, district and local levels.

The case study highlights how Alliance for Public Health supported Kenyan AIDS NGOs Consortium and its partners in Kenya harm reduction programme development within Dutch-government funded project Community Action on Harm Reduction in 2011-2015. The project improved access to HIV prevention treatment and care for people who use drugs, their partners and children; advanced their rights; and increased the capacity of civil society and government stakeholders to deliver harm reduction and health services to communities of people who use drugs.

‘Practical, effective tools that have proved efficient in Ukraine have been swiftly taken to practice in Kenya. When we are thinking about how fast-track can be achieved in AIDS, horizontal exchange is one of the most effective solutions. Alliance Centers* that accumulate technical knowledge is a good example of facilitating horizontal exchange’, says Andriy Klepikov, Executive Director of Alliance for Public Health.

Full publication is provided during Civil Society Hearing in New York this week, and can be downloaded here.

*Alliance Centres of Practice have been set up by International HIV/AIDS Alliance to bridge the gap between evidence and practice in order to end AIDS. All Centres are hosted by Alliance Linking Organisations. They draw on their individual expertise to connect, bring together and develop the Alliance’s collective knowledge, experience and community links on specific expert areas. Alliance for Public Health hosts the Centre on HIV, Hepatitis C and Drug Use. More information on Alliance Centres available here: http://www.aidsalliance.org/centres.

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April 05, 2016

Hepatitis C: Game of Survival?!

On 5 April 2015, Alliance for Public Health (Alliance) together with its partner civil society organizations held Hepatitis C: Game of Survival campaign near the premises of the Cabinet of Ministers of Ukraine. Participants of the campaign demonstrated the “deadly slot machine” to policy-makers and mass media, demanding to solve the urgent problem of allocating budget funding to treat patients with hepatitis C virus (HCV).

According to the official data, there are 73 thousand patients with HCV registered in Ukraine, among them at least 40 thousand urgently need treatment. However, those numbers do not reflect the real situation with the spread of epidemic. As estimated by WHO, more than 5% of people in Ukraine are infected with HCV, which is over 2 million people! It is hard to say how many of them should have already received treatment. There is no official register of patients, though it should be established in accordance with the National Viral Hepatitis Program.

Back in March, people living with HCV, doctors, and civil society organizations were looking for the results of the long-awaited government competitive bidding to procure drugs for HCV treatment, as there was a hope that after international organizations take over the procurement, innovative treatment will become more accessible. However, the bidding results have not been made public yet, and even the expected amount of drugs will cover only a minor share of patients. 6.1 thousand bottles of the modern drug, sofosbuvir, planned to be procured with government funding, may be enough to cover 2,000 standard treatment courses! Such number of patients who will be able to receive treatment will no way help to eliminate the HCV epidemic in Ukraine. According to the best-case scenario, only one of 20 patients who urgently need treatment today, will be able to receive the therapy within the government funding. Patients’ selection criteria should first and foremost depend on the severity of disease, but in practice the existing corruption schemes may make certain adjustments in the selection procedures.

People living with HCV unwillingly became hostages of a very dangerous game, and now their fate depends on the “deadly slot machine” – some of them will be lucky to receive treatment which will give them a chance to survive. Meanwhile, thousands of other patients will not live to see the next round of the slot machine operation! Delays and half words from the side of the Government, the Ministry of Health, and regional administrations make patients and treatment advocates go out on the streets. These days, similar campaigns will also be held in many regions of Ukraine to make responsible public officials review budgets and allocate additional resources to procure treatment courses from local budgets. In 2014-2015, in Ukraine only about 100 patients had a chance to receive treatment at the cost of regional budgets, but unfortunately it is typical when even regions with budget surplus, where over 10 thousand people are registered living with HCV, local authorities count only on the national funding of such treatment. At the same time, there are success stories of regions with budget deficit, which apart from the courses allocated within the National Program, also find a way to procure life-saving treatment within their competence. Most heads of regions count on the funds allocated within the National Program and on the treatment courses provided by Alliance. But such approach is self defeating and extremely ineffective – programs of international donors will be shut down next year, and the National Program will be over in December 2016. Thus we have a paradoxical situation when there is nobody who cares about patients. And the treatment program is available only on paper in order to report on its existence, and even if the program is implemented, it is often done “for the sake of appearance” and not to really save thousands of lives!

