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.

On August 10, 2017 in Dnipro the training for managers of Temporary Detention Centers from Dnipropetrovsk, Zaporizhzhya, Donetsk, Luhansk and Kharkiv regions was organized by Human Rights Office of the National Police of Ukraine in cooperation with Alliance for Public Health.  The questions of cooperation with the police within the framework of harm reduction projects, prevention and treatment of socially dangerous diseases were included into the training program. These issues were highlighted by Pavlo Skala, Associate Director: Policy and Partnership of, who also represents The Law Enforcement And HIV Network (LEAHN) in Ukraine.

On 9 August 2017, an official ceremony was held to sign the Memorandum of Understanding and Cooperation between the Sumy Regional State Administration and the International Charitable Foundation “Alliance for Public Health” (hereinafter – Alliance) within implementation of relevant state programs in response to HIV/AIDS, tuberculosis and viral hepatitis. By signing this memorandum, the regional administration demonstrated its deep interest in the implementation of programs to fight HIV/AIDS, tuberculosis and other socially significant diseases and in further cooperation of local authorities and civil society organizations.

As one of the official co-implementers of the activities stipulated in the National Targeted Social Program in Response to HIV/AIDS in 2014–2018, Alliance makes a significant contribution to overcoming the epidemics in Sumy region, in particular within the program “Investing for Impact Against Tuberculosis and HIV” supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria. In particular, in 2016 technical support and financial resources were provided for the implementation of integrated interventions in response to the spread of such diseases in the region in the total amount of over UAH 13 million 697 thousand. The programs implemented in the region to prevent socially dangerous diseases among key affected populations bring positive results – over 11 thousand people are covered with prevention services, and there is a clear dynamics towards reducing the level of risky behavior among the key populations. Long-term implementation of the prevention programs in Sumy region (since 2001) allowed achieving high safe behavior indicators back in 2011 and maintaining the achieved indicators within the next years. Retention of programs, which include activities in such areas, and their adequate financing are the basis of stabilization of the epidemic in the region. An important factor is allocation of funds from the regional budget to provide social support to the OST patients. Such support is provided by the Club Shans NGO though the social contracting mechanism.

In the region, a program of medical and social support of patients with multidrug-resistant tuberculosis is implemented, with a cure rate higher than the average rate in Ukraine (87% success rate as compared to the average treatment success rate in Ukraine of 47.7%). Within the project to expand access to efficient hepatitis C treatment, 81 members of the key populations received treatment with direct-acting antivirals. Treatment success rate of such new antivirals is over 90%, which is almost twice as high as of the old regimens.

However, taking into account reduction in the scope of international donor funding, on the one hand, budget restrictions and further commitments of the state, in particular towards the Global Fund to Fight AIDS, Tuberculosis and Malaria, on the other hand, effective cooperation and understanding with local authorities is of great importance to ensure further implementation of the integrated programs in response to HIV/AIDS, tuberculosis and other socially dangerous diseases.

That is why support from the side of Sumy Regional State Administration and personal leadership of its head – Mykola Klochko, who realizes that the effective response to the epidemics should be grounded on the productive cooperation of governmental authorities and civil society organizations, which have a valuable long-term experience in prevention activities aimed at the key populations, present real prospects of countering the dangerous epidemics.

Mykola Klochko, head of the Sumy Regional State Administration, started the ceremony with the following statement: “I am confident that only effective changes at the local level can enable sectoral reforms at the national level, in particular, the healthcare reform. At the same time, the health of the nation depends on the efforts focused on key populations. I realize that the document that we signed today with the Alliance for Public Health will not resolve the issue completely, but I am sure that its provisions will ensure better access of such people to qualified medical, social and psychological support and will bring down risks of the spread of socially dangerous diseases.”

At the ceremony, the Executive Director of Alliance for Public Health, Andriy Klepikov, said: “Alliance makes a significant contribution to the response to the epidemics of AIDS, tuberculosis and hepatitis in the region – in 2017 it is almost UAH 12 million. Sumy region is an example both in terms of controlling the epidemics thanks to the effective prevention efforts and in financing the social support services provided by civil society organizations. The Memorandum signed today marks the results of cooperation and defines further priority areas of our activities – increasing HIV case finding, bringing up the number of patients who receive ART and OST services and expanding the innovative treatment of hepatitis.”

