International charitable foundation “Alliance for Public Health” is a leading professional organization in Ukraine working in the sphere of public health response to epidemics of viral hepatitis C (HCV), HIV, tuberculosis and other public health challenges. Alliance is one of co-implementors of the national integrated health programs and starting 2004 of the programs funded by The Global Fund to Fight AIDS, Tuberculosis and Malaria.
Alliance is sustainably addressing its interventions to hepatitis C elimination in Ukraine, in particular providing input in DAAs price reduction, HCV testing, diagnostics and treatment among key groups, general and prison population.
Since 2009 Alliance is implementing integrated HCV testing programs among key populations. In 2012 Alliance jointly with its national and local partners initiated national advocacy campaign “Demand Treatment!” with a component aimed at HCV testing scale up in general population. Under umbrella of this campaign annually thousands of people in most of the regions of Ukraine are screened for HCV. Campaign significantly contributed to pivotal raising of public awareness as for the HCV ways of transmission and safe preventive activities, it mobilized communities and stakeholders to start eliminating hepatitis C epidemic. Campaign activities contributed to HCV diagnostics and treatment price reduction, design and approval of state tasks-based social programs and 15 regional programs aimed at viral hepatitis prevention, diagnostics and treatment with further their funding from state and local budgets; sofosbuvir registration in Ukraine and launched the first Alliance program on HCV treatment with innovative directly acting antivirals (DAAs). First Alliance HCV treatment program started in 2013, it was based on peg-interferons and ribavirin treatment regimens.
Starting 2015 Alliance Centre of Best Practices in HIV, Hepatitis C and Drug Use initiated a global campaign “Unite to Eliminate HepC: Know it, Test it, Treat it”. The campaign united non-governmental and patient organizations, governments, pharma and diagnostic companies, international donors and UN agencies to scale up access to HCV treatment and to eliminate Hep C infection at the global level. This campaign united more than 20,000 participants, including international organizations from among Alliance partners, representatives of WHO, GF, UNITAID, and communities at international and national levels.
In 2015, as the result of Alliance advocacy efforts to reduce DAA prices, the price for the most innovative at that time DAA sofosbuvir was at first drastically decreased to $900, and later, after generics registration, down to $300 for 12 weeks HCV treatment course. Next two years the price was considerably decreased for the state procurement of DAAs funded from the national budget. Price reduction opened the window of opportunities for more people in need to get innovative effective drugs for HCV treatment for free. In the spirit of public health contributing to health system strengthening Alliance in 2019 successfully procured DAAs at the lowest ever for Ukraine price of USD 74.9 for 12-weeks treatment course and implemented GeneXpert HCV diagnostics in the own laboratories of health care facilities.
In 2015 Alliance initiated the new project named “Scaling Up Accessible and Effective HCV Treatment Through Community-Based Treatment Model for Most in Need Populations in the Resource-Constrained Ukraine”, which was implemented till September 2018. The main purpose of the Project was to provide access to effective innovative HCV-infection treatment with DAAs for key populations. The Project started when DAAs were not yet registered in Ukraine and were not used for viral hepatitis C treatment. Focusing on scaling up access to comprehensive package of services Alliance was the first in Ukraine to launch, in 2015, HCV-infection treatment with DAAs and made it accessible for the most challenging patients. For detailed report please follow the link.
To scale up access to HCV treatment for key populations Alliance developed a highly specific approach based on community treatment that included focused social support aimed to retain patient on treatment and free close to reach laboratory diagnostic and medicines. Project social workers practiced individual approach for sessions on prevention of HCV reinfection taking into account problems related to stigma, discrimination and risky behavior of patients from key populations.
In the period of 2016-2018 Alliance provided HCV treatment for more than 2 600 representatives of key populations through successfully implemented community-based treatment model. 25 health care facilities all over Ukraine and 19 local NGOs were involved in treatment and social support. Alliance was the first organization to bring Hepatitis C screening, diagnostic and treatment services to medical settings of the State Criminal Executive Service of Ukraine. First in Ukraine 98% of retention on treatment and 98% of treatment success were reached. Operational research on HCV reinfection rates performed by Alliance showed that only 3% of successfully treated patients had detectable HCV RNA viral load at 48 weeks after achieving SVR12. 94% (based on the FIB4 index) of successfully treated patients with severe liver disease before treatment, showed improvement in liver fibrosis at 48 weeks after achieving SVR12.
Starting 2019 Alliance within current Global Fund program is implementing a simplified model of community based HCV diagnostic and treatment for HIV/HCV coinfected patients from key populations. Till the end of 2020 comprehensive package of services (HCV diagnostic, treatment, care and social support) will be granted for free to more that 3000 patients. For details please follow the link.