On November 28 – December 2, 2016 the study tour was held to learn the experience of Lithuania in ensuring of financially stable medication assisted treatment (hereinafter – MAT), methods and models of organization and realization of MAT program aiming to advocate its further development in Ukraine as well as implementation of new approaches and MAT models that will improve the sustainability and quality of MAT program in general.

The study tour was conducted within the ‘Improved Quality and Sustainability of Medication Assisted Treatment in Ukraine’ Project that is implemented by the ICF ‘Alliance for Public Health’ with the financial support of the Centers for Disease Control and Prevention (CDC) under the United States President’s Emergency Plan for AIDS Relief (PEPFAR).

Representatives of leading governmental institutions of Ukraine, involved in the implementation of MAT, in particular Ministry of Health of Ukraine, the SI ‘Center for Public Health’, the National Police of Ukraine, the State Service of Ukraine for Drugs Control, and employees of the ICF ‘Alliance for Public Health’ participated.

During the study tour representatives of Ukraine learned about the organization of the national healthcare system with a focus on the experience of Lithuania on the development of public health, the forming of the national strategy on treatment of drug addiction, prevention and treatment of HIV/AIDS, studied the organization, regulation and monitoring of MAT as well as provision of psychosocial support to MAT patients. Delegates visited the Ministry of Health of the Republic of Lithuania; the Center of infection disease and AIDS; the Drug, Tobacco and Alcohol Control Department; Corrections Department at the Ministry of Justice; the Police Department; the Vilnius Center for Addiction Diseases; the State Center for Mental Health; the Centro polyclinic; the Society of social and psychological rehabilitation. Gained knowledge on MAT program implementation, as Lithuanian best practices in the context of ensuring its sustainability and quality improvement, will be used in Ukraine. Well-established partnerships will ensure cooperation and exchange of experience on MAT program development in future.

On 1 December 2016, at 12.00, Kyiv Shevchenko Park hosted a campaign dedicated to the World AIDS Day, MUSIC FEST – TAKE A TEST, organized by the Alliance for Public Health together with its partner civil society organizations.
During the campaign, the longest 20-meter ‘red ribbon’ was spread out in front of the red building of Taras Shevchenko National University of Kyiv within the flash mob #PutRedRibbonOn #ПовяжиЧервонуСтрічку – for the first time in Ukraine!
The campaign was simultaneously held in Kyiv, Kharkiv, Odesa and Poltava and was targeted, first of all, at students. Participants of the groovy Music Fest had an opportunity to get free condoms and awareness-raising materials on HIV prevention as well as participate in the flash mob and take ‘red ribbon’ selfies.

This year, as opposed to the campaigns traditionally held on the World AIDS Day, the participants could not just get tested for HIV free of charge, but were able to get single-use rapid tests accompanied with pre-test counseling and information leaflets for self-testing at home. Taking a rapid test is as simple as putting a condom on – it can be done without other people’s assistance, quickly and safely. 

Today, rapid tests for HIV are already available to the wide public through pharmacy network, and their use is recommended in the recently published WHO guidelines. Every person can buy such a test and do self-testing following the instruction, which is also available at the website of Alliance for Public Health. Besides, you can read a special brochure on self-testing and watch an educational video.

“Artificial barriers in access to diagnostics led to a situation when only every second Ukrainian knew about his or her HIV status. – underlined Andriy Klepikov, the executive director of Alliance for Public Health. – Even if we wanted to, we could not do self-tests for HIV. Today – on 1 December 2016 – in line with the newest guidance of the World Health Organization, we initiate the first in Ukraine self-testing program. People in Kyiv were the first to take advantage of such an opportunity”.

If you have any questions about self-testing or its results or in case you would like to get more detailed information on HIV prevention, diagnostics and care, please call our doctors at +38 (050) 425 00 46 or +38 (050) 425 00 36. Healthcare professionals will be available to provide their consultations on a daily basis from 1 to 30 December 2016 (9.00 – 21.00).
Our campaign supports the key messages of the global UNAIDS campaign on the World AIDS Day, HANDS UP FOR #HIVPREVENTION.

