Ukraine is known for having a severe TB epidemic. It is one of the TOP 5 countries in the world with the highest burden of multidrug-resistant tuberculosis (MDR-TB): MDR-TB is detected in each fourth patient with newly diagnosed TB and in each second patient with TB relapses. Besides, Ukraine has the worst in Europe TB cure rates – only 71% of new TB cases and 39% of MDR-TB cases are cured. Generally, every year over 30,000 people in Ukraine are diagnosed with TB (four new cases every hour), with every eighth patient dying.

On World TB Day, Alliance for Public Health is presenting solutions that are making a major difference in a challenging TB environment, comprehensively addressing TB detection and treatment.

Diagnostics

Alliance is implementing a project aimed at early TB detection among most-at-risk populations. In 2016, over 160,000 clients were reached with screening survey, and 14,000 of those screened positive were examined for TB at healthcare facilities. Finally, 92% of those diagnosed with TB started proper treatment at healthcare facilities. In particular, addressing HIV/TB co-infection is our special focus.

Treatment access

With mobilized resources from the Global Fund and other donors, Alliance dedicated over half of its budget for addressing TB, mainly for procurement of MDR-TB medicines. In 2015-2016 only, we reached USD 34.6 million worth of MDR-TB drugs delivered in all regions of Ukraine.

As of January 1^st 2017, altogether 12,551 patients were enrolled to MDR-TB treatment within the program supported by Alliance with the Global Fund funding, and 5,535 of them continued receiving medications and social care from Alliance.

Treatment success

We proved that patient-centred approach with social support is not an additional element which might be added to standard medical MDR-TB treatment. It is a key cornerstone element of the successful MDR-TB treatment.

Within its pilot projects supported by the Global Fund, Alliance proved that combination of medical, social and psychological support allows increasing MDR-TB cure rate twofold. 80% of patients with MDR-TB were cured. This is a really impressive result, considering that the average treatment success rate for such patients in Ukraine is less than 40%.

Despite the growing challenges, Alliance continues its work on the temporarily occupied territories in the east of Ukraine. Alliance successfully delivered humanitarian aid, including MDR-TB treatment, for over 1,400 patients. We also support our 12 partner civil society organizations in Donetsk and Luhansk oblasts working to ensure early TB detection among most-at-risk populations.

Alliance applauds the governmental leadership and growing commitment to stop the TB epidemic. The result is our joint success based on the partnership with the Ministry of Health, State Centre for Public Health, Ukrainian Red Cross Society, Network of PLWH and numerous civil society organisations, community groups and medical facilities. We are greatly thankful to our international partners: The Global Fund, WHO, TB Europe Coalition, Stop TB Partnership, UN Secretary General Special Envoy on HIV/AIDS in Eastern Europe and Central Asia, United Nations Special Envoy on Tuberculosis, UNAIDS, Zero TB Cities, Global TB Caucus, PAS Center, US Government, PATH and other programs we are coordinating our response with.
Ukraine is currently developing a new proposal to the Global Fund for 2018-2020, with significant funding for TB. It is critically needed to scale up patient centred approach to all in need and eligible MDR-TB patients, to focus on missed TB cases and those lost to follow up. Over the new program, Alliance is planning to gradually transfer the civil society components ensuring patient-centred approach to the MDR patients currently funded by the Global Fund to the domestic funding. The newly approved by the Government 2020 Strategy to fight TB and HIV epidemics sets a good framework for this.

According to UNICEF estimates, in Ukraine there are 21,700 adolescents aged 10-18 years using injecting drugs with detrimental consequences for their health (no data on non-injectors). In the first half of 2015,  159,638 PWIDs accessed harm reduction services in Ukraine. Only 657 (or 0.41%) of clients served within this period were younger than 19 years. Vulnerable and neglected adolescents are most likely to use drugs. These include children whose parents abuse drugs or alcohol, or face other difficult family circumstances (are unemployed, single parents, parents who work long hours). Access to out-of-school activities is limited or very expensive so many adolescents spend considerable amount of their time unsupervised on the streets. Alliance for Public Health started an innovative project “Harm Reduction for Children and Young People Who Use Drugs in Ukraine” supported by Elton John AIDS Foundation.