On 28 July 2017, Alliance for Public Health (Alliance) together with 28 partner organizations held a traditional all-Ukrainian awareness-raising campaign dedicated to the World Hepatitis Day, which is marked on this day all over the world. In Kyiv, the event was held in the Shevchenko Park. All participants had a chance to get tested for Hepatitis C for free, get qualified consultations of doctors and social workers, and receive information materials. Though today we live in an information-oriented society, the level of public awareness concerning this dangerous diseases remains extremely low. As estimated by WHO, 95% of people are not aware of their status, which is to a great extent related to the fact that the disease may be asymptomatic. Annual campaigns organized by Alliance on this day show: it is time to open our eyes as this challenge knocks on the door of almost every family. Since 2012, Alliance has already run over 252 thousands tests among the members of key affected populations. Besides, almost 18 thousand people from among general population have been tested, the rate of positive testing results being within the range of 8-12%.

This year, the main task of the campaign was not so much to provide testing, but to communicate to the public the importance of knowledge on the routes of hepatitis C transmission, timely testing and treatment, which becomes more and more accessible.

Participants of the press briefing underlined that, though the WHO classifies Ukraine as one of the 17 countries responsible for 70% of the viral hepatitis burden in the world – WHO estimates show that one to two million of Ukrainians have hepatitis C – the official statistics contains only about 49 thousand registered cases. This is a sign demonstrating that the epidemic remains hidden – people do not want to open their eyes and see it, and symptoms develop not at once, but over the time. Public officials often prefer not to talk about it.

Since long ago, hepatitis is not considered an incurable disease. New direct-acting antivirals appeared, which have up to 95% treatment success rate (old regimens – 30-40%). 

“Today for the first time ever we have confidence to say that Ukriane has got a real chance to overcome the challenges of hepatitis C, – said Larysa Hetman, Deputy Director of the Public Health Center of the Ministry of Health of Ukraine. – The government together with civil society organizations was able to achieve the reduction of prices for modern effective antivirals and is now making further steps to develop the system of hepatitis prevention services and ensure that they are accessible to all people who need them”.

“Joint efforts of the Ministry of Health of Ukraine and non-governmental organizations allowed to create the conditions for providing patients with highly effective drugs in the country – up-to-date treatment guidelines were approved and direct-acting antivirals were registered, the price for which has been decreased both for public procurement and pharmacy networks. That is why access to treatment will be growing every year, – said Olga Golubovska, Head of Infection Disease Department of the National Medical University named after O. Bogomolets. – Due to budget restrictions, within the national program we can treat only those patients who are approaching the stage of irreversible liver damage, which may lead to lethal consequences. This is an international practice. The government should ensure a proper level of financing for prevention and treatment to stop the spread of hepatitis C epidemic. Doctors should not be the buffer between dying patients and inadequate health care system”.   

Alliance was one of the first to draw attention to the issue of hepatitis C in Ukraine, initiating voluntary testing back in 2009 and launching “We Demand Treatment!” advocacy campaign in 2012.  For the first time in Ukraine, Alliance implements a program of treatment with innovative new-generation drugs at the lowest price per course in the world, in 25 health care institutions.  Each of almost 1,900 saved lives is the source of pride for the Alliance team as well as all involved doctors, medical and social workers, but we do not stop focusing on comprehensive response to the hepatitis epidemic in Ukraine. Taking into account successful results of the treatment project and persistent efforts in cooperation with international partner organizations, the Ministry of Health revised Hepatitis C treatment guidelines, including to those guidelines as well as to the list of medical drugs to be procured within national and regional budgets direct-acting antivirals, and procures such drugs with national budget funds for the second year already.

