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%).
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!
TB hotline: 0800503080
Government hotline: 1545
Ministry of Health of Ukraine: 0800505201
Public Health Center of the MoH of Ukraine: 0444254354
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.
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)”.
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 doctorwith 30 yearsofexperience, 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 availablefreeofcharge, ataconvenientforyoutimeandplace. Content of supervision is confidential.
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.
On 29 December 2019, Andrii Yarovyi together with 75 other captured Ukrainians finally came back home within the prisoner exchange successfully initiated by the President of Ukraine!
On 26 August 2018, Andrii Yarovyi, consultant of the Alliance for Public Health carrying out an important humanitarian mission, was unlawfully captured by representatives of the so-called “Ministry of State Security of the Luhansk People’s Republic” (MSS LPR) on the area of Luhansk region temporarily not controlled by the Ukrainian government.
For the first six months, Andrii was unlawfully detained in the MSS LPR dungeons, then for two more months – in Luhansk “pre-trial detention center”. On 22 February 2019, he was wrongfully sentenced to ten and a half years of imprisonment for alleged “drug smuggling in especially large amounts” (when he was arrested, 38 pills of the narcotic drug used for opioid substitution treatment – buprenorphine hydrochloride – in the total amount of 0.15 gram, which was legally received by Andrii in a Kyiv-based clinic for further self-administration, were unlawfully seized from him).
In the Boryspil airport, captured military servants and civil prisoners were met personally by the President of Ukraine Volodymyr Zelensky and by family members of the Ukrainian captives, including Andrii’s mother and his younger brother. Unfortunately, Andrii’s father didn’t live to see his son again and died of a severe disease six months before his return.
Currently, Andrii together with other ex-prisoners goes through a careful medical examination and rehabilitation in Feofaniya clinical hospital.
Alliance for Public Health would like to thank the President of Ukraine Volodymyr Zelensky and its national and international partners who were concerned about Andrii and did all their best to facilitate his fastest release!
It is just one year left to reach ambitious 2020 targets. The ending year results Alliance for Public Health (APH) is happy to share, made Ukraine and other EECA countries closer to the success, with the scale, innovations, transitioning and sharing effective solutions.
Nation-wide HIV prevention efforts focusing on Key Populations has brought the epidemic under control. During 2019 APH with its partners was providing HIV prevention and testing services to over 170 000 PWID, 38 000 SWs, 42 000 MSM, thus reaching the highest coverage figured in the entire Eastern Europe and Central Asia. Besides the standard package, 2019 was marked with
Reaching those left behind with effective and innovative interventions.
Bringing PeEP: APH-led successful Kyiv pilot scaled up to 22 oblasts with 15 times PrEP coverage increase (from 100 to 1500) just over current year;
Self-testing: APH reached out to partners of key populations with HIV oral and blood self-testing; online selftest.org.ua confidentially delivered self-tests to rural and remote areas;
Artificial intelligence and Machine learning algorithm worked in APH-led extended risk network testing in community-based outreach to optimize HIV case-finding among key populations in Ukraine, including focus on recent infections;
Experimenting with sex and drugs youth: innovatively reached out to users of recreational drugs at night clubs and electronic music festivals, online Free2Ask App and Drugstoreresources;
Transgender people are at the highest risk of HIV. During the year over 1000 trans people in Ukraine reached with essential services, promoting rights of trans people at Kyiv Pride in June 2019;
Achieving the 2nd 90 – 90% on ARV – in the group of HIV+ clients of Opioid Agonist Treatment run with APH support.
Transitioning the largest KP program in EECA to the governmental funding
At the end of 2019 the largest harm reduction program funded by the Global Fund was transferred to the government funding. APH transitioned its approach to services for key populations which now became the standards approved by the Ministry of Health. The transition is a great result of the joint work with Public Health Center, 100% Life and all implementing NGOs across the country. APH will continue assisting with program oversight, monitoring and technical support and support additional interventions to ensure consistently high quality and maintain coverage.
The successful experience of Ukraine has been used in EECA region. APH-led consortium started 2019-2021 regional GF #SoS_project. This project will ensure sustainability of HIV-services for key populations in 14 countries in EECA region and by 2021 national funding for HIV/AIDS programs will be increased by $10 million from national, regional and municipal budgets and $73.4 millionsavings ensured in the country’s budgets through optimized ARV procurement.
WOW results in TB response
APH adopted Optimized Case Finding methodology for finding missed TB cases. 12 months results show 4.4. times increase in TB detection rate per 1000 contacts in comparison with routine contact tracing. There is a 20% increase of those offered diagnostics in the early detection project (22 536 clients over year). On the treatment side, due to medial and psycho-social support APH managed to increase successful treatment outcomes to 91% and 89% for susceptible and DR-TB patients respectively.
