On 20 – 24 November, 2017 Alliance for Public Health organised the second module of Harm Reduction Academy, Cycle 4. The module took place in Mombasa (Kenya) and participants learnt about monitoring, evaluation and research. Organisation of this module was possible with the support from Kenya partner organisations: Kenya Red Cross Society, Government of Kenya (National police), Reachout Centre Trust and MEWA. After theoretical part participants had a chance to work on group assignments and apply theory into practice.

HRA alumni from Kenya helped to organise site visits and participants learnt how harm reduction programme work in the costal part of Kenya. They visited drop-in centres, opioid substitution therapy sites, went for outreach to see how services are provided on the ground, visited the prison and probation services.

Here is the feed-back from some of our participants: «Great balance of theory and practice through keeping and showing the big picture in monitoring and evaluation and seeing some of the details.»

«That was really great to have ppt presentations and site visits. They were awesome and I liked the team building exercises»

The next module will take place in Kuala Lumpur and will be on policy, advocacy, community mobilisation and empowerment.

The application for Cycle 5 is already open and everybody who wish to start an exciting learning journey with Harm Reduction Academy are welcome to learn more about it and apply by 15 January, 2018. http://aph.org.ua/en/our-works/world/harm-reduction-academy/

The results of the assessments on gender barriers and key populations in the context of tuberculosis conducted in Ukraine within the project by the Alliance for Public Health in collaboration with the Stop TB Partnership will inform the national TB policy and programs. This message was voiced by Andriy Klepikov in his welcome speech at the stakeholders meeting within the project “Communities, Rights and Gender Tools Assessments for TB in Ukraine”, which was held in Kyiv on 24 November 2017.

In her presentation, the project manager, Yuliya Chorna, emphasized the importance of this study both at the global and national levels. She pointed out that in the course of the study its organizers expect to find out, which gender barriers exist in TB diagnostics and treatment and what should the effective services for women, men and people with other gender identities look like to help them go through the long treatment course successfully. The speaker also emphasized that Ukraine was the only country from our region, which was present at the workshop of the STOP TB Partnership earlier this year to present the study tools, and thus it plays a key role in the roll out of the assessment tools in Eastern Europe and Central Asia.

At the beginning of the meeting, Natalia Spivak legal consultant of the STOP TB Partnership and Serhii Kondratiuk, APMG Health consultant delivered overview presentations on the assessment of the national regulatory framework in the area of TB and relevant human rights barriers.

Representative of the Ukrainian Ministry of Health, Serhii Platov said that the Ministry is ready to work together with the outcomes of the study initiated by Alliance. Olha Klymenko, a former TB patient, told that her treatment as well as the life of her family could be much better if she was offered ambulatory needs-based treatment at the first place.

In the second part of the meeting, informative presentations on the situation with TB morbidity and treatment were offered by Yana Terleyeva, Head of Ukrainian Center for Socially Dangerous Diseases Control, State Institution “Public Health Center of the Ministry of Health of Ukraine” and Alliance consultants, Kateryna Maksymenko and Lilia Masiuk. Representatives of the Ukrainian Institute on Public Health Policy initiated a discussion of the study tools and presented the results of discussions in groups as well as in the broader circle of participants.

During the group activities, there was a heated discussion on how to define the key populations in terms of tuberculosis. It is important to mention that men face a higher risk of tuberculosis than women. Most of the participants said that the risk groups should include people with TB/HIV co-infection; migrants/refugees/internally displaced persons; urban population below the poverty line/rural population below the poverty line. We expect that the study will offer a well-justified response to this question.

This research study is based on the tools developed by the STOP TB Partnership: the TB/HIV Gender Assessment Tool (STOP TB & UNAIDS) and the Data for Action Framework on key, vulnerable and underserved populations. Two focus group discussions and in-depth interviews with target populations will be held. It is expected that the results of this research will be presented in Kyiv in mid-December 2017 and will be a source of the vital information to strengthen the national response to TB and TB/HIV.