On 20 March 2017, Practice Centre for HIV, Hepatitis C and Drug Use run by Alliance for Public Health organized a webinar “Harm reduction for adolescents who use drugs in Ukraine: reaching the underserved”. Iryna Zharuk, Project Coordinator presented the experience of Alliance for Public Health in implementing this innovative project. Participants of the webinar learnt about the intervention design, planning steps, networking and partnership, project activities, research component, challenges and how they are addressed. To listen to the webinar, follow the link.

A two-day meeting for Ukrainian experts in implementation of rapid change model for the improvement of addiction treatment (NIATx-RCM) was held on March 1–2 by ICF “Alliance for Public Health” within the research project “Expanding Medication Assisted Therapy (MAT) in Ukraine” within the partnership with the Yale School of Medicine (USA) with financial support of the National Institute on Drug Abuse (USA). Narcologists, nurses and representatives of NGOs who are actively involved in OAT scaling-up in Ukraine attended the meeting. 27 participants from 13 Ukrainian oblasts shared their experiences about progressive strategies of access and retention in OAT, namely: alignment of patients’ routes, peer-to-peer navigation, take-home care, prescriptions, advocacy and process efficiency of OAT drug dispensing. During nominal group techniques the special attention was paid to the barriers for scaling-up OAT services in Ukraine and the ways to overcome these barriers.

The project is implemented in strong collaboration with Ukrainian Institute on Public Health Policy and Public Health Center of the Ministry of Health of Ukraine.

On the International Sex Workers Rights Day marked on 3 March 2017, for the first time in Ukraine a group of civil society activists and sex workers with support of human rights advocates held a Sex Workers March, demanding to cancel administrative responsibility for prostitution   (article 181-1 of the Code of Administrative Offences of Ukraine). This day was announced as the national day of mourning for miners who died as a result of the tragic accident on March 2, so organizers (All-Ukrainian League “Legalife” and Alliance for Public Health) after a minute’s silence called on participants to proceed with the event in the format of a “silent procession”.

To draw the attention of public officials to the problem of violation of sex workers’ rights,  their stigmatization and violence towards them, marchers with improvised posters “My work is my choice!”, “Sex work is also work!”, “Taxes, not penalties!”, “armed” with red umbrellas and hard hats, masks, “certificates of sex workers” as well as some elements of their professional “workwear”, led their silent peaceful procession along the government quarter, heading their way from the building of the Supreme Council, past the Cabinet of Ministers, to the Administration of the President of Ukraine, which was the final point of the march.

“Currently article 181-1 of the Administrative Code is still used as a repressive instrument of corruption, extortion, intimidation and violence”, – said Yulia Dorokhova, leader of the movement for the rights of sex workers, lawyer of the All-Ukrainian League “Legalife”.

Threats to issue an administrative offence report for prostitution are traditionally used by corrupt members of law enforcement bodies as a means of psychological pressure on sex workers, which often leads to mental and physical violence as the legislation of Ukraine works against them, depriving them of their rights to human dignity and protection.

“In Ukraine, the laws are used to commit unlawful acts! I had to do “volunteer work” in police [provide sex services to policemen for free] for them not to issue an administrative offence protocol.  If I said no, they could have beaten me”, – confesses Olena, a sex worker from Zhytomyr region.

“Administrative responsibility for prostitution is one of the essential factors contributing to the spread of HIV epidemic in Ukraine. According to the joint estimates, today in Ukraine there are about 80 thousand of sex workers. Only in the capital city, there are almost 11 thousand of them. In the east of Ukraine, over 25 thousand people provide sex services to earn their living. The Supreme Council of Ukraine with billions of dollars in cash recorded in electronic declarations of people’s deputies, cannot continue to shamelessly ignore and marginalize a rather big group of Ukrainian citizens”, – said co-organizer of the event, Pavlo Skala, Director: Policy and Partnership at Alliance for Public Health.

Participants of the march brought to the Parliament, Government and President’s office a draft law developed by them on canceling the administrative responsibility for prostitution, calling people’s deputies to sign this legal document and submit it for consideration to the Supreme Council, rather than engage in “political prostitution” behind the scenes. Though this week the premises of Parliament was empty and quiet as the deputies are currently away “working with their voters”.

