OST Program in Ukraine imposed enhanced measures to avoid negative consequences in conditions of COVID-19 epidemic

Lessons from REAct implementing countries within SoS_project.

As for now, the countries where we currently operate are not the ones most severely affected by COVID-19. However, states have already started to apply prevention measures in different ways: from state of emergency in Georgia, night curfew in Kyrgyzstan to the absence of any restrictions in Tajikistan so far.

СCovid-19 statistics by country as for 22/04/2020 (WHO)

Human rights is the second (after public health care) issue we have to keep an eye on, when preparing for potential pandemic crisis, as they are most likely to be sacrificed by the states trying to stay in control over the situation. This article aims to share lessons and ideas, gained by REAct communities and NGOs to ensure sustainable and effective work of the human rights organizations during lockdown.

1. Care about REActors’, outreach-, social-workers’ safety first

• inform your team members about the COVID-19 prevention measures
• provide REActors with basic protection materials (masks, gloves, antiseptics)
• reorganize the way your NGO provides services (remote, online work, permanent shift groups, home delivery)
• disinfect regularly the office and the distribution sites.

Human rights protection services should not be stopped due to the lockdown. Legal and psychological support, as well as health care, prevention and harm reduction services must meet people “where they are”. Currently outreach workers are at the same level of risk as primary health care employees, as they have to keep contacting clients and meeting them outside. Their safety is our number one priority.

In Tajikistan, there are no officially registered COVID-19 cases yet and the government did not impose any quarantine restrictions. Anyway, NGOs and service organizations take all the necessary measures to prevent virus spreading: interviews with victims of HR violations are held remotely and there is mandatory moping and sanitization of the meeting room after each session.

In Georgia service (as well as human rights protection) organizations continue working to ensure sustainable assistance for the clients. It was decided to optimize working hours and divide employees into several permanent shift groups. So that, in case one person gets infected, only one group (this person was working in) will go on quarantine, but other groups will continue working.

2. Ensure sustainable channels of communication to reach clients out and to be reached by them, in case their rights are violated

• establish 24h crisis hotline
• disseminate business cards with emergency phone numbers
• collaborate with governmental COVID-19 hotline or crisis center
• look for the new ways of communication (social networks, for example)

As clients are locked in their homes we barely can know what is happening to them, moreover we barely will find out if something bad does happen. Now it is time to build new channels of communication to replace face-to-face talk. NGOs can create an emergency 24h hotline, so clients will be able to inform us if their rights are violated or any help is needed.

In Moldova, our partners have contacted the Non-Governmental COVID-19 Crisis Hotline and have asked to inform them immediately if there is an appeal from key groups or PLHIV. So if this happens, the comprehensive, two-sided response can be provided to the victim (key group representative).

Georgia due to lockdown started to search for KPs’ human rights violations on Facebook. REActors monitor Facebook groups, where sex workers and drug users, LGBTQs communicate, share information and seek help, when their rights are violated. Additionally, REActors track hate speech posts and contact the victim in direct to provide psychological support and legal protection if needed.

For the next deliveries of ARV treatment to clients’ homes, in several countries it is planned to disseminate brochures to inform beneficiaries about their rights during COVID-19 lockdown, as well as to present emergency phone number cards. This small piece of paper can bring the “I-am-in-safety” feeling and serve as a life-jacket stored under the seat, as emergency situations, new lockdown rules cause anxiety, fear and uncertainty, especially for those who are the most vulnerable and unprotected.

3. Inform clients about COVID-19 prevention measures and quarantining restrictions

• keep clients updated
• disseminate brochures with accurate information written the language that is understood by beneficiaries

Our partners together with UNODC Moldova distributed COVID-19 prevention brochures amount prisoners and people in detention. In Georgia the same kind of brochures were disseminated amount drug users. Five international recommendations brochures were translated into Georgian for common and overall use by NGOs.

4. Inform clients about their rights and potential HR violations in COVID-19 environment

5. Monitor the situation, collect and share information

• Hold regular and frequent online-meetings/calls with your community members, partners to receive and share information
• Call/message your clients to find out about their current livelihood, health, conditions
• Exchange information and notify other civil society stakeholders.

In Kyrgyzstan, the national REAct coordinator holds everyday phone status update calls with 8 REActors, who stay at home due to lockdown and do not have access to the Internet. These REActors keep on consulting beneficiaries on human rights by phone, as well as continue reporting by phone about the number of cases.

