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!

The International learning course Harm Reduction Academy has opened its doors again: Module 1 of Cycle 2 has started on October, 17^th in Kyiv.

Harm Reduction Academy (HRA) is a global learning, dialogue and skills building course established with the vision to end AIDS and eliminate Hepatitis C among people who inject drugs.

Over the course, three exciting weeks will be dedicated to lecture hours, combined with practical field visits in three countries in Europe, Asia and Africa.

After the Cycle 1 which took place in March-June, 2016 and inspired a huge attention, the Harm Reduction Academy continued its work and brought together a multinational audience for Cycle 2:

15 most distinguished participants from Cambodia, Indonesia, Kenya, Nigeria, Tanzania, Uganda, UK and Ukraine.

. The Cycle 2 participants are the leaders and key advisors of national NGOs, leaders of national and regional Key Populations networks, programme managers, advocacy managers, business owners, national government officials, city council officials.

The Harm Reduction Academy offers a unique combination of:

• International Harm Reduction Scope,
• Uniting theory and practice,
• Learning the decades of experience in 3 weeks.

Feedback from a participant of Cycle 2:

“What impressed me most has been a wide comprehensive range of harm reduction interventions that we have been able to cover. Having done the Academy, when I return, I am going to be a lot more assertive about how I go forward strategically and implement harm reduction in our strategic thinking…”            

Mags Maher, Coordinator, EuroENPUD

Diverse international experience and peer exchange will equip our Students to find the optimal solution for every challenge in their harm reduction work:  the programme planning, communication with stakeholders or organisational and managerial issues in the scarce resources.

Our trainers are the leading program developers and activists having profound harm reduction expertise.

Pavlo Smyrnov from Alliance for Public Health (Ukraine) has experience in health policy and strategical planning, finance management, project development and management. Mr.Smyrnov has good knowledge of study design, research and M&E methodology, statistical analysis, also he has a good understanding of statistics, biostatistics and epidemiology.

Vyacheslav Kushakov from the Alliance for Public Health (Ukraine) will share his extensive experience of work with non-governmental as well as governmental entities in a variety of fields ranging from academic research and sociological explorations of gender, to development, management and evaluation of complex HIV prevention and care programs and projects, with particular focus on vulnerable and marginalized communities.

We will be involving other great speakers and harm reduction experts presenting experience of their work in Ukraine and internationally.

The Harm Reduction Academy has announced the call for applications for Cycle 3. The deadline is December, 1^st. Details and registration form are available by the link

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Alliance in partnership with Yale University Medical School held a two-day meeting Academy for Ukrainian specialists in implementing rapid change model for the improvement of addiction treatment (NIATx-RCM) on October 5–6.

Twenty-three participants from 13 oblasts of Ukraine shared and received knowledge, experience, as well as agreed on the new emerging strategies for enrolling and retaining OAT patients, such as prescriptions and take home dosages, adequate dosing, scale-up, standard time dosage escalation protocol, and standardized intake information. The essence of NIATx-RCM lies in implementation and assessment of an evidence-based intervention to improve processes at OAT sites in order to improve the levels of client enrolment and retention in the program. The results of implementations of selected interventions will be presented during the next meeting.

The project is implemented in strong collaboration with Ukrainian Institute on Public Health Policy and Ukrainian Center for Disease Control.

More information on NIATx implementation at OAT sites is available at: http://arcg.is/1Ijqjos

Alliance for Public Health presents the first newsletter “Hepatitis C: Response to the Epidemic.”

The newsletter contains the most up-to-date information on the possibilities of hepatitis C treatment in Ukraine, updated statistics on the number of people who have already received treatment with direct-acting antivirals, comments of experts, etc.

In the newsletter, you may also read about the most important events in the sphere of hepatitis C diagnostics and treatment which are held at the international level and define the new strategies and areas of response to the epidemic of hepatitis in the world.

The readers will learn more about the results and new developments of global advocacy campaign Unite to Eliminate and will have a chance to support the campaign initiatives in Facebook.

The newsletter will be released once a quarter. You may read the first issue here

Global Fund has proven its effectiveness and received nearly US 13 billion for its work over the next three years.

Alliance for Public Health greatly welcomes the news which defines the response to AIDS, tuberculosis and Malaria for the three next years – donors pledged over US$12.9 billion to support the work of the Global Fund to end HIV, tuberculosis and malaria as epidemics and transform the lives of millions.

Photo Marco Urban/Friends of the Global Fund Europe

“We congratulate Global Fund’s leadership – Board Chairman Norbert Hauser and Executive director Mark Dybul – for establishing true global partnership which resulted in the increased governments’ pledges across the world. Global Fund proved to the donors its leadership in achieving incredible results and saving lives!” – said Andriy Klepikov, executive director of Alliance for Public Health. – “Being an implementer, we have demonstrated to the donors the convincing results of the Global Fund investment to Ukraine: the epidemic here is getting under control, HIV and TB incidence are declining.