“Current HCV treatment is very expensive, in developed countries it may cost up to USD 80,000 per course, – underlines a community activist, Julia Dorokhova. ¬– Today the innovative drugs have already been registered in Ukraine, and hundreds of patients were able to get treatment within the Alliance program. But now we have all found ourselves in a situation when we are players in a “state casino” – nobody knows if any money will be allocated for treatment, if policy-makers will remember about tens of thousands of patients or if they will go on thinking that there is no epidemic of HCV? It is not enough to just approve a program, when people’s lives are at stake”.

At the same time, in the center of Kyiv a mobile clinic was operating, where all people could receive professional counseling on HCV diagnostics and treatment as well as special forms for examinations.

“Not a single country in the world knows the exact number of people infected with hepatitis C virus, because the infection process is hidden, – says Professor Olha Holubovska, Head of Infectious Disease Department at the Bogomolets National Medical University, chief infectious disease specialist of the Ministry of Health of Ukraine. – Our consolidated efforts allowed to approve the National Viral Hepatitis Program as well as 16 regional programs; introduce amendments to the treatment guidelines, which were brought in line with the international standards; and register innovative direct-acting antiviral agents in our country. Now Ukraine has to develop new modern strategies aimed at elimination of viral hepatitis in line with WHO objectives. That is why we are currently working on those tasks together with civil society organizations. Unfortunately, the level of funding of the National Program is very low, with many activities not financed at all. Also, not all regions of the country demonstrate sufficient commitment in this regard – even the existing local programs are either not financed at all or are financed at an extremely low level. To comply with the WHO Global Strategy, it is not enough to provide only treatment – this strategy also stipulates improvement of the epidemiological surveillance system, implementation of prevention activities, etc. If we stop at this stage, further spread of HCV epidemic will have disastrous consequences for Ukraine”.

So far treatment of HCV depends on the operation of the “deadly slot machine”, allowing only one in twenty patients to win a chance to receive life-saving treatment within the state budget. But will this machine operate at all or will the statesmen just forget about tens of thousands of patients waiting for their therapy? The situation with HCV epidemic becomes more and more pressing. The countdown of people’s lives in this Live Casino is going on…

***

Over 150 million people in the world are infected with hepatitis C. The threat of the spread of epidemic in Ukraine grows in the context of the economic crisis and military conflict in Eastern Ukraine. One of the priority areas of the activities of Alliance for Public Health and its partners is response to the epidemic of hepatitis C in Ukraine and provision of HCV diagnostics and treatment for vulnerable groups and general population. In 2015, Alliance launched the first program of treatment with a new-generation drug – sofosbuvir, which is expected to cover up to 2,000 people. 203 patients have already completed their treatment courses. As per the set standard, 12 weeks after completion of the therapy patients are to go through a follow-up examination – and it shows that in 90% of those who receive treatment HCV is undetectable. This is a huge step forward as compared to the old treatment regimens (peginterferon + ribavirin), when the indicator of successful treatment outcome was no more than 50%. In 2014, Alliance managed to negotiate significant price reduction with the manufacturer, which allowed for the first time in Ukraine to procure sofosbuvir at the price of USD 900 per course.

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March 24, 2016

“Black holes” and “blind spots” of TB epidemic in Ukraine

24 MARCH IS A WORLD TB DAY

Today, every fourth person with tuberculosis (TB) remains unnoticed by our national healthcare system! Due to the lack of minimum conditions required for early TB detection in the context of the military conflict in the East of Ukraine, the development of TB epidemic is now uncontrolled like a “black hole”, which is a real threat for other regions of the country, especially considering high level of migration and big number of internally displaced persons. This is a catastrophe which should be in the focus of attention of policy-makers, government officials and national media!