Recognized human rights organizations also supported the main demand of the marchers:

“People who provide sex services are one of the most socially unprotected populations in the world. They are very vulnerable to discrimination, violence and abuse of power. We advocate for complete decriminalization of all aspects of voluntary provision of sex services and call for comprehensive legal protection of sex workers from exploitation, trafficking and violence,”- told Oksana Pokalchuk, director of Amnesty International in Ukraine.

Media Coverage of Event

On February 28, 2017, the mayor of Odesa Gennadiy Trukhanov signed Paris Declaration of commitment to Ending AIDS and has therefore joined the global cities movement initiated by the Mayor of Paris and UNAIDS in 2014. The city takes the commitment to significantly increase HIV testing and treatment coverage of Odesa residents with the aim to end AIDS in 2030 and to focus on programs for key populations.

Currently in Odesa, like on average in Ukraine, one in two HIV-positive persons knows his/her diagnosis while access to ART is lower than across the country. The leadership the city is demonstrating today can make a critical difference in responding to AIDS and sustaining the response.

The ceremony gathered representatives of Centre of Public Health, UN Secretary General special envoy on HIV/AIDS in EECA Michel Kazatchkine, representatives of UN family in Ukraine, including UNAIDS, UNICEF, representatives of the Embassy of France, representatives of the Network of People Living with HIV, Alliance for Public Health and other civil society organizations, Olena Pinchuk Anti-AIDS Foundation, partners of the city AIDS response programs.

Michel Kazatchkine extended warm greetings from the mayor of Paris, Anne Hidalgo, who was one of the initiators of the Paris Declaration in 2014.

Mayor of Odesa Gennaidy Trukhanov said: ‘The city is well prepared to take this commitment. We have a good level of collaboration with the municipal services, strong AIDS service, partner NGOs to make this commitment possible’.

Andriy Klepikov from Alliance for Public Health acknowledged the leadership role of Odesa civil society in responding to HIV epidemic: ‘Currently the Global Fund program implemented by Odesa partner NGOs is annually reaching to over 24 thousand (or 65% of the estimate) of representatives of key populations groups. Thanks to a large extent to the prevention programs new HIV cases are going down in Odesa in last years’.

Odesa is the first city to sign Paris declaration within the Global Fund supported EECA regional cities program implemented by Alliance for Public Health (Ukraine) together with AFEW International (The Netherlands), Contact Netz/Licit (Switzerland) and under technical guidance of Stop TB Partnership and UNAIDS EECA office.

‘Odesa signing Paris declaration within our regional city project on HIV and TB in EECA is setting an example for other cities of the project from the 5 countries – Bulgaria, Georgia, Kazakhstan, Moldova and Ukraine,’ said Tsovinar Sakanyan, the Global Fund portfolio manager.

Vinay Saldanha, Regional Director for Eastern Europe & Central Asia, UNAIDS, comments: ‘As new HIV cases continue to increase in Eastern Europe and Central Asia (EECA), the epidemic is focused in major cities. Concentrated among key populations and their sexual partners, particularly people who inject drugs, this can be reversed if cities get on the ‘Fast-Track’ to end AIDS. The leadership of the city of Odesa is the kind of immediate and decisive leadership needed to fast-track its AIDS response by 2020’.

Representative of SWAN who attended the ceremony expressed her expectation that key populations groups will be supported and prepared to  actively engage in planning and implementation of the follow up steps in Odesa to make 90-90-90-90 a reality for those most vulnerable to the epidemics.

Tuberculosis should become a priority in the general trend towards health system reform as currently we have all leverages to change the situation with the epidemic in Ukraine for the better!

This statement was voiced by Andriy Klepikov during the press conference at UNIAN news agency held on 24 February 2017, which was aimed at discussing patient-oriented models of TB care. The executive director of Alliance also mentioned that there is a vital need to support transition to the outpatient models of TB care delivery and increase treatment efficiency. Unfortunately, today only about 40% of patients with multidrug-resistant tuberculosis are successfully cured. This indicator may be increased up to 80% and more thanks to the social support of patients so that they do not stay alone with their disease and life problems. Within its pilot projects, Alliance for Public Health proved that the combination of medical, social and psychological support allows doubling treatment success rate for patients with multidrug-resistant tuberculosis.