Due to the recent information about increasing domestic violence in Kyrgyzstan⁴, national coordinator works on building sustainable connections with domestic violence hotlines and with other organizations, which work generally on women human rights protection not focusing on HIV-positive, sex workers or female drug users, to be informed if KP women contact them about domestic violence..

By Victoria Kalyniuk, Regional REAct Coordinator

1. https://www.ohchr.org/EN/NewsEvents/Pages/COVID19Guidance.aspx
2. https://www.hrw.org/news/2020/03/19/human-rights-dimensions-covid-19-response
3. https://www.ohchr.org/EN/NewsEvents/Pages/COVID19Guidance.aspx
4. https://www.hrw.org/news/2020/04/08/women-risk-domestic-violence-during-kyrgyzstans-lockdown

40 participants from 22 cities of Ukraine participated in a two-day training on the basics of motivational counseling and social support for project clients with HIV rapid test positive result and clients, who are not covered by medical care.

Participants learned about the latest normative documents in the field of HIV prevention and the benefits of early medical treatment and treatment initiation. Thanks to the capabilities of modern technology, the participants were able not only to get acquainted with presentations, but also to share their practical experience, discuss the difficulties they encountered while working, and get answers to complex questions from experienced trainers-consultants and specialists of the Program Department of Alliance.

As a part of group work, participants discussed existing barriers of taking medical care for HIV-positive clients from vulnerable groups as well as specifics of support for such clients. Moreover, the participants clearly defined the goals and objectives of case management and the principles of providing client work in order to achieve the goals of the cascade. Through interactive voting, participants discussed ways to get HIV infected and myths related to the issue.

Particular attention was paid to the social support of clients in the context of the COVID-19 pandemic. Participants received pieces of advice on the peculiarities of remote client work as well as on high quality and effective support and telephone counseling. As a result of the survey, the most active participants were identified and received memorable prizes from the Alliance.

Despite the fact that many participants were initially apprehensive about the idea of online training, the overwhelming majority expressed positive evaluations of this format. “Being able to gain new knowledge, even in quarantine, inspires and adds strength and confidence for further work,” is one of the conclusions the participants made during the training.

Even in the terms of quarantine and movement restrictions, Alliance for Public Health does not stop providing technical assistance and capacity building for supported projects and goes on to provide online trainings for NGO staff.

To ensure uninterrupted and quality operation of the HIV/HCV/TB/OST projects in the regions of Ukraine during the COVID-19 pandemic, Alliance for Public Health initiates unscheduled deliveries of an extended range of personal protective equipment (PPE), which is vital in the current circumstances. In the course of this and next week, 97 partner civil society organizations and healthcare institutions in all government-controlled regions of Ukraine (125 sites) are going to receive Safe Boxes with:

– 750 liters of antibacterial and disinfecting substances
– 46,300 three-layer protective face masks
– 22,500 medical nitrile gloves (standard and reinforced)

The total of about 70 thousand PPE items have been urgently procured with support of the Global Fund to Fight AIDS, Tuberculosis and Malaria amounting almost one million hryvnias. It is worth noting that many of the PPEs procured will be used in the prevention projects, currently supported from the state budget of Ukraine through the Public Health Center of Ukraine.

Be safe! Help others! And we will take care of you!

On the occasion of the World TB Day commemorated annually on March 24, Alliance of Public Health is addressing Members of Parliament, Government, public authorities, doctors, scientists, international partners and civil society with the urge, in the context of rapid spread of the new coronavirus infection, to pay special attention to people affected by tuberculosis (TB).

“People with TB are one of the populations most vulnerable to COVID-19, with high likelihood of infection and severe complications. That is why we insist they should be provided with prompt and barrier-free access to diagnosing and treatment of coronavirus infection”, stresses Andriy Klepikov, Executive Director of the Alliance.

We welcome recommendations from international and national partners on immediate revision of outpatient treatment protocols aimed at reducing the frequency of patients’ visits to TB facilities and other drug dispensing sites, or using public transport because of their need to travel to healthcare facilities to get medications. At the same time, we urge them to strengthen efforts to raise patients’ awareness about critical importance of continuity of tuberculosis treatment because of the risk of development of drug resistance. In the situation of the global coronavirus pandemic, we all now face new challenges in public health that have drastically changed the world and people’s attitudes. The Alliance is quickly responding to the COVID-19 spread, providing our partners with professional recommendations about adjustment of their operations in the context of the pandemic.