Recently, a tendency is observed in Ukraine and in the world of further transmission of the forms of tuberculosis not sensitive (resistant) to most traditional drugs. Ukraine ranks fifth in the worldaccording to the prevalence of multidrug resistant tuberculosis (MDR-TB)! According to the results of the first national epidemiological study, the level of MDR-TB among newly diagnosed patients is 22.0%, and among people with recurrent cases of TB – 55.6%.

Ukraine still has the worst in Europe TB cure rates – only 71% of newly diagnosed TB cases and 34% of MDR-TB cases are cured.

The main activities of International Charitable Foundation “Alliance for Public Health” (hereinafter – Alliance) as a co-recipient of the Global Fund to Fight AIDS, Tuberculosis and Malaria (hereinafter – Global Fund) in countering the TB epidemic are aimed at its early detection among members of key populations and providing effective treatment to patients with MDR-TB.

In 2015, almost five thousand patients with MDR-TB received drugs and social support withsupport of Alliance; in total, it is planned to provide treatment courses to 9,300 patients.

Alliance implementing partner in support of patients with MDR-TB who receive outpatient treatment is the Ukrainian Red Cross Society (hereinafter – Red Cross). Cure rates of the patients who receive medical and social support of the Red Cross with the help of Alliance are encouraging: cure rates went up to 89.6% as compared to 32% among the patients who did not receive such support. Thus, social support of patients and forming adherence to treatment are as important for eliminating the epidemic as financing of TB treatment.

If the cost of a treatment course for drug-sensitive tuberculosis is $35, the cost of MDR-TB treatment is about $2,200, which is 62 times higher! Providing access to high-cost TB treatment for members of key populations is one of the key tasks of Alliance. Since 2012, we have been procuring drugs for treatment of patients with MDR-TB, and the scope of our procurement has been increasing every year. Thus, in 2015 drugs were procured in the total amount of USD 11.7 million, which will allow providing treatment to 5,250 patients or half of all MDR-TB patients in Ukraine.

Nine percent of MDR-TB patients develop side effects, which often result in treatment termination. To minimize the number of patients who drop out of treatment and to prevent development of drug-resistant TB forms, last year Alliance for the first time procured medications to eliminateside effects for all MDR-TB patients who needed them, which is very important to improve their quality of life.

The situation with tuberculosis treatment in Ukraine is aggravating due to the outdated approach to patients’ hospitalization. The average period of hospital stay is 90 days, while according to WHO data most patients are no longer dangerous to people around them three weeks after they start their therapy, and they can switch to outpatient treatment. So their isolation in inpatient units is not justified. Alliance also promotes modern approaches to TB treatment that should be first ofall patient-oriented, which stipulates expansion of outpatient service delivery models, case management practices, and multidisciplinary approaches to meet social and psychological needs of the patients.

Despite considerable restrictions of the activities of humanitarian organizations in the temporarily occupied territories in the East of Ukraine, in 2015 Alliance conducted six successful deliveries of humanitarian consignments, including 23 thousand packs of TB treatment drugs. Aggravation of the epidemic situation in the East of Ukraine is more and more critical. For example, the numberof cases of active TB forms even in Ukraine-controlled areas of Luhansk oblast grew by almost30%, in particular among children and adolescents – 2.3 times! As for the incidence of TB/HIV co-infection, its level increased almost 30% among the general population of Ukraine-controlledareas of Luhansk oblast. There are no official data related to the areas not controlled by Ukraine. The war in Eastern Ukraine led to the creation of some kind of a “black epidemic hole”, which may become a source of transmission of socially dangerous diseases in Ukraine. Alliance plans to provide further support to 14 partner civil society organizations in Donetsk and Luhansk oblasts, which work to provide early TB detection among the key vulnerable populations.