Alliance for Public Health is a leading Ukrainian non-governmental organization, co-implementer of the National HIV/AIDS Program and recipient of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Though the main activities of Alliance are aimed at HIV prevention among the most vulnerable populations, significant efforts are made to also work with the general public, especially young people, as according to the official statistics the parenteral route of HIV transmission, which was typical for Ukraine in the first decade of the epidemic development, is no longer prevailing – according to the latest data, over 70%  of people are infected with HIV through sexual contacts. Only in the first 9 months of 2016, 189 thousand people in all regions of Ukraine were tested for HIV within Alliance programs, with 2.9 thousand positive test results (1.5%)!

On 1 December 2015, we held a rapid testing campaign at the railway stations of Kyiv, Dnipropetrovsk, Vinnytsia, Kharkiv and Kryvyi Rih, with 544 persons tested and over 3% of positive results.

National HIV/AIDS Hotline: 0-800-500-451

Links

Inter TV Channel

http://podrobnosti.ua/2147439-den-borotb-z-sndom-v-ukran-zapustili-proekt-samotestuvannja.html

NTN TV Channel

http://ntn.ua/uk/video/news/2016/12/01/22840

Espresso TV

https://www.youtube.com/watch?v=wF83vpRRwrY

STB TV Channel

https://www.youtube.com/watch?v=lgYC19SR2oc

UBR

https://www.youtube.com/watch?v=nDZAlsYTZis

Street testing campaign in Poltava

https://tribuna.pl.ua/news/znati-svij-vil-status-maye-kozhna-lyudina-u-poltavi-vidbulosya-bezkoshtovne-testuvannya/

Street testing campaign in Kharkiv

Video: http://www.visti.tv/new.aspx?newsid=43940

Street testing campaign in Sumy

https://www.youtube.com/watch?v=jnuunJ-ZmCU

Street testing campaign in Ternopil

https://www.youtube.com/watch?v=0pvaV7oLxog

Ukraine is still suffering from the HIV/AIDS epidemic, though lately we have seen a trend towards its stabilization, with forecasted reduction in the number of new HIV cases. The recent trend is a decreasing share of the parenteral HIV transmission (mostly though sharing injection equipment) which used to be prevailing – according to the official statistics, in 10 months 2016 it was only 21% – and a growing share of the heterosexual route of transmission. As of October 2016, 132,714 people living with HIV were officially registered with healthcare institutions in Ukraine, though it is estimated that their real number exceeds 217,500 people (almost 0.5% of the total population). The increased share of HIV transmission through unprotected sex defines new challenges in the activities of those organizations, which work in HIV prevention. Based on the modelling data, almost 80% of sexual transmission cases are related to sexual contacts with the members of vulnerable populations, which is why there is an urgent need to elaborate new, innovative approaches to prevention – and that’s what we focus on.

Alliance shares the priorities of UNAIDS, which on the eve of the World AIDS Day underlined the key role of prevention, – in his statement, the Executive Director of UNAIDS, Michel Sidibé, pointed out that “prevention should be central to our effort in the future”. UNAIDS campaign Hands Up for HIV Prevention is based, in particular, on the great work done by our country.

We continue working with the populations vulnerable to HIV – in 2016 in cooperation with partner NGO about 300 thousand clients were covered with our programs (69% of the estimated number of people who inject drugs, 43% of sex workers and 27% of men who have sex with men, representatives of other vulnerable groups including adolescents with risky behavior). We distributed almost 11 million condoms, 21 million needles and syringes and offered over 1 million consultations with social workers.

Over the recent 10 years, prevention projects allowed providing 1.3 million rapid HIV tests, with 55,630 positive results detected. The biggest number of positive results was found in Dnipropetrovsk, Donetsk, Odesa regions and Kyiv. As of today, the rate of HIV case finding among new clients who have not received prevention services before, is 16 times (!) higher than among the regular clients of prevention projects, which demonstrates effectiveness of the years-long operation of Alliance-supported projects.

In 2016, Alliance continued implementing the approach of assisted self-testing for HIV, which allowed extending the range and increasing the number of clients covered. As compared to 2014, the number of tests performed grew by 250%, which has already allowed detecting over 3.2 thousand clients with positive results and referring them to healthcare institutions.