Hepatitis C: getting the best treatment and serving the most in-need patients
Over 2500 patients (PLWH, PWID, prisoners) got through APH comprehensive package of services – starting from HCV diagnostics, followed by treatment, social support, preventive and educational activities and treatment results evaluation. In 2019 Alliance obtained lowest ever in Ukraine price for direct antiviral drugs for HCV 12 weeks treatment course (US$74.9) and launched HCV diagnostic with GeneXpert in laboratories of health care facilities in such a way developing national health system.
Promoting Universal Health Coverage (UHC) agenda
APH is the only Ukrainian organization in the global UHC Civil society Mechanism. In this capacity APH organized a series of consultation prior to the UN High Level Meeting on UHC in September 2019, and is following up with developing multi-stakeholders’ accountability mechanisms. During the year APH expanded its work to supporting vaccination, launching mental health program in 12 regions of Ukraine in partnership with
Ukrainian Institute on Public Health Policy, Yale School of Medicine and U.S. National Institute on Drug Abuse (NIDA).
Leadership of cities in HIV and TB response
APH firmly believes that leadership of cities in HIV/TB response can stop the epidemics. APH completed 3-year regional project “Fast-track TB/HIV responses for key populations in 5 EECA cities” which has significantly improved HIV/TB responses in cities and ensured sustainability achieving a full return of the Global Fund investment of 3.9 Million USD – from cities budget (video). In the new regional project #SoS_project 25 more cities are joining the fast-track initiatives and will sustain response by increasing municipal funding allocations. Just during 2019 political support was provided by mayors of Chisinau (Moldova), Osh (Kyrgyzstan), Svetlogorsk (Belarus) who signed Paris Declaration and ZERO TB Initiative, and Podgorica, Bar, Bijelo Polje (Montenegro) who signed Paris Declaration.
Watch the video: Andriy Klepikov presentation in major event of the year, defining future HIV and TB response in the EECA region.
“Time is what really matters when it comes to tackling HIV. Therefore, we are looking for leaders. Leaders who can make a difference in their countries. Not the day after tomorrow, not tomorrow, but today”, says Andriy Klepikov, APH Executive Director.
14 awards were provided celebrating distinguished leadership in 2019.
ALLIANCE FOR PUBLIC HEALTH CONTINUES TO STRENGTHEN ITS CONTRIBUTION TO THE DEVELOPMENT OF SUSTAINABILITY OF SERVICES FOR KEY POPULATIONS IN EASTERN EUROPE AND CENTRAL ASIA THROUGH ITS PARTNERSHIP WITH THE GLOBAL FUND, PEPFAR, OTHER DONORS
On December 16-17, 2019 in Istanbul the Regional Consultation for Eastern Europe and Central Asia took place on «Development and adaptation of national HIV guidelines, including self-testing (HIVST) and pre-exposure prophylaxis (PrEP)».
Participants from 21 countries of the region discussed the specific steps and prospective to implement in the EECA countries the most updated WHO recommendations on pre-exposure prophylaxis and self-testing, international practice and cases of Germany, Moldova and Ukraine. The consultation was organized by the Alliance for Public Health team with the technical support of the WHO Regional Office for Europe and with the financial support in the frames of the regional #SoS_project.
«More and more countries adopt the policy supporting HIV PrEP. There are many researches, which prove the effectiveness of several PrEP regimens for different populations. This gives the grounds to presume flexibility, choice and accessibility for people who might benefit from PrEP. As of today, there are no hesitations regarding the need to ensure access to PrEP as a part of the standard HIV prevention service package», – says Olga Denisyuk, project manager of the Alliance for Public Health.
Discussions of the specific steps to implement these interventions gain pace during the events of different levels and involve wide range of stakeholder audience. The apparent significance and importance of the issue for the countries and readiness to develop healthcare systems to introduce these services gathered international experts and representatives of national teams of regional healthcare systems representing Azerbaijan, Armenia, Belarus, Bosnia and Herzegovina, Germany, Georgia, Denmark, Kazakhstan, Kyrgyzstan, Lithuania, Moldova, Romania, North Macedonia, Serbia, Russia, Tajikistan, Ukraine, Uzbekistan, Montenegro and Switzerland.