Alliance implements TB programs not only in Ukraine, but also in other countries of WHO European region. Thus, January 2016 was a starting point of the first three-year regional project “Strengthening health systems to effectively control TB and MDR-TB in Eastern Europe and Central Asia”. Alliance together with TB Europe Coalition is one of the leading partners involved into implementation of the project, focusing on its vital component – coordinating and uniting efforts of partners and stakeholders. In particular, this component is aimed at uniting the efforts of CSOs to advocate for the development of outpatient care systems with high-level efforts aimed at reforming healthcare systems to increase the effectiveness of TB control in target countries.

On the occasion of the World TB Day, the Alliance for Public Heals calls to policy-makers andresponsible government officials of all levels not to delay reforms of healthcare systemsnecessary to implement patient-oriented approaches in the delivery of timely and high-qualitymedical and social support to TB patients!

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March 24, 2016

European TB Coalition Statement for World TB Day

Press Release

TB AND HIV IN EASTERN EUROPE AND CENTRAL ASIA ARE EU’S BUSINESS!

 Brussels, 24th March 2016: On the occasion of World TB Day, the TB Europe Coalition (TBEC) is alarmed by the withdrawal of donor support to TB & HIV programmes in Eastern Europe and Central Asia, dealing a catastrophic blow to patients. While joint efforts from all stakeholders is needed to ensure we do not recede on progress made so far, TBEC calls on the European Commission to play a stronger political convenor role in the region to help achieve a sustainable and effective transition to domestic funding of health systems.

As the economies of countries in Eastern Europe and Central Asia (EECA) grow, international donors withdraw support. Yet external funding for TB and HIV services is critical in the region. Progress made in TB & HIV services is dangerously at risk if governments don’t step up to the plate. EECA is home to the fastest growing HIV epidemic and the highest rates of multi-drug resistant tuberculosis (MDR-TB) in the world, often focused on key populations who are frequently the hardest to reach.

Civil society is central to the TB/HIV response, often being the only players able to reach and ensure access to medical and social services for key populations.. Yet, it is these critical services that are most at risk as international donors withdraw and domestic financing is slow to appear. For example, in Serbia when the Global Fund’s support ended in 2014, the government did not fill the funding gap. Since then programmes serving 3,000 people who inject drugs have cut or stopped services. The 2015 national HIV budget allocated just 3 percent for HIV prevention, with no funds for key populations.

Similarly, USAID support to TB programmes and Global Fund’s support to HIV prevention programmes in Romania stopped in 2007 and 2011 respectively. As a result, the country saw the number of new HIV infections double from 2009 to 2012.

“In Romania, domestic funding of the TB response is still extremely low. Moving from international funding to local resources is a work in progress. While the TB National Strategy for 2015 – 2020 does have a multiannual budget which should significantly be covered from domestic sources, neither the Government nor the local authorities seem ready to take over from international donors.” said Silvia Asandi, General Manager of the Romanian Angel Appeal Foundation.

Too often countries in the region are also facing difficulties in providing full and complete access to TB treatment to patients in need, due to complex regulatory frameworks. When facing transition, a country must ensure that there are no legal barriers in place for the purchase and import of medicines required to complete treatment. There is a desperate need for planned and well-executed transition processes in order to maintain services for the people who need them.

“Successful transition can happen, Croatia is a good example. Yet, this process needed strong political commitment and lengthy planning. It demands programmatic, governance and fiscal reforms which cannot be done overnight” said Fanny Voitzwinkler, Coordinator of the TB Europe Coalition. “All stakeholders, including donors, civil society, technical agencies and governments need to work together if we are to be successful, but we shouldn’t underestimate the political role that the EU institutions can play in this process“, she added.

The EU has a framework of bilateral cooperation with many countries in the region, including those which aspire to join the EU. Thus EU institutions are in a key position to play a political convenor role.