To sum it up, Andriy Klepikiv said that he welcomes scaling up government commitments to finance the response to tuberculosis in 2017: only budget to procure drugs will amount to half a billion hryvnias! At the same time, the most important task today is to guarantee that as compared to the previous years money will be spent for the most effective TB treatment models. From its side, Alliance as one of the key partners of the TB-REP regional project, contributes to the cooperation with all stakeholders in terms of implementation of patient-oriented approaches in response to the crisis situation with TB in Ukraine.

On behalf of the government, representative of the Ministry of Health of Ukraine, acting Head of Public Health Department, Natalia Piven thanked civil society organizations for their active involvement into the response to the TB epidemic in the country and underlined that currently efforts are underway to re-focus on evidence-based medicine and outpatient models of TB care. Piloting of those models is stipulated within the TB-REP project and is included to the concept of the National TB Program 2017-2021.

Head of TB Prevention and Treatment Unit of the Public Health Center of the Ministry of Health of Ukraine, Iana Terleieva informed that 8 thousand cases of MDR-TB are detected in Ukraine annually – in every fifth case of newly diagnosed patients and in every second case in patients with recurrent conditions. Besides, a focus was made on the main advantages of patient-oriented approaches: better treatment success rates as compared to those patients who are treated in in-patient healthcare facilities and cost efficiency due to re-allocation of funds to cover patients’ needs. Iana Terleieva underlined that it is very important to unite the efforts of governmental and non-governmental organizations!

The press-conference with participation of governmental institutions and civil society organizations was organized by Ukrainians against TB NGO within the TB-REP regional project (TB in Eastern Europe and Central Asia Project on Strengthening Health Systems for Effective TB and DR-TB Control). The Project is aimed at reforming TB care system as part of general health system reforms and provides technical support to TB projects of civil society organizations in 11 countries of Eastern Europe and Central Asia (Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan). The Project is implemented with financial support of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the principal recipient of the Project is Center for Health Policies and Studies (PAS Center).

Cornerstone decisions about the future of the TB Europe Coalition (hereinafter – TBEC) were made last week in Kyiv.

On 9-10 February 2017, Alliance had an honor to host Steering Committee strategic meeting of the TB Europe Coalition. Its participants included members of the TBEC Steering Committee, among them – civil society organizations – implementing partners of the TB-REP project and members of TBEC Secretariats – Global Health Advocates (Brussels), Results UK (London), and Alliance for Public Health (Ukraine). Welcoming speeches were delivered by Andriy Klepikov, Executive Director of Alliance for Public Health and member of the TBEC Steering Committee and by Fanny Voitzwinkler, Head of the Brussels Office of the Global Health Advocates.

The meeting was convened due to a new turn in the development of TBEC as well as new challenges and opportunities in TB response, which call for strategic decisions. The Coalition was founded in 2009 and over the years became a dynamic network of civil society organizations and activists, who join their efforts to end the epidemic of tuberculosis in Eastern Europe and Central Asia (hereinafter – EECA). TBEC develops joint initiatives with TB People, which is the first network of people with experience of TB in EECA, and the Global TB Caucus, an international movement that brings together over 1,500 parliamentarians from 130 countries of the world committed to the fight against TB.

A very important partnership for TBEC is its participation in the TB-REP project – the first regional project in the area of TB implemented in 11 EECA countries supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria (hereinafter – GF) with a component of civil society network engagement. The principal recipient of the GF grant is the Center for Health Policies and Studies (PAS Center, Moldova). TBEC together with Alliance are responsible for the support of civil society organizations within the TB-REP project. The main task in this respect is to make sure that the experience of people who were or are sick with TB are taken into account when governments are making decisions to shape people-oriented TB care.

Members of the Steering Committee and Secretariats as well as partners invited to take part in the meeting in Kyiv during the strategic planning session formulated a joint TBEC vision “World Free of Tuberculosis” and a relevant mission “Civil Society driving the TB Response”!