However, during last week alone, twice as many people died of tuberculosis than of COVID-19 during the whole time of the outbreak. According to WHO, tuberculosis annually kills 1.5 million people worldwide, and is one of the top-10 causes of death globally; also, it is the main cause of death among HIV-positive people.

Ukraine today is one of top-20 countries of the world with the highest drug-resistant TB burden. In 2019, almost 6 thousand cases of drug-resistance TB were registered in Ukraine. This type of TB is not susceptible to conventional medications and requires longer and costlier treatment, while the success rate of such a treatment is lower. Last year, more than 25 thousand new and recurrent TB cases were diagnosed in Ukraine; at the same time, according to WHO, about 23% of cases of the disease go unnoticed in our country. The situation is further aggravated by increasing risks of TB spread in the context of fighting, on the territories temporarily uncontrolled by the Government of Ukraine, and the growing number of cases of TB/HIV co-infection. Despite the availability of modern effective medications, last year 3.7 thousand TB patients died, which is an evidence of inadequacy of the Ukrainian healthcare system.

In the recent years, non-government organizations of Ukraine have acquired significant experience in TB response, and we hope that successful cases produced by civil society will eventually be incorporated into the state TB policy. When implementing new methods or practices, Alliance for Public Health always study their effectiveness and create evidence for development of further interventions.

In particular, the Alliance have been able to produce unique practices of detecting TB among key populations, which last year allowed to detect TB in 665 people of key populations, of which 96% then started treatment. Contact screening projects allow detecting 6.5 times more TB cases than the routine work with contacts conducted by the TB service of Ukraine.

Implementation of patient-centered models of care and combining the medical component with social support in 2019 allowed increasing the success rate of treatment of patients with drug-resistant tuberculosis, on the average, to almost 90% (while the official figure for the country is below 45%).

Acting as a coordination center for Ukrainian civil society organizations working with the Global TB Caucus, an international movement of members of parliaments, the Alliance continues providing technical support to the interfaction Parliamentary Platform against Tuberculosis. The new association includes 50 members of the Ukrainian Parliament, and its activities were mentioned by the WHO as a successful example of developing partnership to overcome TB in Compendium of good practices in the implementation of the Tuberculosis Action Plan for the WHO European Region 2016–2020.

The Alliance would like to thank partners and donors, civil society activists and key communities, professional and government organizations for fruitful cooperation in TB response. In the nearest weeks we are going to actively respond to COVID-19 impact on HIV and TB programs. The World TB Day is an opportunity to reflect on the experience and lessons learnt while fighting TB and HIV that could be of use in COVID-19 response, including defending human rights of the people.

In these challenging times — both for our country and the world — we welcome the unprecedented measures against COVID-19 implemented by governments, and truly appreciate the consolidation of efforts and considerable financial contribution to protecting the health of the people and overcoming the pandemic. We are by all means convinced that the humanity will be able to defeat the dangerous coronavirus soon and expect the countries to similarly unite their efforts and resources to get rid of the TB burden!

#ItsTimeToEndTB  #FightCOVID19

TB hotline: 0800503080

COVID-19 hotlines:

Government hotline: 1545

Ministry of Health of Ukraine: 0800505201

Public Health Center of the MoH of Ukraine: 0444254354

Ministry of Foreign Affairs: 0442381657

Andriy Klepikov, Alliance of Public Health Executive Director, was selected as one of twelve plenary speakers for the 2020 International AIDS Conference to be held in July in San Francisco & Oakland. He will present the very important topic: “The global epidemics among people who inject drugs: Time for urgent reform”. Such possibility is an incredible honor for the Alliance, Ukraine and all EECA region as the competition during the selection process was tough.

The full list of plenary speakers can be found here: www.aids2020.org/plenary-line-up

Announcement of materials of the #SoS_project regional digest  #4

2020 is the year of sustainable leadership and effective partnerships!