“In the first six months of 2017, 51,688 hepatitis C tests were provided within the Alliance programs, with 8,925 positive results, – told Andriy Klepikov, Executive Director of the Alliance for Public Health at the press briefing. – At the same time, hepatitis is a curable disease – over 94% of patients, who received treatment with modern antivirals delivered by Alliance to health care institutions of Ukraine – Sofosbuvir or Harvoni – recovered and got free from hepatitis! We not only cooperate with the Public Health Center and the Ministry of Health of Ukraine within the current program, but we also work together for Ukraine to approve the Hepatitis Elimination Strategy”.

Alliance for Public Health and its partners call Ukrainians to learn more about hepatitis C, get tested and practice safe behaviors! We also address the MInistry of Health and public officials responsible for the national and local budgets, calling them to stop the epidemic of hepatitis C at the national level!  On the streets of Ukrainian cities our new hero, Petrovych, urges people who pass by not to postpone the question of hepatitis, but to get information, test and get timely treatment.

Over 150 million people in the world are infected with hepatitis C, with over 2 million of such people living in Ukraine. According to the WHO estimates, over 1.3 million people in the world died of hepatitis in 2015, among them over 400 thousand – of liver diseases caused by hepatitis C. Most people are not aware of their disease as in 80% of cases the acute phase of the disease is asymptomatic. One of the priorities in the activities of the Alliance for Public Health is response to the spread of viral hepatitis C in Ukraine and provision of hepatitis C diagnostics and treatment for most affected populations. In 2012, Alliance initiated an all-Ukrainian advocacy campaign “We Demand Treatment!” with the main goal of scaling up access to hepatitis C diagnostics and treatment in Ukraine.

We would like to thank Norton Ukraine pharmaceutical company and Pharmasco LLC for the tests provided to conduct testing among general population in Kyiv, Kharkiv, and Dnipro.

 http://www.aph.org.ua/hepc/

Alliance for Public Health in collaboration with 11 partner organizations in Eastern Europe and Central Asia (EECA) presents the report “Hepatitis B and C in Eastern Europe and Central Asia: response to the epidemics”.
The purpose of this report is to provide an overview of key aspects of the hepatitis  B (HBV)  and C (HCV) epidemics and response in 11 EECA countries (Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Ukraine and Uzbekistan).

It also includes tools and activities for civil society organizations (CSOs) and community-based groups working on expanding access to treatment of viral hepatitis in the region. Right now, there is a strong global movement towards elimination of the viral hepatitis hepatitis It is essential that this analysis is available to ensure that the EECA region is not left out of global strategies being developed to provide universal access to innovative curative treatment regimens currently in the pipeline.

The overview summarizes data with scesial focus on availability of HCV medicines, HCV treatment guidelines, national/donor HCV treatment programs, and civil society involvement in the HCV response. It also offers possible approaches and steps that could be taken by CSOs to improve access to HCV treatment in their countries.

You may find the updated report here

On 25 July 2017, an official ceremony was held to sign the Memorandum of Understanding and Cooperation between the Mykolaiv Regional State Administration and the International Charitable Foundation “Alliance for Public Health” (hereinafter – Alliance) within implementation of relevant state programs in response to HIV/AIDS, tuberculosis and viral hepatitis. Mykolaiv region became the first in the list of signatories, demonstrating leadership of the regional administration in forming the commitment of local authorities and civil society organizations to the sustainable implementation of programs to fight HIV/AIDS, tuberculosis and other socially significant diseases.

As one of the official co-implementers of the activities stipulated in the National Targeted Social Program in Response to HIV/AIDS in 2014–2018, Alliance makes a significant contribution to overcoming the epidemics, in particular within the program “Investing for Impact Against Tuberculosis and HIV” supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria. In particular, in 2016 technical support and financial resources were provided for the implementation of integrated interventions in response to the spread of such diseases in Mykolaiv region in the total amount of over UAH 24.2 million. The prevention programs implemented in the region, which was one of the first to start providing services to prevent socially dangerous diseases among key affected populations, brought positive results – over 12 thousand people are covered with prevention services, and there is a clear dynamics towards reducing the level of risky behavior among the key populations. In turn, such dynamics reduces the risks of further spread of HIV among the general population. Despite the fact that the region ranks third in Ukraine in terms of HIV rate (699.7 per 100 thousand people), and in 2016 it became the “leading” region in terms of new HIV cases detected, HIV prevalence is growing alongside with reduced morbidity levels and stabilization of the incidence. It proves the impact of prevention programs in terms of reduction in the number of new HIV cases as well as efficiency of care and support programs. Retention of programs, which include activities in such areas, and their adequate financing are the basis of stabilization of the epidemic in the region. An important trend is reduced HIV prevalence among people who inject drugs (27% in 2015 as compared to 40% in Ukraine).