TBEC strategic goals for the nearest years include ensuring a strong and responsible civil society network in the area of TB response. It requires supporting the development of strategic partnerships and skills of
activists to impact the policy-making processes for effective response to TB. At the meeting, the following areas of TBEC activities up to 2020 were defined:

• Advocate for the transition to people-centered TB care,
• Participate in the transition processes to ensure sustainable response of countries to the TB epidemic after termination of the GF funding,
• Ensure access to the available TB drugs and diagnostic methods for all those who need it,
• Engage CSOs to monitoring and evaluation processes, in particular with regard to implementation of the national TB programs,
• Advocate for conducting research and developing new more effective drugs, vaccines and diagnostic methods.

Meeting participants agreed on the key priorities and further detailed steps required to achieve strategic development goals.

On 13 February 2017, Alliance for Public Health joined the One Night Stand project organized by Elena Pinchuk ANTIAIDS Foundation to mark the International Condom Day. Kyiv shopping center TsUM hosted presentation of special “safe kits” designed by Masha Bekh, comprised of bathrobes, T-shirts, condoms, and, what is most important, for the first time the “standard protection kit” also included self-tests for HIV provided by Alliance as well as information leaflets specially prepared for the campaign. Besides, during the event all visitors of the shopping center had a chance to learn about the process of HIV self-testing and receive relevant consultations.

Alliance makes a special focus on promotion of HIV self-testing as any person can test his/her fingertip blood for HIV antibodies, this process is rapid and safe and does not require other people’s assistance. Currently HIV self-testing is recommended by the World Health Organization, and rapid HIV tests may be purchased in pharmacies. On the World AIDS Day marked on 1 December 2016, Alliance for the first time handed out tests and initiated the campaign to promote HIV self-testing. To guide the process of self-testing and correctly assess test results, please consult the instruction, which can be downloaded from Alliance website, the special self-testing leaflet and the educational video.

Video from the campaign

On 6-9 February 2017, Alliance for Public Health held a four-day working meeting for partners implementing the project “Harm Reduction for Children and Young People Who Use Drugs in Ukraine” with support of the Elton John AIDS Foundation aimed at comprehensive prevention work with adolescents. Such project is implemented in Ukraine for the first time.
This project is unique because adolescents are an integral part of project team, which includes diverse specialists who are open to implementing new initiatives and demonstrate unbiased attitude to adolescents. As of today, project teams engaged over 5,000 adolescents to prevention efforts.
The working meeting held in the beginning of February 2017 was aimed at sharing the results of project activities in the field and discussing new areas, such as enrolment of adolescents from risk groups, online counseling, project supervision as well as capacity building of staff in partner organizations.
Participants of the meeting discussed successes and challenges in achieving 90-90-90 targets and key barriers in HIV testing and jointly developed ways to overcome such challenges.

One of the important program components is organizing social and medical support for adolescents who use drugs. The participants reviewed scheme of the work of social and medical support teams, criteria of client enrolment into the support program and practical cases, with which local teams face.

“The meeting allowed to once more discuss the issues arising in the course of project implementation, I learned a lot of new and important things concerning first contact with adolescents.”
Anatolii, project coordinator, Our Help NGO (Sloviansk)

“It really helps that our work is structured and we are supported by our partners in solving difficult situations. We like it that we can use the wide range of forms and tools in working with this target group.”
Iryna, psychologist, The Way Home NGO (Odesa)

On 3 February 2017, Alliance for Public Health officially presented the project “Fast-track TB/HIV responses for key populations in EECA cities” supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria. Ukraine will be represented in this project by Odesa, where the regional project was announced today. The goal of the project is to develop sustainable response to the HIV/TB epidemics in key populations at the level of Odesa, which will significantly contribute to achieving the 90-90-90 targets in key populations. Gennadiy Trukhanov, the mayor of Odesa, assured that he supports the initiative and is ready for future cooperation. It is expected that the project will help to enhance the dynamics towards reducing AIDS and TB mortality in Odesa and ensure sustainable response to the epidemics at the city level.  Launch of the project was announced at the meeting of a wide range of civil society organizations and relevant agencies of the city chaired by the mayor. Andriy Klepikov, executive director of Alliance, expressed his sincere gratitude to the city administration for their commitment to improving the health of Odesa residents. He said, “We hope that such attitude will both set the tone for this regional initiative and will become an example for the mayors of other Ukrainian cities”.