The regional #SoS_project team continues to advocate for the sustainability of HIV services at the regional and national levels in Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Northern Macedonia, Moldova, Montenegro, Romania, Russia, Serbia, Tajikistan, Ukraine and Uzbekistan.
The international forum “Leadership of Cities in Response to the HIV/AIDS and TB Epidemic” was held, with the participation of top officials of cities – mayors and vice-mayors, representatives of international, national NGOs, invited experts, heads of AIDS and TB centers from 50 cities of the world. This event became an obvious landmark of the past year.
Unprecedented Results 2019 of Political Commitment to end AIDS/TB: in November-December, the record number of 10 political declarations on HIV/TB were signed by mayors of leading cities in Eastern Europe and Central Asia (Svetlogorsk, Podgorica, Bar, Bielo Pole, Chisinau, Osh , Bishkek, Kyiv, Balti).
An international mission was held in Serbia to develop a sustainable development plan for prevention, harm reduction and treatment adherence for key populations vulnerable to HIV.
The cost of an ART medicine in Belarus was reduced by 35.3%
Kyrgyzstan: a new clinical protocol for the treatment of HIV and a SOP for the management of ARV drugs has been developed, pre-qualified generics D, TLD were registered.
The Working Group on Transition plan is created in Moldova.
The first “Alena Asayeva ENPUD Forum” took place in Tbilisi. At the Forum venue, 70 participants from Ukraine, Russia, Georgia, Belarus, Kazakhstan, Kyrgyzstan, Moldova, the Baltic countries, Canada gathered together, and the issues of human rights and protection of their rights were the cornerstone topics of the event.
Widespread adoption of self-testing and PrEP will accelerate the EECA progress in the fight against HIV/AIDS or results of regional consultation for Eastern Europe and Central Asia was held in Istanbul on the topic “Development and adaptation of national HIV protocols, including self-testing (HIVST) and pre-exposure prevention (PrEP)”.

Read full Digest #4 on your browser.

Thank you for your attention and enjoy the reading.

Since October 2019 ICF “Alliance of public health”, with the support of the Global Fund, has been successfully implementing the innovative project “Alliance Online supervision”. The service of online supervision is available for the specialists working in medical centers and NGOs, which are Alliance partners.

Aims of the projects:

• Professional support of the specialists working in the field of public health;
• Improving the quality of medical-social services;
• Reduction of stigmatization and discrimination of representative of vulnerable groups;
• Prevention of professional burnout.

During three months, a team of professional supervisors – doctors and psychologists with a strong experience in public health and specialized training preparation, has successfully completed more than 206 supervisions.

Supervisees highly appreciate results of the supervision session:

«A unique experience! You can personally ask doctor with 30 years of experience, chief medical officer of a regional AIDS center all your questions about HIV, opportunistic infections, ART, adherence, etc. and get comprehensive answers. Professional doctor, interesting person to talk to. Thank you for every minute of supervision! ».

«Supervision helped me a lot to structure my work in the prevention project, identify deficiencies and plan work on their correction. Thank you for this opportunity! ».

Supervisees who have successfully completed 8 hours of online supervision receive electronic certificates. These certificates enable medical specialist to earn 10 points prior to their certification.

Online supervision is available free of charge, at a convenient for you time and place. Content of supervision is confidential.

For more information on «Alliance Online supervision» and process of obtaining this service, please visit https://supervision.org.ua/ru/

On January 9, 2020, the Mayor of Skopje, Petre Shilegov, and Konstantin Voytsekhovich, adviser of the UNAIDS Regional Office for Eastern Europe and Central Asia, signed the Paris Declaration to end AIDS in the capital of North Macedonia. 

Thus, a new important milestone has been achieved for the #SoS_project team. Fourth city at Balkans has signed Paris Declaration, and that is one more step for the SEE region to sustainable HIV services provided.

The official signing ceremony was visited by Deputy Prime Minister of Northern Macedonia Mila Tsarovskaya, Minister of Health Venko Filipce and deputies of the Government of Northern Macedonia, as well as employees of the Ministry of Health, representatives of the city authorities of Skopje, the UNAIDS Regional Office for EECA, the Alliance for Public Health, nongovernmental organizations Stronger Together, HERA, Healthy Options Project Skopje, media, etc.