From November 20 to 22, 2017, the 2nd Eurasian Gender Academy taking place in Tbilisi (Georgia), which unites 21 participants from seven countries: Armenia, Georgia, Moldova, Belarus, Ukraine, Azerbaijan and Russia. Within the framework of the academy, two professional trainers from Alliance for Public Health – Varban Marina and Badalyan Karen will familiarize participants with significant topics of gender. Topics include the foundations of gender theory, the concept of gender roles, gender mainstreaming, gender equality and human rights, concepts and peculiarities of gender stereotypes, interrelationships between gender and culture, gender peculiarities in communities, etc.

“Gender Academy will combine theoretical knowledge and practical skills of gender analysis in the provision of health services to target groups. It is very good that there are professionals of various specialties and experience among the participants of the academy, which will provide an opportunity to share new ideas and experiences.» – mentioned Varban Marina

On November 14th-17th, delegations from Balti, Chisinau (Moldova), Odesa (Ukraine) and Sofia (Bulgaria) conducted a study and knowledge-sharing visit to Bern (Switzerland) to learn about the experience and best practices in building successful and sustainable city models of responses to HIV in key populations. The group of 23 people included representatives of “Fast-Track TB/HIV responses for key populations in EECA cities” project implementing NGOs, partner NGOs, AIDS and TB services, City Health Departments, Members of City Councils, the police and representatives of the key populations.

During the study visit to Bern, licit, CONTACT, the city of Bern and other partners contributed their expertise in establishing a pragmatic and coherent drug policy on national, county and city levels; in innovative harm reduction interventions on HIV, HCV, night life, substitution, safe injection rooms, social enterprises, housing and cooperation with the police for more security in the public space; in the role in designing municipal and county funding and cooperation approaches to support harm reduction, HIV, TB and viral hepatitis interventions.

The delegations had an extensive agenda: the participants visited harm reduction NGOs, counselling centre for sex workers, work integration programs, clinic for addiction and substitution treatment, the Ministry of Health, Bern regional prison where condom, syringe distribution, and OST are available, a pharmacy where PWID have access to OST, a safe injection room, where people can consume drugs, and have access to other services including shower, laundry, healthy and tasty food, and counselling.

The study visit ended with a meeting with the Mayor of Bern, Alec von Graffenried, who stated that only cooperation between the Municipality, the police and NGOs could lead to such successes in response to the HIV/TB epidemic as in Bern.

Summarizing the study visit, the Mayor of Odesa Gennadiy Truhanov said: “We need to change the mentality and philosophy of our people. We will definitely use Bern experience and the changes that were made within the last 30 years with drug use and HIV to change the situation in Odesa for the better. Unfortunately, today we treat people who use drugs as criminals, but we should treat them as sick and addicted people”. Inspired by the Bern drug policy experience, the Mayor Truhanov promised to open a safe consumption room in Odesa that will become the first one in the EECA region.

The Mayor of Balti, Ihor Sheremet thanked the Mayor of Bern Alec von Graffenried for the fantastic drug programs that have been implemented in the city, and stated that implementing them in Balti will be much easier because Balti needs only to ‘copy and paste’ the 30-year experience of Bern. Mr Sheremet promised to share with the Mayor of Bern an action plan to open a safe consumption room in Balti.

Irena Dimitrova from Sofia Municipality in her speech emphasized that the delegation from Sofia during the study visit was really impressed with the scope and the level of services offered to the members of key populations in Bern and said that she hopes that upon her return to Sofia she will be able to ensure that the services for drug users are more patient-centered. She also hopes that Bulgaria will be able to achieve the same level of cooperation between the municipality, the law enforcers and the NGOs as in Bern.

“Fast-Track TB/HIV responses for key populations in EECA cities” project will further support the cities in implementing their ambitious plans during 2018-2019.

“Fast-Track TB/HIV responses for key populations in EECA cities”  is the Global Fund funded EECA regional project of Alliance for Public Health (Ukraine), AFEW International (The Netherlands), licit and Stop TB Partnership (Switzerland) under technical guidance of UNAIDS EECA office which is there to support city responses to HIV and TB in key populations in the five cities of EECA: Almaty (Kazakhstan), Balti (Moldova), Odesa (Ukraine), Sofia (Bulgaria) and Tbilisi (Georgia). The project will be implemented throughout 2017-2019 and plans to develop efficient and sustainable city models of HIV/TB responses that would allow to reduce AIDS and TB mortalities in the project cities as well as increase the allocation of city funding to HIV/TB interventions for key populations.