Alliance continued its efforts to scale up access to opioid substitution treatment (OST): in October 2016, a new benchmark of 9 thousand patients was achieved. This is the biggest OST program in the countries of Eastern Europe and Central Asia, within which 9,073 drug-dependent people received OST (as of 1 November 2016), with each fifth patient receiving OST drugs based on an alternative model, with such drugs handed out for several days for self-administration by clients (based on prescriptions, from healthcare institutions, “home care”). This component was implemented in cooperation with Center of Public Health of Ministry of Health of Ukraine. Such alternative models contribute to sustainability of the OST program, its scale up and create more comfortable conditions for the program clients. Alliance developed effective models to deliver OST, which in 2017 will be provided to most patients within budget financing.

Comprehensive approach to HIV prevention and care stipulates detection and treatment of concurrent infections, including tuberculosis (TB) and viral hepatitis. In 2016, Alliance greatly intensified its efforts in those areas: over 138 thousand members of vulnerable populations were screened for TB; about 14 thousand people were referred to clinical and laboratory TB diagnostics. Out of 435 clients of prevention projects, who were diagnosed with TB, 92% started treatment. 2016 was marked with acceleration of the first in Ukraine hepatitis C treatment program with direct-acting antivirals (sofosbuvir), allowing more than 1,200 patients – members of vulnerable populations – to get access to HCV treatment with innovative regimens. Based on the diagnostic tests performed 12 weeks after the completion of treatment, hepatitis C virus was undetectable in 94% of patients – which is the best outcome in all the history of viral hepatitis treatment in Ukraine!

We are proud that during all the years of our activities we consistently support and involve communities into program development and bidding processes (to procure OST drugs and consumables for harm reduction projects) as well as into research activities, program monitoring and evaluation, in particular – on the temporarily uncontrolled areas. Thus, members of vulnerable communities are not only beneficiaries of our innovative and efficient services, but also equal partners and meaningful participants of their development and implementation.

Prevention and treatment are equally important to stop the HIV epidemic in Ukraine and ensure fast tracking to 90-90-90 targets. However, it should be noted that major part of government funding is aimed at the procurement of medical drugs. Thus, curbing the growth of the new HIV cases is possible mainly thanks to the international donors and civil society organizations. Innovativeness and effectiveness of such programs are recognized at the international level. Ukraine is currently among the world leaders – those several countries, which were able to overcome the artificial barriers in HIV testing, initiating self-testing programs based on recently published WHO guidelines. Now HIV testing will be more accessible for millions of Ukrainians.

We welcome the steps done by the Government of Ukraine to increase financing of the response to AIDS, TB and hepatitis, in particular to significantly scale up treatment. Nevertheless, financing of prevention programs from state and local budgets is still disproportionately low, so those programs still depend on support of the international donors.

We hope that in 2017, prevention will be a priority of the national healthcare policy, and the state will start to make targeted investments to reduce the number of new HIV infections.

Together we will be even more effective!

The First Regional Winter School «Women, Girls, Transgender (WG/TG) Empowerment and Advocacy on Gender and HIV/AIDS» was held on 17 – 19 November, 2016 in Tbilisi, Georgia. This event was conducted in the framework of Robert Carr civil society Networks Fund funded Project “Eastern European Regional Platform for Accelerated Action for Women, Girls and Transgender in in HIV/AIDS Context”. The winter school was conducted for 23 participants from 7 project implementing partners from Azerbaijan, Armenia, Belarus, Georgia, Moldova and Russian Federation. The goal of the school is to strengthen the capacity of HIV-service NGOs to provide gender-sensitive services to representatives of PWID, CSW, MSM and transgender.

According to Karen  Badalyan, Project Director, “It was great to have had this Regional Winter School for the first time ever. This School managed to bridge personal experience, clinical perspectives and community responses, offering views from various perspectives, mixing scientific background with the community experts, practices with examples, theories with participatory approach. The variety of organization represented and open and frank discussions of not only the speakers but the audience members, gave us the optimism about work in gender area in the future in EECA. Discussions on political implications and homophobia, differencing gender-oriented services from gender sensitive ones, gender mainstreaming, gender equity, gender budgeting, gender based M&E, etc. were in our focuses in order to provide holistic Information and ideas about community responses on gender in HIV/AIDS context. I hope that we will have a continuum for this, since it is an absolute best practice for EECA region”.