On the day of signing, Andriy Klepikov, Executive Director of the Alliance for Public Health, presented the mayor of the city, Petra Shilegov, with the first international award #InYourPower in 2020 for responsible leadership in the fight against HIV/AIDS. This award also symbolizes support from the #SoS_project team and international partners, which will be provided to the capital of Northern Macedonia at all stages of the Paris Declaration implementation. After all, by signing the PD, the mayor of Skopje not only made a commitment, but also joined the regional team of leaders who are improving the HIV / AIDS situation in their cities today. Mayors who take responsibility for the health of citizens and take specific steps to improve the situation in the city.

In his speech, Petre Shilegov called on the mayors of other cities in the Balkan region to follow the Skopje’s example:

“We want to reaffirm our commitment to promoting collective health in the city of Skopje and around the world, and to contribute to reducing the incidence of newly diagnosed HIV cases. We are aware of the potential risks of HIV and AIDS, tuberculosis and viral hepatitis, and we are responsibly involved in national efforts to protect the health and well-being of the population. As one of the few Balkan cities to join the initiative, I urge the remaining cities, especially our neighbors, to join efforts to put an end to the virus in the next 10 years to provide healthier societies. That is why we are committed to creating and maintaining a healthy society because only in this way we can build a happy future not only for our fellow citizens, but also for all citizens in the country and beyond”.

Andriy Klepikov welcomed such an important strategic decision, thanked the city leadership for their openness to the introduction of innovative approaches in the fight against HIV and a great example for other cities, and not only at Balkans, but also in EECA:

“We congratulate Mr. Petre Shilegov, Mayor of Skopje, on the Paris Declaration signing and the firm intention to end AIDS by mobilizing municipal resources. We welcome the great work of our partners from North Macedonia – Stronger Together, whose efforts led to political commitment and support for introduction of new approaches to HIV prevention/treatment. For example, we expect that KPs in Skopje will get access to PrEP and self-testing already in the first half of 2020. This is a very important strategic decision for the fourth city in the SEE region, which solidly strengthens the growing leadership of the Balkan region in the fight against AIDS. APH and #SoS_project team will continuously support the city at all stages of the Paris Declaration implementation “.

“We welcome Skopje to the “Fast Track Cities” initiative and congratulate the City on taking this decisive step in complementing its response to HIV. We hope that other cities in North Macedonia will follow Skopje’s lead. Cities can play a vital role in tackling the HIV epidemic. They are positioned in a way that can make HIV services accessible by working with central government, the Ministry of Health, NGOs and communities – for example, by providing space for awareness-raising, counseling and HIV testing activities. This work will undoubtedly make Skopje and other Macedonian cities more inclusive, safe, friendly to all and contribute to raising the quality of life, social and economic development”, – said Konstantin Voytsekhovich, adviser to UNAIDS Regional Office in EECA at the official signing ceremony.

Andrej Senih, Executive Director, North Macedonian NGO “Stronger together:

“For people living with HIV in Skopje and North Macedonia this step of the city of Skopje sends a message of support and encouragement. For those who don’t know they are living with HIV it may be an incentive to take the test and then access treatment, knowing that the problem of HIV is not neglected anymore, but institutions and the city are taking measures to ensure accessible and quality services for prevention, treatment, care and support”.

Ms. Eleonora P. Nikolovska also shared her confidence that international support and the political will of the mayor of Skopje gives reason to believe that the goals will be achieved and the lives of citizens will be saved.

“We are ambitious to become the first city in the Balkans to achieve 90-90-90. The Mayor’s signing of the Paris Declaration yesterday sets us on the fast-track to end AIDS”, said Eleonora P. Nikolovska, Head of Department of Social, Child and Health protection of the Skopje City, at a working meeting with #SoS_projectteam.

Let’s remind that 2019 was the year when strengthening the responsible leadership of cities started in the region of Southeast Europe. The mayors of three cities at once – Podgorica, Bar and Bielo Pole, simultaneously signed the Paris Declaration on December 2, 2019, thus, Montenegro became the first country in the world where three cities at the political level declared their intention to defeat AIDS and achieve development goals 90-90- 90.

The Paris Declaration assumes that the city commits itself to do everything in order to achieve the 90-90-90 goals by 2030. This means that 90% of all PLHA should know their HIV status, 90% of those infected should be on treatment, and 90% of them should have undetectable viral load (the virus must be completely suppressed). According to the World Health Organization, by 2030 the world will be able to stop the HIV epidemic.