Sergey Filippovych, #SoS_project director: «It’s important even today to more rapidly move from pilots, which proved their relevance, to immediate implementation of the effectively functioning strategies of HIV prevention, testing and treatment. Broad implementation of self-testing and PrEP in the countries of our region will significantly fast-track the EECA regional progress in combating HIV/AIDS. I’ll stress that in the countries of our region strategic implementation of these interventions is supported not purely at the level of operational researches; there’ll be also broad spectrum of technical support provided in the frames of the regional project «Sustainability of Services for Key Populations in Eastern Europe and Central Asia» (#SoS_project).
As regards to application of operational researches, Olga Denisyuk mentioned that the important task remaining for EECA region is in rapid introduction of PrEP maximally adapted to the local context. This is possible to achieve at local level just through initial organization of operational research. «These researches can help develop and evaluate the models of low-threshold access to PrEP in a short time and further serve as basis to scale up the program for the whole country». However, it goes without saying that, based on the results of researches, the NGOs should be involved in order to rapidly implement the important steps to improve health and not to lose the time and the expertise developed in the bureaucratic routine.
We will mention that the primary drug for PrEP is TDF, which is used in different PrEP combinations and regimen.
EECA region needs a kick: WHO recommendations on HIVST/PrEP
It’s worth mentioning that during recent years the evidence base on reasonability of self-testing introduction and PrEP effectiveness in or region significantly increased.
In 2019 WHO updated its PrEP recommendations as well as HIV self-testing (HIVST) as the effective approach to improve detection of new HIV cases. In the updated HIVST guidelines there were new recommendations outlined regarding optimization of self-testing implementation, including effective service delivery models and linkage to care and support tools.
As the newest recommendations are publicized, their rapid implementation at local level in the countries is very important. Moreover, the evidence base for this is available; also, the negative trends of the region should be considered and controlled by the countries.
Elena Vovc, Technical Officer, TB, HIV & Viral Hepatitis program within the Division of Health Emergencies and Communicable Diseases of the WHO Regional Office for Europe, told that, irrespective to all efforts, WHO European region is not achieving the targets by 2020. Let’s mention that the action plan for healthcare in response to HIV epidemic on the WHO European region adopted by all the countries of the region in 2016 set up the specific goals and target to fast track the response before 2020 in all countries of the WHO European region, including EECA countries.
Surely, it’s consolidated work in the countries in order to:
– achieve decrease in number of new infections by 75% in comparison with 2010,
– mortality resulting from AIDS was less than 30 000 cases (for information: the global target on AIDS mortality is less than 500 000),
– mortality resulting from TB among the people living with HIV was decreased by 75%,
– HIV service cascade achieved the level of 90-90-90.
«HIV self-testing is effective, and in order to introduce it, support is needed as well as relevant policies in the countries. Strategic implementation of this step requires participation of many stakeholders, and I’m glad that currently we’re discussing this issue in such extended format with participation of teams from countries. And we’re not simply talking about scaling-up opportunities of HIV detection; this will help cover more people with the treatment needed at early stages. This is that necessary kick, which can be done by the region right today», – says Elena Vovc, WHO Regional Office for Europe. – «As regards to PrEP, its introduction could potentially save the costs for the HIV combating programs. Thus, with a view to the new data and WHO recommendations, countries already can offer in their national recommendations day-to-day PrEP for all facing the higher risk of getting HIV-infected as well as PrEP intake when needed. It has to make our efforts in the area of STI prevention, including HIV, more efficacious ».
To make this important kick, it’s necessary to introduce pivotal actions at all stages including prevention, detection, and treatment.
Global experience and barriers that might be prevented
In the frames of the Regional Consultation in Istanbul global experience in implementation of PrEP and self-testing was reviewed as well as experience of the countries of the region – Ukraine, Germany, Moldova and Russia.
Olga Denisyuk, program manager of the Alliance for Public Health, shared the experience of Ukraine on PrEP implementation. She stressed the key points, which should be taken into consideration by all countries before introduction of PrEP, in particular, availability of national guidelines and/or relevant instructions on PrEP. Also she stressed that the barrier for this intervention may lay in absence of the indications to use for PrEP in the instructions of some manufacturers of TDF/FTC or other drugs recommended for PrEP! It is important to understand that the potential participants of the program are not always interested in visiting healthcare facilities, that is why it is important to maximally involve community-based organizations to cooperation in this area.
«In order to successfully introduce PrEP in any country of our region I’d recommend to envisage and/or analyze availability of the regulations to implement PrEP at national level. It’s necessary to ensure development of strict mechanism on how to implement PrEP at local level; also the needs have to be considered, since this intervention is not that much known in our countries. I mean development and launch of national information campaign on PrEP promotion among MSM and other key populations. Also pay attention to PrEP inclusion to HIV prevention service package and its accessibility at the community level», – Olga Denisyuk told.