 The number of new infections in Eastern Europe  among WG has grown over the last few years, indicating a shift in the nature and trajectory of the epidemic. Every hour 50 young women are newly infected with HIV in the world (UNAIDS Gap Report 2014). For women in their reproductive years (ages 15–49), HIV/AIDS is the leading cause of death and in 2013, almost 60% of all new HIV infections among young people occurred among adolescent girls and young women (UNAIDS Fact Sheet 2014). The region is dramatically missing any data on TG both biological and behavioural. MSM programs with no sensitized and special needs based approaches mostly cover them.

WG/TG from key populations, especially those of drug users, sex workers and transgender women are particularly likely to experience violence. Studies in different countries have detected the high prevalence of rape, physical violence, etc.

There is generally a growing recognition of and attention to gender equality – including Gender Based Violence (GBV) and harmful gender norms – as a cause and consequence of HIV. Despite this greater understanding, programming and policies to address the intersection have not yet reached the scale, depth, or breadth required to reverse the overlapping epidemics of GBV and of HIV.

In the EE there is a general lack of evidence related to the linkages between human rights/gender equality and HIV and approaches to ensuring regular documentation of cases with a platform for the voices of persons experiencing human rights violence, gender inequalities in the context of HIV.

This Winter school is developed in response to the pressing need to address the persistent gender inequalities and human rights violations that put Women, Girls and Transgender (WG/TG) at a greater risk of, and more vulnerable to HIV.

One of the participants – L. Norenc, Board member of WFCE – mentioned: “In the 3 days of the school, I liked the variety of themes. It was useful to have such an extent prospective about the different parts of the gender phenomenon, because only in this way you can get a chance to better understand it and to approach it. I found it really useful to know that I am part of a wider community dealing with gender stereotypes and GBV. It provided a clear message of hope and community leadership, that I’m proud to be part of!”

Interactive map of all OAT sites in Ukraine (as of September 1, 2016) was developed by the team of Expanding Medication Assisted Therapy (MAT) in Ukraine (ExMAT) research project implemented within the partnership with the Yale School of Medicine (USA).

The map contains information on each region of Ukraine (estimated number of people with opioid addiction; % coverage with OAT program from the estimated number of people with opioid addiction etc.) as well as information on each of the 176 AOT sites countrywide: address and contact information of the site; number of patients on methadone (both liquid and tablet forms) and buprenorphine; average dosages of AOT drug per site; number of patients on prescription/home-care type of OAT drug intake; number of patients with HIV/HCV etc.

The link to the map is: http://arcg.is/1CqOcgE

On 21-25 November 2016, Kyiv hosts the Second School for Trainers “Tolerance and Non-Discrimination” (School) in partnership with five organizations – International Charitable Foundation “Alliance for Public Health”, USAID HIV Reform in Action Project (Deloitte), Eurasian Coalition on Male Health (ECOM), All-Ukrainian Charitable Organization “Initiative for Life” and the Coalition for Combating Discrimination in Ukraine.

This School is organized to train the regional activists of HIV service organizations, who are interested in the development of trainers’ skills and plan to hold trainings on Tolerance and Non-Discrimination.  Among 27 participants of the School there are representatives not only from Ukraine but also from other countries of the Eastern Europe: Georgia, Armenia, and Kyrgyzstan.

Such School for Trainers is held for the second time already, with the participants of the first cycle invited as trainers to conduct some sections. Such format allowed alumni of the first training cycle to improve their professional competence and qualification six months after their “graduation”, with an opportunity to receive supervision as well as feedback. As for organizers and the trainer team of the School, they could see the results of their work.

There were 70 applications to take part in the School, with participants selected among those candidates who demonstrated high level of motivation and willingness to implement the knowledge and skills acquired in their further activities.

The participants learn to raise awareness and change attitudes among such challenging groups as public officials, healthcare workers, enforcement officers, educators, and mass media representatives.  Future trainers have an opportunity not only to be participants of the training and learn the theory of Tolerance and Non-Discrimination, but also to conduct their own sessions and get feedback from their supervisors.