The Alliance for Public Health, in collaboration with the Stop TB Partnership launched the implementation of the project “Communities, Rights and Gender Tools Assessments for TB in Ukraine”, utilizing a participatory approach for the involvement of the broad circle of stakeholders in its core.

The study conducted within the project is based on the Stop TB Partnership Tools – TB/HIV Gender Assessment Tool and a Data for Action Framework on key, vulnerable and underserved populations. We expect that the study which will address both gender aspects and analysis of key, vulnerable and underserved populations in TB will provide helpful data to strengthen the National TB response, including TB/HIV aspects.

Socio-cultural norms in many countries may lead to different levels of stigma, discrimination and gender inequalities. Therefore, gender has a critical impact on health seeking and treatment behavior, determining how men, women, transgender people, boys and girls seek health services and bear different kind of barriers. It will also look at how stigma and discrimination lead to delays in seeking diagnosis, poor treatment outcomes, loss of income and rejection of people at health services. Applying gender-based frame to the assessment of TB care will help to reveal these barriers, making TB programs sensitive to these issues by developing interventions that address specific risks for men and women, boys and girls and people with other gender identities.

On the data for action framework, we will focus on the key, vulnerable and underserved populations in TB who are at increased risk of developing the disease due to biological and behavioral factors. These groups vary, based on the country context, but in all cases we will focus on the people who are most likely to be missed by health systems and suffer particularly detrimental consequences as a result of TB. Applying the framework we plan to reflect on the existing approaches to key populations as well as ensure that our health system responds to the needs of all populations that are high risk.

The 1^st stakeholder meeting for introduction of the tools and ensuring the public consultation is planned for November 24, 2017.  The broader circle of stakeholders invited for the meeting is encouraged to contribute to the assessments by sharing their expertise and experiences, and developing and implementing follow up interventions based on the study recommendations. The stakeholder meeting will be complemented by a desk review and two focus-group discussions with people affected by TB and with direct TB experience. We will also utilize in-depth interviews with different groups and stakeholders to have the qualitative information for further analysis and recommendations to strengthen National TB response.

Alliance of Public Health together with 15 civil society organizations call for decriminalization of people who use drugs.

HIV and Hepatitis epidemics still grow while people who use drugs have no access to prevention and treatments.
23% of new HCV infections are caused by sharing unsterile injecting equipment.
15 international organizations, acting at global and regional levels, endorsed the Declaration of the hepatitis community.
“We, the viral hepatitis community, whole-heartedly support Member States’ commitment to the goal of eliminating viral hepatitis by 2030. In order to achieve that goal, we call on world political leaders to remove all barriers to the uptake of the full range of prevention services by people who use drugs by reforming laws, law enforcement procedures and discrimination that hinder access, including the criminalization of minor, non-violent drug offences and to adopt an approach based overwhelmingly on public health promotion, respect for human rights and evidence”.
Please find here the Declaration, which has been officially released during the World Hepatitis Summit (1-3 November 2017, San Paolo, Brazil)

On October 3, 2017 in Verkhovna Rada of Ukraine, an interfactional platform of Parliamentarians was established to consolidate efforts to fight longstanding epidemic of tuberculosis (TB) in Ukraine. Members of Parliament representing different factions and committees willing to contribute to end the disease in our country joined the Parliament Platform to Fight Tuberculosis.

For over a year, the Alliance of Public Health, which is the focal point of the civil society organizations for working with the Global TB Caucus  in our country, and the international movement of parliamentarians Global TB Caucus, contributed to the development of the deputy initiative in Ukraine and its setting in the interfractional parliamentary association to fight against TB. As a result of this activity, on October 3, 2017, the Speaker of the Verkhovna Rada announced the official creation of the Parliament Platform to Fight Tuberculosis.