“The European Union should accept that abrupt withdrawal of support to middle income countries is not the way and come up with concrete political strategies to ensure sustainability of aid. The issue is made more relevant when considering that the TB and HIV epidemics in our region are threats of a cross-border nature.” says Timur Abdullaev a TB activist from Uzbekistan.

The TB Europe Coalition calls on the EU to appoint a transition focal point across European Commission services. This would be an important first step in ensuring dialogue between EU country delegations, civil society and donors to identify political solutions and ensure sustainability of TB/HIV services.

The TBEC together with the Eurasian Harm Reduction Network, the Stop Aids Alliance and AIDS Fonds specifically call on the European Commission to convene a Partnership Meeting by the end of the year, bringing together all stakeholders to discuss and agree on concrete roadmaps for a successful transition to domestic funding.

Editors Notes:

· Tuberculosis retains the unwelcome distinction of being the world’s single deadliest infectious disease. In 2014 alone, the epidemic killed 1.5 million people worldwide. A far cry from the image of a disease consigned to the past, TB remains a painful reality for millions across the world and in Europe. In particular, countries from Eastern Europe and Central Asia (EECA) are those who harbour the greatest percentage of multi drug-resistant TB (MDR-TB) cases. Fifteen out of the world’s 27 countries hardest hit by MDR-TB are situated in EECA.

· The TB Europe Coalition is an informal advocacy network of non-governmental organisations and individuals that share a commitment to raising awareness of TB and to increasing the political will to control the disease throughout the WHO European Region and worldwide.

Tweet suggestions:

#TB and #HIV in Eastern Europe and Central Asia are @EU_Commission business!http://tinyurl.com/homtoaf #WorldTBDay #UniteToEndTB

Together we are stronger to fight #TB in EECA region http://tinyurl.com/homtoaf #WorldTBDay #UniteToEndTB @EU_Commission

#WorldTBDay is today. Time to #UniteToEndTB in Europe and Central Asia @EU_Commission

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March 17, 2016

WORKING MEETING WITH HEADS OF CSOS

On 15-17 March 2016, Alliance for Public Health for the first time conducted a large-scale working meeting with the heads of 78 civil society organizations (CSOs) implementing harm reduction projects in Ukraine aimed at the prevention of HIV, hepatitis, sexually transmitted infections and tuberculosis among people who inject drugs (PWID), commercial sex workers (CSW) and men who have sex with men (MSM).

 The meeting included analysis of 2015 activities, discussion of the ways to improve the efforts of assisted testing, early detection of tuberculosis, operation of mobile clinics, aspects of internal monitoring of project activities, etc. The participants discussed the problems they face when building partnerships with health care facilities as well as challenges related to the health care reform.

Project Managers – Larisa Melanich (New Family CF), Olena Romanets (Avante CF), Oleksandr Solianik (Light of Hope CF), and Yulia Adirkhayeva (Vertikal CF) – shared their experience in project activities and best practices implemented in their organizations.

Besides, Alliance presented the preliminary results of 2015 bio-behavioral studies among PWID and CSW. Project managers were recommended to optimize operation of service delivery sites taking into account the results presented.

Considering creation of new police units in the regions of Ukraine, the session concerning peculiarities of interaction with territorial units of the national police and the necessity to train policemen in the regions in the basics of harm reduction was very timely.

The participants were informed about the urgent issues in implementing substitution maintenance treatment, scale up of treatment of viral hepatitis C, specifics of PIMA program implementation, Global Fund Speak Out! anti-corruption campaign, Alliance training agenda for 2016-2017, procedure of preparing and printing awareness-raising materials, planned Alliance publications, and implementation of gender-sensitive services.

Besides, to settle problematic issues related to the procurement of commodities in the conditions of military conflict in Eastern Ukraine, a separate meeting was held among program and finance officers of Alliance, procurement expert from the Network and the heads of those projects which operate on the temporarily uncontrolled areas of Donetsk and Luhansk oblasts. The session resulted in finding optimal solutions to continue procurement activities within the projects.