The Global Fund funding in so critical for saving lives millions of people, and for protecting even more – especially key populations – from getting infected. This task is even harder in the context of challenging operating environment. Despite all the challenges, Alliance for Public Health continues to work in the conflict affected areas in Eastern Ukraine and in the annexed Crimea, supporting vitally important services there.

It should be acknowledged that the great work was done prior to the Replenishment conference resulted in its success. One of the recent events called “15 Years of Achievement. 15 Years ahead” was conducted on September 6 in Berlin by the Friends of the Global Fund Europe with the goal to support a fully funded Global Fund. Andriy Klepikov, Executive Director of Alliance for Public Health, presented Ukraine there with the case “Upholding health services in modern armed conflicts”. Eastern Europe and Central Asia remains the region with growing HIV epidemic, and with severe MDR TB burden, and Global Fund’s funding is really critical for our region.

Huge efforts were done by civil society organizations across the world in mobilizing governments’ contributions. Three civil society delegations – Developing Country NGO Delegation, Communities Delegation and Developed Country NGO Delegation – and their respective constituency members contributed a lot to the successful replenishment results. Global Fund Advocates Network (GFAN) led on supporting the voices for the field – from the affected communities.

Anton Basenko is one of them. “The Global Fund has already saved 20 million lives (mine included) and with this money will save 8 million more and will prevent 300 million new infections. But such a successful result would not be possible without the global advocacy efforts of partners, one of which is the Global Fund Advocates Network (GFAN), in the Speakers Bureau of which, thanks to Alliance nomination, I was honored to represent the PWID/PLWH community of the EECA region as a person, on whose life the Global Fund programs had a vital impact, calling the governments of different countries to fully fund the Global Fund”, stated the activist Anton Basenko.

According to the Global Fund “The Replenishment Conference hosted by Prime Minister of Canada Justin Trudeau in Montreal, raised nearly $1 billion more than the previous replenishment conference in 2013, and benefitted from participation by leaders from countries all over the world, United Nations Secretary General Ban Ki-moon, and Bill Gates, Co-Chair of the Bill & Melinda Gates Foundation. The United States led the pledging with US$4.3 billion, approximately one-third of total funding. The United Kingdom pledged £1.1 billion, the second-largest pledge for this replenishment period; France pledged €1.08 billion, maintaining their position as the second-largest donor to the Global Fund overall. Germany pledged €800 million, a 33 percent increase”. More information can be obtained from The Global Fund’s official press release on the replenishment.

PRESS RELEASE

On 16 September 2016, during the press briefing held within the international meeting aimed at ending the tuberculosis (TB) epidemic, competent experts offered evidence supporting implementation of the ambulatory model of TB care as one of the crucial components to reform the healthcare system to end the TB epidemic in Ukraine. This model stipulates treatment of patients with smear-negative TB in outpatient facilities, within primary health care and in home-based settings. It will account for the individual needs of patients and thus will contribute to improving the patients’ adherence to treatment, which will ultimately help to reduce the prevalence of the disease. Such care, more convenient for patients, is called patient-oriented care.

The need to shift to integrated, patient-oriented systems of ambulatory TB care is arising due to the critical situation with the spread of multidrug-resistant tuberculosis (MDR-TB) which is observed in Ukraine as well as in the region of Eastern Europe and Central Asia as a whole. In our country this situation has become a real catastrophe – Ukraine is one of the TOP 5 countries with the biggest burden of MDR-TB in the world! Unfortunately, our country still has the worst TB treatment success rates in Europe – only 71% new TB cases and 38.6% MDR TB cases are cured. According to WHO, in 2015 about 23% TB cases were not diagnosed. In 2015, prevalence of all active TB forms in Ukraine was almost 85 persons per 100 thousand people.

“In most cases, reducing the time of patient’s hospitalization, and sometimes even initiation of treatment at home (provided that there are appropriate conditions of infectious control) are more reasonable,” – said Andriy Klepikov, Executive Director of the International Charitable Foundation “Alliance for Public Health”. – “From the point of view of public health, inpatient treatment does not prevent the spread of TB as most cases of TB transmission take place before the patient is diagnosed with TB and hospitalized. The risk to transmit the infection is greatly reduced 14 days after initiation of the effective treatment. And staying in inpatient units often leads to hospital-acquired forms of drug-resistant (i.e. not sensitive to most TB medicines) forms of the disease.”

Hospitalization of people who do not need to stay in hospitals is, on the one hand, a waste of financial and human resources and, on the other hand, may have a negative impact on the employment situation or social life of the patient or his/her family. According to experts, reducing the time of patients’ hospitalization at least for 1 day during a year may help Ukraine save at least UAH 50 million.

“Currently we are finalizing the Concept of the National TB Program for 2017—2021 and the Strategy of sustainable response to TB, including drug-resistant TB, and HIV/AIDS for the period up to 2020. Those documents will be in line with the international standards and we will make our best to implement them”, – told Oksana Sivak, the Deputy Minister of Health for Public Health and European Integration.