“We united regardless of party affiliation or political views. Within the framework of the Parliament Platform to Fight Tuberculosis, beside legislative resolution of issues concerning elimination of TB, our goal is to effectively cooperate with all related authorities, listen to the needs of the patients, ensure sustainable budget to fight the disease, collaborate with the civil society and parliaments of other countries. That is, to be the center of partnership and joint efforts. A special task of the Parliament Platform is to promote the rights of people affected by TB and overcome discrimination and stigma toward the patients and their families”” —noted during the Round Table on Establishing the Parliament Platform Mr. Serhiy Kiral, Member of Parliament of Ukraine, PACE Reporter on antimicrobial resistance and tuberculosis in Europe.

Participation in the event was attended by peoples’ deputies of Ukraine,, delegates of key international organizations, leaders of respective authorities, representatives of civic society, patients, and people affected by TB. At the beginning of the Round Table Olha Klimenko, a former patient and author of the book “The World in Me. Confessions of Tuberculosis Patient”, told the participants of the event about importance of supporting patients during treatment and considering their needs, based on her own experience: “A patient with any diagnosis is, first of all, a human being in need of help and support. It is important for people receiving treatment to be able to count on all the human and professional support to complete it successfully. We have a goal: to introduce outpatient treatment models in our country. For patients, provided medical indications are positive, to be able to choose whether they get treatment in the TB dispensary or at home, with regular visits and support provided by a social worker”.

Acting Minister of Health of Ukraine stated: “We have the money, we have the medicines, we have new treatment protocols. Our task now is to change the system to serve to the needs of the patients, and not its own needs. We have to make quality diagnostics and effective treatment accessible to people.”

Andriy Klepikov, Executive Director of International Charitable Foundation “Alliance for Public Health” informed regarding the need to switch to comprehensive people-centered systems of outpatient TB care that arises out of the critical situation in Ukraine and throughout Eastern Europe and Central Asia (EECA) region especially with the burden of multi-drug resistant tuberculosis (MDR-TB). He noted that our country is among the countries with the greatest burden of MRTB and that this form of the disease is diagnosed in every second patient with recurrent case of the disease, and in one of every four new cases. “Civil society organizations have proven to be key players in provision of quality and people-oriented TB care. In particular, combining medical, social and psychological support allowed doubling the success rate of MDR-TB treatment! About 80% of patients with MDR-TB were cured! This is a really impressive result, considering that on average in Ukraine, the success rate for such patients is as low as 42%.” — stated Andriy Klepikov – “In view of future switching from donor support to domestic budget sources, it is important to ensure sustainability of funding of effective approaches to detecting and treating tuberculosis. Availability of budget funds and mechanisms for social contracting of services is the foundation of the sustainability of Ukraine’s response to epidemic of tuberculosis.”

Congratulations of the initiative to create a Parliamentary Platform on behalf of the Global TB Caucus announced Rosanna Flury, EECA Regional Director of Global TB Caucus. She noticed that today Caucus has already united more than 2,400 parliamentarians from 132 countries of the world. Due to the political will and support that can be provided by members of the Parliament Platform to Fight Tuberculosis as representatives of the main legislature of the state will enable achieving sustainable outcomes, approving respective budgets and rendering significant public influence required to overcome stigma and raise the awareness of Ukrainians about the disease. Rosanna Flury also stated that “Global political actions are crucial to draw the attention to the problem of tuberculosis, a disease that kills more people than any other infection.  We are approaching an important moment in fighting TB — the 2018 UN High-Level Meeting on TB. Ukraine will play an important part in fighting TB in Eastern Europe and Central Asia, as well as on the global level.  Global TB Caucus welcomes establishing the Ukrainian Parliamentary Platform.”

The Alliance is confident that the Parliamentary Platform is waited for the fruitful cooperation with the executive authorities, international organizations and civil society. It is very important today to combine all the efforts and key components of the response to the TB problem, in particular, within the framework of the regional TB-REP project, which Ukraine is a participate in.

Follow the official Facebook page at www.facebook.com/platformaborotbiTB  for specific steps of the Parliament Platform to Fight Tuberculosis.