Elena German, organizer and trainer: “Often HIV service organizations have to prove that their activities are important and high-priority. After graduating from our School, the participants will not only be able to conduct trainings but also, through formation of tolerant attitude among public officials, to contribute to the sustainability of their organizations.”

Nina Verbitska, trainer: “At the training, we unite people who think and care, who do not want and are not ready to remain silent.”

Armen Aghajanov, PINK Armenia: “I saw the information about the School for Trainers on Facebook. I applied as I have been an activist for a long time, but have never took part in trainings for trainers. What I appreciate about the School is that it gives practical skills and knowledge. This School combines theory and know-how which may be used in the trainers’ activities.” 

Aleksey Rulev, Kryvyi Rih branch of All-Ukrainian Network of PLWH: “Participation in the School allows coming to a single conceptual framework of tolerance and non-discrimination. I want to start a career of a trainer to deliver trainings on non-discrimination for doctors and educators in my home town.”

Andrey Klepikov, Executive Director of Alliance for Public Health, delivered a speech at the plenary session of the first day of the conference.

On 21 November 2016, the Third National HIV/AIDS Conference “For Each Life Together: Fast Track to 90-90-90” started its work in Kyiv. The event gathered experts and community representatives from Ukraine and from all over the world to analyze the challenges related to the HIV epidemic, which Ukraine faces at the stage of government reforms, European integration and shrinking resources in the context of financial and military crisis.

The aim of this annual conference is defining the perspectives in achieving the global fast track targets in overcoming the HIV epidemic by 2030 and searching for the ways to use best practices aimed at ensuring sustainability and effectiveness of the response to HIV epidemic in Ukraine.

On the first day of the conference, Andriy Klepikov, Executive Director of Alliance for Public Health, delivered a speech at the plenary session. In his presentation, he focused his attention on the achievements of prevention programs for key populations and the challenges which should be overcome to achieve the UNAIDS 90-90-90 targets as well as the innovative approaches implemented by Alliance. Such approaches include assisted testing, which allowed increasing the number of clients screened for HIV by 250% in the first 9 months of 2016 as compared to the same period of 2014. Another approach allowing to significantly increase the effectiveness of referral of people who test positive for HIV is case management – in 9 months 2016, 68% of clients who worked with case managers were registered at healthcare facilities, among them 91% started treatment (as compared to the clients who received rapid test results but were not enrolled into the case management project – only 17% of them were registered at healthcare facilities and only 43% of those who sought confirmation of the diagnosis in specialized treatment institutions actually started treatment).

Special focus was made on Alliance activities in the military conflict areas in Eastern Ukraine, where 11 civil society organizations continue receiving support in Donetsk and Luhansk oblasts. In 9 months 2016, prevention services were provided to 40,411 members of key populations in Donetsk and Luhansk oblasts, with 372 people testing positive for HIV, who were all referred for further diagnostics.  At the temporarily uncontrolled areas, clients received 4,129 counseling sessions of psychologists, 1,132 counseling sessions of medical workers with the delivery of medicines and healthcare goods and 2,419 food and hygiene kits.

“Thanks to the international donors and partners, who landed their shoulders to us during the hard times, Ukraine held out, – stated Andriy Klepikov in his speech. – Our country is now at the crossroads. The resources are shrinking, with the epidemic concentrated mainly in high-risk groups. We need to define and concentrate on the most effective activities and interventions. This conference really united Ukraine, today in this room there are representatives of civil society organizations from the occupied Crimea and temporarily uncontrolled areas of the Eastern Ukraine. Only together, with our joint efforts, we will overcome the epidemic.”

Also, a speech at the plenary session was given by an Alliance employee, Anton Basenko, as a member of the Communities Delegation to the Board of the Global Fund.

Materials from Andriy Klepikov’s presentation:

Scale up of HCV treatment with highly effective drugs is well on the way in the countries of Eastern Europe and Central Asia (EECA).

Alliance for Public Health in collaboration with the International Treatment Preparedness Coalition (ITPCru) and more than 17 partner organizations updates the report “Hepatitis C in Eastern Europe and Central Asia: Civil Society Response to the Epidemic”.