 “Today there are 16 thousand beds in TB treatment facilities of Ukraine, but only 55% of such facilities meet the requirements of infection control, which leads to a high risk of the spread of hospital-acquired forms of TB in inpatient units,” – underlined Natalia Nizova, Director of the State Institution “Ukrainian Center for Socially Dangerous Disease Control of the Ministry of Health of Ukraine”. – “Patients with smear-negative TB may receive ambulatory care with no risk of transmitting the infection to other people. Such approach has been proven effective in European countries and is in line with the WHO guidelines.”

Currently, our state receives multilateral international support to reform the approaches to overcoming the TB epidemic and prepare the society to accept the new model of treatment. For such reforms to be successful, it is very important for the government authorities to be ready for resolute actions.

“I have a special attitude to resolving the issue of tuberculosis. My great grandfather, a world-famous scientist Oleksandr Bohomolets, acquired tuberculosis from his mother as a child and, as a result, passed away prematurely,” – told Olha Bohomolets, the people’s deputy of Ukraine, Head of the Verkhovna Rada Healthcare Committee. – “Today the state allocates money but there is a question if this money is used effectively. We should ensure a comprehensive approach to unite prevention and treatment programs.”

MPs play a significant role in ending TB as with no political will of the main legislative body of the country it is not possible to achieve sustainable results, approve relevant budgets and make a significant public impact necessary to overcome stigma and raise public awareness of this disease. In 2014, a unique international movement was created, which currently unites over 1,400 MPs – the Global TB Caucus.

“The Global TB Caucus is a network of parliamentarians from 130 countries of the world, who campaign for and work on ending the global TB epidemic both individually and jointly. The Caucus implements activities at the global, regional and national levels,” – told Baroness Alison Suttie, life peer in the UK House of Lords, member of the Global TB Caucus. – “We also work closely with partner civil society organizations to make sure that the TB response is sustainable through local leadership. In Ukraine, we work with the Alliance for Public Health, which is the Focal Point of the Caucus in this country.”

“In the recent years, Alliance implemented a number of innovations in TB diagnostics and treatment. The equipment supplied to all the regions of Ukraine allows finding out about the diagnosis in 15 minutes (instead of two weeks); and the quality medicines procured by Alliance with financial support of the Global Fund as well as the effective social support of patients allowed reaching the cure rate for patients with multidrug-resistant TB at 85% (as compared to the national indicator of 38.6%),” – added Andriy Klepikov. – “Now it is time to change the approaches to treatment in line with most up-to-date international standards, which include ambulatory treatment of patients with smear-negative TB. It will allow to save state funding, treat more patients and prevent the spread of TB. It’s a win-win situation!”

*       *         *

Every year, TB is diagnosed in over 30 thousand people (4 new cases every hour) in Ukraine. Every eighth patient dies. TB situation is critical in the whole region of Eastern Europe and Central Asia (EECA): 14 out of 27 countries with high burden of drug-resistant tuberculosis are located in this region. In many countries, there is an urgent need to shift to integrated, patient-oriented systems of ambulatory care. TB in Eastern Europe and Central Asia Regional Project on Strengthening Health Systems for Effective TB and DR-TB Care (TB-REP), which is co-implemented by Alliance for Public Health on behalf of TB Europe Coalition, is aimed at reforming the system of TB care as a part of general healthcare reforms. Overall goal of the Project is to decrease the burden of tuberculosis disease and halt the spread of drug resistance in target EECA countries through increasing political commitment and translating evidence into implementation of patient-centered TB models of care. The TB-REP Project is aimed at reforming the system of TB care and providing technical support to TB projects implemented by civil society organizations. The project is implemented with financial support of the Global Fund to Fight AIDS, Tuberculosis and Malaria and covers 11 EECA countries (Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Turkmenistan, Ukraine and Uzbekistan). In the nearest future, advocacy strategies to develop ambulatory models of TB care within healthcare system reforms will be developed in Ukraine and other countries participating in the Project.

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

The third edition of the report was published only 2 month ago, but the changes that have taken place during this time cannot remain unnoticed. So we invite you to get acquainted with the dynamic development of treatment access in the region:
– New national protocols of hepatitis C treatment with interferon-free regimens were endorsed in Ukraine and Moldova.
– Direct-acting antivirals were registered in Moldova, Azerbaijan and Kyrgyzstan. The newest DAAs sofosbuvir+velpatasvirandelbasvir+hrazoprevir were registered in the Baltic states.
– The cost of hepatitis C treatment in Azerbaijan can be reduced by almost 20% due to the appearance of cheaper generic drugs on the market.
– Updated information on patents and patent opposition.
To learn more interesting facts, recommendations to countries on how to scale up the access to treatment, and the best practices in advocacy, read our report.