Video recording of the Round Table can be viewed at http://newsvideo.su/video/7664241

Video recording of the press briefing on the establishment of the Parliament Platform to Fight Tuberculosis can be found at http://newsvideo.su/video/7664241

21 participant from 13 countries visited Kyiv, Ukraine, on September 25-29, to start Harm Reduction Academy course which is developing global leadership in harm reduction. Ukraine has been purposefully chosen as one of the world’s biggest and efficient harm reduction programs that allowed to reverse the pace of HIV epidemic in injecting users and the country as a whole.

HIV epidemics is growing among PWID in the world – 10% of new infections in 2015 were through dirty needles when injecting drugs. Although there are effective and proven practices to respond to drug use driven HIV and HCV epidemics recommended WHO – clean needles, substitution therapy and ART for HIV-plosive persons – these services are available to only 10% of the estimated global population of people who are injecting drugs. Harm Reduction Academy appeared as response to the critical lack of access to key services  with ambition to generate leadership, technical knowledge and action to mainstream the interventions for people using drugs and end epidemics of HIV, HCV and TB.

The Academy started in 2016 and since then it has reopened doors to 4th group of participants this week. The students and alumni are public health professionals, national and local government workers, civil society, community, police – totally from 18 countries of the world. In the course of 3 weekly Modules they get exposed the themes of harm reduction services and interventions, data and research, drug policy and community mobilization. Combination of learning an practical exposure to programs in 3 of the hosting countries – Ukraine, Kenya and India/Malaysia – allow to receive international understanding of harm reduction and equip students for action in their home countries.

Thanks to the  participation in the academy, some significant progress has been made in developing city responses in Kyiv and Odesa, conducting international police dialogues on TB and harm reduction, initiating interventions on HIV response among people injecting drugs in Kenya.

We are really grateful for our supporters and donors, Stop TB Partnership and EQUIP project, Centre of Public Health and NGOs that kindly welcomed our visitors in Kyiv. Next module will take place in November in Mombasa, Kenya

On September 13-14th, the 6th International City Health International (CHI) Conference was held in Basel, Switzerland. City Health international is an annual international conference, which examines current policy and practice in relation to public health and health behaviours in cities.

The main theme of the CHI 2017 was ‘Empowerment, Engagement and Partnership: participating to develop healthy cities’. This reflects the belief that measures and actions for health promotion and urban development are more effective if the affected populations play an active and co-decisive role in the process of design, development and delivery. Evidence demonstrates that such engagement and participation contributes to sustainable solutions, to a greater identification with urban public space and increased intergenerational communication. These measures should lead to better improving health of city residents, increase life expectancy and social security of the population.

The conference was attended by about 130 delegates, including partners from the “Fast-track TB/HIV responses for key populations in EECA cities” project from Ukraine, Moldova, Georgia, Bulgaria, Kazakhstan, Switzerland and the Netherlands. Representatives from NGOs that implement the project in cities, municipalities, key populations, city AIDS Centres held a separate meeting to discuss the progress, achievements and challenges of the project, as well as the forthcoming visits of city delegations to the municipalities of Bern and Amsterdam, and exchange visits between project cities.

The conference covered broad public health topics, including sessions on homeless people, alcohol, nicotine and cannabis use, physical culture, sports, life expectancy, ecology and environmental protection, etc.

The conference ended with the announcement of City Health International 2018 Conference, which will be held on September 13-14, 2018 in Odessa, Ukraine. This will be the first City Health Conference in the Eastern European region.

On August 10-11 2017, Alliance of Public Health together with the All-Ukrainian Liga Legalife conducted meeting with representatives of the sex-workers community for strengthening the advocacy potential and mobilize community members.
The meeting participants, including community representatives and non-governmental organizations. Community members got knowledge about:
– Implementation of prevention, harm reduction and access to treatment during the transition period regarding new financing model;
– Advocacy at the regional and national level;
– Argumentation of the abolishing of the administrative responsibility, stipulated in art. 181-1 of the Code of Administrative Offences of Ukraine
Participants practiced on:
– Initiative group leader’s work
– Delegation of the interests and requests of the community to the CCM representative:
– An algorithm for actions in case of violation of their rights
According to the positive feed-back from community representatives, the meeting was very useful and informative. Some of the participants became new members of the All-Ukrainian Liga Legalife. Alliance continue to support and develop communities, which play the key role in HIV,viral hepatitis and TB elimination in Ukraine.