Mykolaiv region is one of the leaders in terms of efficiency of treatment of patients with multidrug-resistant tuberculosis – thanks to the case management programs supported by Alliance, cure rate here is higher than the average rate in Ukraine (59.3% treatment success rate (2014 cohort) as compared to the average treatment success rate in Ukraine of 45.9%). An important role in increasing treatment success belongs to the project of Alliance and the Ukrainian Red Cross Society, which stipulates support of patients with MDR-TB at the ambulatory stage of treatment. Thus, out of 120 patients (2013), who received such support, 98 (82.3%) were cured. Alliance was the first to initiate an innovative program of hepatitis C treatment with direct-acting antivirals, which demonstrates the best outcomes, with over 94% of patients being cured.

However, taking into account reduction in the scope of international donor funding, on the one hand, budget restrictions and further commitments of the state, in particular towards the Global Fund to Fight AIDS, Tuberculosis and Malaria, on the other hand, effective cooperation and understanding with local authorities is of great importance to ensure further implementation of the integrated programs in response to HIV/AIDS, tuberculosis and other socially dangerous diseases. That is why support from the side of Mykolaiv Regional State Administration and personal leadership of its head – Oleksii Savchenko, who realizes that the future achievements should be grounded on the productive cooperation of governmental authorities and civil society organizations, which have a valuable long-term experience in prevention activities aimed at the key populations, present real prospects of countering the dangerous epidemics.

At the ceremony, the Executive Director of Alliance for Public Health, Andriy Klepikov, said: “We hope that, combining the resources from the local budget, Alliance and the national funding, Mykolaiv region will be one of the first regions in Ukraine to achieve the 90-90-90 targets – international commitments, which our country has to meet by 2020. The Memorandum signed today is an evidence of the strategic partnership in response to the epidemics of HIV, tuberculosis and hepatitis. This year, we are going to invest over UAH 18 million to the region. You can count on us in our future joint efforts”.

Information about event from Mykolaiv Regional State Administration: http://www.mk.gov.ua/ua/news/?id=38413

The publication “Analysis and description of MAT models/approaches” was developed within the project “Improved quality and sustainability of medication assisted treatment in Ukraine” with support of U.S President’s Emergency Plan for AIDS Relief (PEPFAR) in collaboration with U.S. Centers for Disease Control and Prevention (CDC). It includes detailed description of six models/approaches on provision of MAT services, studying and implementing of which is significantly perspective for Ukraine in the context of ensuring the violability of the program.

As of shortage in the government budget, there is a need to find the alternative plan for implementing the most cost-effective models/approaches to MAT provision. The issue of ensuring the violability of the program is a serious challenge for the country and the only way to solve it is the rational reinterpretation of further program development, optimization of expenses and introduction of efficient approaches to service provision of national level.

The aim of this publication is going to be fulfilled through the implementation of the following objectives:

• To analyze the experience of MAT services from 35 countries (Pacific Rim, Near East, North Africa, Latin America, Europe, Caucasia) stressing out the countries with similar social and political background.
• To collect experts` opinion on the implementation of different models of MAT sustainability (it was questioned 11 national and 9 regional experts: medical personnel, government representatives, representatives of international organizations/projects, NGOs representatives that work on policy making in the area of MAT).
• To choose long-term MAT models/approaches for Ukraine in terms of program funding and service provision for supporting the sustainability, using the international experience and the results of expert questioning.
• To study and describe chosen models/approaches and develop the strategy in order to create conditions for further practical executing (it was involved experts with experience of practical implementation)

The full text of the publication and Annexes you may find by clicking the link.