The meeting allowed heads of the projects to get answers to vital program and finance questions, share their knowledge and experience.

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March 09, 2016

Humane drug policy and the new police

Twenty-eight members of the management of special unit of the fourth territorial office of the Drug Control Department in Vinnytsia, Kirovohrad and Cherkasy oblasts for the first time ever took part in a one-day workshop “National Police, Harm Reduction and Human Rights” recently held in Vinnytsia with support of Alliance for Public Health (Alliance), Law Enforcement and HIV Network (LEAHN), and local, CBO “Independence Center”.

Pavlo Skala, Alliance Associate Director: Policy and Partnership and representative of the international Law Enforcement and HIV Network in Ukraine, rationalized the priorities in protection of human rights of people who use drugs – clients of harm reduction and opioid substitution treatment (OST) programs – based on case studies as well as his own practical and professional experience, presented to law enforcers considerable national and international experience in implementation of such programs, and new regulatory documents, which substantially deregulate the procedures of medical narcotic drugs turnover, in particular for the OST needs. Special attention was given to safety measures which should be observed by policemen to prevent HIV, viral hepatitis C and other socially dangerous diseases.

Roman Panasiuk, Head of the local office of the the Drug Control Department, was present at the workshop and took an active part in the training together with his subordinates.

The participants actively discussed challenges in the access to prevention services and OST with Irina Veretko, drug treatment doctor, and Oksana Oryshchuk, head of CBO “Independence Center”.

The knowledge obtained at the workshop is important for law enforcers not only in terms of general re-orientation away from the repressive approaches to drug dependence in compliance with the new state strategy in drug policy, but also in the context of re-qualification which is to be held in the nearest weeks.

Alliance in cooperation with local partners already held similar workshops for law enforcers in Kyiv, Lviv, and Kharkiv. Alliance is ready to support local initiatives to conduct such training events for re-qualified law enforcers in other regions of Ukraine.

Contact person: Natalia Kravchenko (044 490 54 85, ext. 235, kravchenko@aph.org.ua)

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February 25, 2016

Launch of the new regional project (TB REP)

In January 2016, the first TB in Eastern Europe and Central Asia Project on Strengthening Health Systemsfor Effective TB and DR-TB Control (hereinafter – the Project) waslaunched. The Project is implementedwith the financial support of the Global Fund to Fight AIDS, Tuberculosis and Malaria (hereinafter – GF) in the countries of Eastern Europe and Central Asia (hereinafter – EECA).

 Period of project implementation: 2016 – 2018.

Overall goal of the Project is to improve TB and DR-TB treatment outcomes in the target EECA countries[1]through health systems strengthening, resulting in wide implementation of the patient-centeredapproaches in the delivery of TB prevention, treatment and care services.

Project objectives:

– To increase political commitment to end TB and MDR/XDR-TB through regional cooperation and evidence sharing for better governance of the National TB Control Programs.

– To develop and disseminate evidence on effective TB services delivery systems for implementation of the patient-centered approaches and innovative models of care.

– To ensure sustainable financing in TB Control and efficient funds allocation mechanisms.

With technical leadership of WHO Regional Office for Europe, the Principal Recipient of the GF grant to implement the Project is the Center for Health Policies and Studies (hereinafter – PAS Center, Republic of Moldova). Besides, a wide range of partners is involved into project implementation, including TB EuropeCoalition, on whose behalf ICF “Alliance of Public Health” acts, the European Respiratory Society, other academic and service institutions of the region.

One of the Project components is support of the activities of civil society organizations (hereinafter –CSOs) in TB advocacy. To achieve this objective, in November 2015 a call for proposals “Establishingsustained advocacy for transition to the outpatient model of health care for the key groups of population affected by TB” was announced. Based on the competition results, ten winning bidders were defined for organizations representing EECA countries (Republic of Azerbaijan, Republic of Armenia, Republic of Belarus, Georgia, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan,Ukraine, and Republic of Tajikistan).