There have been positive changes during the recent two months since the date of last publication which we would like to present:

–          Interferon-free regimens of hepatitis C treatment are accessible in 9 of 11 EECA countries.

–          In the countries of the region there is a burst in the registration of the generic versions of direct-acting antivirals. The leader in registration of generics is Kyrgyzstan (5 generic versions of sofosbuvir and 3 generic versions of sofosbuvir/ledipasvir combinations).

–         Two sofosbuvir generics and a daclatasvir generic were registered in Moldova. Neighboring Belarus also registered a generic version of sofosbuvir.

–          At the end of September 2016, European Association for the Study of Liver (EASL) undated its guidelines on HCV treatment, stipulating 8 peg-interferon-free HCV treatment regimens for six virus genotypes.

To learn more interesting facts, recommendations to countries on how to scale up the access to treatment, and the best advocacy practices, read our report.

At the meeting, Financing HIV and TB Services and Advocacy in Middle Income Countries: Developing an Action Plan, which was recently held in Amsterdam, civil society and community leaders from 35 countries called on international donors and implementing governments to meet their commitments to fund HIV and TB programs in middle-income countries.

Meeting participants are indignant with the reduction in program funding by USD 1.1 billion in 2015. The World Bank classification used by the Global Fund and other donors is based on a simplistic and crude per capita income estimate. According to experts, it is not appropriate for assessing health needs. “Middle income” countries are home to most people living in poverty and the majority of all people living with HIV and TB.

The consequences of funding cuts are evident in many countries where transitions have already taken place. For example, after the Global Fund stopped funding harm reduction programs in Romania, the percentage of new HIV infections related to injecting drug use rose from 4.2% in 2010 to 49.2% in 2013.

In Ukraine, Alliance for Public Health supported this call for action.

You can read the detailed text here.

To support the call, please send a request to mics-transitions@dgroups.org

Ukraine is on the way to fulfill its obligations to provide funding for opioid substitution treatment!

Some days ago, the Ministry of Health and the Ministry of Finance of Ukraine finally approved their joint order “On Introducing Amendments to 2016 Budget Program Passport” N 1128/888, which for the first time stipulates allocation of budget funds (UAH 13 million) to procure methadone for 7,300 patients of opioid substitution treatment (OST), which is an evidence-based method of HIV/AIDS prevention and drug treatment in Ukraine.

We would like to remind that in accordance with the 2014-2018 National HIV/AIDS Program, this year 16.200 patients were supposed to receive OST, in particular with medications procured with budget funds, but due to the lack of state funding and strict regulation of controlled drugs the actual number of such patients today is only 8,900 people.

There were some unpleasant incidents during negotiation and approval of the new Budget Program Passport. Thus, in the list of criteria of the passport it is mentioned that the budget will cover OST only for “patients with HIV/AIDS”, though currently only 40% (3.3 thousand) patients who receive methadone comply with this criterion. We sincerely hope that the Ministry of Health will promptly correct this technical error and will not impose discriminative restrictions to limit access to OST for the remaining 4 thousand patients with no HIV-positive status.

On 28 October 2016, the Order of the Ministry of Health of Ukraine N 1011 dd.  29.09.2016 “On Approval of the Methodology to Calculate the Need in Substitution Maintenance Drugs for Patients with Mental and Behavioral Disorders Caused by the Use of Opioids” came into force, which will allow to calculate the real needs to procure OST with budget funds in future. This methodology is based on the recommendations and estimates used by Alliance for Public Health to procure methadone within the Global Fund-supported program.

It should be mentioned that the stock of OST drugs procured by Alliance with support of the Global Fund should be enough to cover the OST needs at least till the end of the first quarter 2017!

We would like to remind that on 22 August 2016 the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) sent an official letter to Vice Prime Minister of Ukraine for Humanitarian Affairs, Pavlo Rozenko, emphasizing the real threat for Ukraine to lose non-repayable financial aid in the amount of USD 27 million (15% of the total amount of 134-million-dollar grant) in case of failure of the Government to comply with its previous obligations undertaken in 2015 to provide funding for the OST program. During further visits of the official delegation of the Global Fund to Ukraine, Government officials and representatives of the Ministry of Health of Ukraine confirmed their previous commitments!