July 19^th,  2017 stakeholders meeting, initiated by Alliance for Public Health (Alliance), was conducted with involvement of Ministry of health of Ukraine, Public Health Center, WHO office in Ukraine and non-governmental organizations, namely Alliance, All-Ukrainian network of PLHIV  and up to 30 NGOs from majority ukrainian regions.

Participants discussed general vision and action-oriented proposals on situation with viral hepatitis in Ukraine and steps required for hepatitis elimination in Ukraine.

As a result of discussions, participants approved the Resolution on viral hepatitis, which includes development and endorsement of National hepatitis elimination strategy and corresponding action plan.

Also development of surveillance system, immunization strengthening, development and endorsement of the donorship policy, prevention services for general and vulnerable populations, guaranteed inclusion of vulnerable groups into treatment programs, etc were included into the Resolution.

Ministry of health of Ukraine and Public Health Center attended the meeting as co-organizers.

In addition, Alliance announced new HCV treatment project for vulnerable groups with application of “test&treat” approach, which allows to shorten the time and number of test from the moment a positive HCV test results is received and before receiving treatment with the preservation of the therapeutic efficacy.

Full test of the resolution available here

Almaty signed Paris Declaration on HIV

On July 20, 2017 Akimat of Almaty signed Paris Declaration of  of commitment to Ending AIDS in the city.
Signing is carried out as part of the project of Alliance for Public Health (Ukraine) «Fast-track HIV/TB response for key populations in EECA cities» with the support of Joint United Nations Programme on HIV/AIDS in the Republic of Kazakhstan and AIDS Foundation East-West (AFEW) in Kazakhstan
The project is implemented for the funds of the Global Fund to Fight AIDS, Tuberculosis and Malaria during 2017-2019 in five countries.

Signing the Paris Declaration is an important and responsible task for all mayors of the world’s cities in order to support activities to improve the situation in their cities in identifying and treatment of HIV-infection, as well as reduce death cases related to HIV-infection and tuberculosis to 2020, and stop the AIDS epidemic by 2030.

Without any doubts, signing the Declaration will attract the attention of city residents to HIV-infection related issues, which will allow them to make testing on time and begin treatment. Almaty will become a direct participant of international healthcare activities and will have access to the most advanced achievements and developments in HIV and AIDS. The best world practices on the improvement of HIV/TB programs until 2023 will be included in Almaty City Plan, which will allow ceasing the growth of the HIV and AIDS epidemic and improving the health of the population.

The HIV epidemic in Almaty is kept in a concentrated stage. 5172 cases of HIV have been registered since the beginning of the epidemic. 448 new cases of HIV were identified based on the results of 2016. The parenteral route of transmission of HIV infection (through the blood) among new HIV infections in 2016 was 30%, the sexual way of transmission – 65%. Preventive programs are actively working in the city to fight the epidemic. Thanks to these programs, testing for HIV infection is the highest in the country.

Andriy Klepikov from Alliance for Public Health said: «Almaty again sets the tone to the response to HIV-infection in Central Asia region. This is the first city in the region to sign the declaration. This is not surprising, as the city is already taking real steps in response to the epidemic – harm reduction programs among risk groups are financed from the city budget».

The ceremony gathered representatives of Republican Center on Prevention and Control of AIDS, Almaty health department, Almaty AIDS Center, UN agencies, other international and public organizations, ambassadors, people living with HIV.

Paris Declaration was signed in 2014. Mayors pledges to include their cities in the fast-track programmes to end the AIDS epidemic through the implementations of a number of obligations.   These commitments include the achievement of AIDS targets of 90-90-90, so that 90% of people living with HIV will be aware of their HIV status; 90% of people who are aware of their positive HIV status will receive antiretroviral treatment; and 90% of people receiving treatment will have a suppressed viral load that will allow them to stay healthy and reduce the risk of HIV transmission.