Within the performance of project proposals, CSOs in partnership with the wide range of stakeholders inthe relevant countries should develop advocacy strategies aimed at the support of efficient and cost-effective outpatient model of health care for TB patients.

ICF “Alliance of Public Health”, which acts in cooperation with TB Europe Coalition for the Project implementation, is responsible for providing general technical support to CSO projects, coordination of advocacy activities, monitoring and exchange of best advocacy practices in EECA region

[1] Republic of Azerbaijan, Republic of Armenia, Republic of Belarus, Georgia, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan, Ukraine, Republic of Tajikistan, and Republic of Turkmenistan.

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February 25, 2016

Over 5% of Ukrainians are infected with hepatitis C

The results of competitive bidding to procure medical drugs for hepatitis C treatment in adults and children will be announced within the next few days.
For the first time ever, this important function was delegated to the United Nations Development Program (UNDP), which will make innovative treatment of hepatitis C (HCV) more accessible to several thousand patients in Ukraine. It depends on the final price of drugs which will be defined in the contract.

The price for a standard HCV treatment course with original direct – acting antivirals (including sofosbuvir) in developed countries varies from 30 to 80 thousand US dollars, but Alliance for Public Health (hereinafter – Alliance) back in 2015 was able to procure sofosbuvir at the lowest price for the original drug – USD 900 per standard 12-week treatment course. This price became a reference point of the “upper price limit” for the current UNDP tender within 2015 state procurement!

According to the data presented by the World Health Organization (WHO) last year, over 185 million people in the world are infected with HCV, leading to 350 thousand deaths per year. Only in WHO European Region, 84 deaths per year are caused by hepatitis C-related cancer and cirrhosis.

In Ukraine, the epidemic of HCV is growing every year. The main independent infectious disease doctor of the Ministry of Health of Ukraine, Head of theInfectious Disease Department of the Bogomolets National Medical University, Professor Olha Holubovska makes an emphasis on the critical situation with HCV in the country: “According to WHO, in Ukraine over 5% of people are infected with hepatitis C, in absolute numbers it is more than 2 million people. In certain populations, the rate of infections is much higher. Thus, based on the data of the Monitoring and Disease Control Center of theMinistry of Health of Ukraine, the level of infections among people who often stay in hospitals is around 12%, and among patients of drug treatment clinics – up to 67%.”

Back in 2009, Alliance initiated large-scale HCV screening in vulnerable populations, and since 2011such testing is offered to general populationduring mass campaigns held within the all-Ukrainian “Demand Treatment!” advocacy campaign. In 2013, the Ukrainian Government approved the first National Targeted Program of HCV Prevention, Diagnostics and Treatment. However, the state allocates funding only for the treatment component, covering only 20% of the existing needs, while other important components of the program, including diagnostics, are not covered from the state budget at all. As a result, we have a vicious cycle: not many people may afford quality diagnostics, which is quite expensive, and as a result the statecannot make a reasonable estimate of the need in HCV treatment, plus it is not really interested in it… due to state budget limitations.
In 2015, Alliance initiated the first program to offer treatment with a new-generation drug – sofosbuvir – which is expected to reach 2,000patients.According to the results of the first stage of the program, in over 90% out of several dozens of patients who already received treatment HCV was not detected! Based on our treatment experience, at the end of the previous year amendments were introduced to the Unified Clinical Guidelines “ViralHepatitis C”, and the drug was included into the State Register of Medical Drugs and the national list of drugs which may be procured with budget funds. It will allow to provide treatment to hundreds thousands of patients.

“Based on the practical experience of Alliance in expanding access to HCV treatment, we found that civil society and international organizations canmake an important contribution to the response to the epidemic. For this purpose, we consistently join our efforts with all stakeholders, – underlinesLudmila Maistat, Senior Program Manager: Hepatitis, Alliance for Public Health. – We anticipate that at the next session of the World Health Assemblymember states will approve the first Global Health Sector Strategy for Viral Hepatitis, into the development of which Alliance has also contributed.Provided that there is sufficient funding, reduced prices for direct-acting antivirals, and access to quality generic drugs, Ukraine has a good chance to successfully implement this strategy and radically scale up access to innovative HCV treatment.”

Due to the critical underfunding of the national hepatitis program, the drugs which are planned to be procured with state budget funds will cover thereal needs only in part. Alliance was able to launch treatment with support of the international donors, but the amounts and the timeframes of suchfunding are also limited.

Alliance implements its programs in close cooperation with the Ministry of Health of Ukraine, having developed a joint vision of eliminating theepidemic in the country – including only modern drugs into treatment regimens, in particular quality generics, holding further negotiations withpharmaceutical companies, reducing prices for diagnostics and expanding the network of diagnostic centers, training of doctors and patients, and making a special focus on most vulnerable populations, with large-scale preventive activities among the general population – those are the comprehensive measures which will help to eliminate the HCV epidemic!

The experience of Georgia may be used as an example of efficient approach in the response to HCV epidemic. Government of the home country ofcurrent Ukrainian Minister of Health covers 70% of the cost of HCV treatment in most disadvantaged populations, with the remaining 30% provided by the municipal budgets. For other categories of patients, the state compensates 30% of the cost of treatment, with the remaining 70% allocated between the local budget and the patient, depending on the income of the latter. Such funding scheme functions like a certain social guarantee for low-income citizens. Free treatment of the members of vulnerable populations was defined as a paramount and top-priority task as this approach, according to WHO recommendations, is one of the key factors in making an impact on the epidemic. In Georgia, where the population is much smaller than inUkraine, the Government reached an agreement with the manufacturer on allocation of 20,000 HCV treatment courses and financial donations to improve the system of patient registration and effective medical support of the project.

The results of HCV screening held among over 4 thousands of those conscripted to the military forces, those involved into the military operations in theEast of Ukraine and demobilized soldiers, held by Alliance in 2015, demonstrated a rather high level of infections – about 4%, and in the main military hospitals – even up to 10%, which made the Ministry of Defense of Ukraine and mass media finally turned their attention to this burning issue.

In the time of military conflict in the East of our country and long-term economic crisis, we need to join our efforts in response to the epidemic. Sharp reduction in the cost of diagnostics and treatment with advanced drugs, their procurement at adequate prices (taking into account the price already achieved by Alliance in 2015) will become crucial and prominent steps on this way, which will prove the commitment of the state to care about the health of its citizens and will allow saving thousands of lives even in 2016!

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February 18, 2016

Manifesto Our vision for a Hepatitis C-free Europe

On February 17, Brussels hosted the EU HCV Policy Summit.

The Summit was attended by over 100 participants, including members of the European Parliament, national policymakers, representatives of the ministries of health from European countries. The Summit was aimed to define the global WHO strategy for viral hepatitis as well as discus and develop a joint Manifesto and call for active actions to eliminate the epidemic of hepatitis C. European best practices, including extended prevention services, treatment access for vulnerable populations, and effective harm reduction programs may play a key role in reducing the number of new infections.

At the Summit, Alliance for Public Health was represented by Ludmila Maistat, Senior Program Manager: Hepatitis C/HIV Policy and Advocacy and the Ministry of Health of Ukraine – by Professor Olga Golubovska, MD, PhD, Head of the Infectious Disease Department, Bogomolets National Medical University, Chief Infectious Disease Doctor of the Ministry of Health of Ukraine. Alliance and the Ministry of Health share a common position and vision of the strategy of elimination of HCV epidemic in Ukraine and in Europe. Ludmila Maistat read out the joint Manifesto “Our vision for a Hepatitis C-free Europe”. You can follow the link to read and sign the Manifesto:

http://www.hcvbrusselssummit.eu/elimination-manifesto

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