Such PrEP pilots already are operating in the frames of the #SoS_project in Moldova; their launch is planned in Belarus, North Macedonia, Bosnia and Herzegovina; as regards to self-testing – in Georgia and North Macedonia.
Executive Director of the “Fenix Plus” NGO Yevgeniy Pisemskiy shared the experience of work in Russia: «We think that self-testing has good prospective not only among key populations. We hope that in nearest future the self-testing kit might be bought in any supermarket, like it is now in Switzerland».
Yevgeniy told about implementation of large-scale research project in Russia on the issue of HIV self-testing among MSM and transgender people. 26 thousand people got the “SAFE BOX” self-testing kit and reported on its result using the web-site gaytest.info. The research team representing Higher School of Economy measured, to which extent this method of HIV testing is applicable for MSM.
«Per our calculations, we detected more than 2000 HIV cases, and the approach by itself proved to be first-best applicable for MSM and transgender people. We developed the report, which describes in details how people got the self-test kit and their reaction on its usage», – Yevgeniy Pisemskiy tells. – «We see that there are projects currently being developed in Kazakhstan, Kyrgyzstan, Russia and Ukraine, which will really help to countries to achieve first 90% while testing key populations. Since self-testing allows to have HIV test in comfortable conditions and by oneself, without facing stigma and discrimination».
Also he mentioned that national Ministry of health methodological guidelines on work with key populations the self-testing method was envisaged, and currently the work on inclusion of these recommendations to national strategy is ongoing.
What about EECA countries?
Low level of PrEP and HIVST accessibility is still observed in the EECA region.
Aibar Sultangaziev, head of the “Partnership Network” Association, took part in the Regional Consultation on Self-Testing and PrEP in EECA countries, which took place on December 16-17 in Istanbul. We asked him whether the country is ready to introduce these interventions at national level and if there are any barriers for the moment, and he replied as following:
“The opportunities of self-testing and PrEP are included in our new national HIV treatment guidelines, which are currently under discussion and approval in the Ministry of Health. If compared with the acting guidelines, these issues were described rather frivolously; the new guidelines are fully in line with the latest WHO recommendations dated December 2019. The company manufacturing saliva tests is currently starting the process of their registration, and we will support them. After the registration is complete, we will promote introduction of mechanisms to make the tests available in the pharmacies”, – says Aibar Sultangaziev. – “PrEP is already available in the country, and currently about 30 people (according to the Republican AIDS Center) already get it, but Truvada (TDF+emtricitabine) is currently procured for the Global Fund costs. Our goal is to make it accessible for the national budget costs. Actually, Truvada is already being procured for the national budget costs during this year, but the reporting mechanism on distribution of the drugs for people has to be improved.
Yes, as of now, or physicians and governmental officials can hardly understand that the person is not currently ill, but already has to take drugs. But it’s about timing. When one understands economic reasons and economy, which PrEP can ensure, no more questions arise”.
In North Macedonia the situation is a bit different.
Andrej Senih representing the Association to support people living with HIV “Stronger Together”:
“The roll-out of PrEP and self-testing in North Macedonia has been very delayed. We are now working intensively within SoS project, and with WHO support, on national PrEP guidelines and a protocol for а PrEP program, while at the same time making plans for introducing several self-testing options. We are ambitious in our objectives, but it is realistic to expect that we will achieve access to PrEP and self-testing for key affected populations already in the first half of 2020”.
In Moldova, the national information campaign on PrEP is under development. Currently more than 70 people started PrEP already.
Vyacheslav Mulyar, LGBT Community Health Program coordinator within the Information Center “GENDERDOC-M”: “As of today, in the Republic of Moldova everyone who needs PrEP can have it. During next year we plan to advocate for changes to the National PrEP clinical guidelines, namely, by supplementing it with the mechanism of the Community PrEP and case scheme (2 + 1 + 1) recommended by WHO as alternative to the existing scheme. We are also open for exchanges of experiences, which proved to be fruitful, with the partner organizations and governmental structures, and we think this experience has to be considered in the changes, which will be brought at national and international level. We are also grateful for the National HIV Program, Hospital of Dermatology and Infectious Diseases, А.О. «Positive Initiative» and others for cooperation”.
Yevgeniy Goloschapov, Director of the Advocacy department of the public association Initiativa Pozitiva: “When we were developing the PrEP campaign, we requested the potential participants in order to attentively consider the most effective mechanisms of informing about #PrEP, counseling of those interested in PrEP and distribution of drugs. The pilot envisages that about 100 male and female will take PrEP”.
Participants of the PrEP campaign also get social support and counseling of NGOs’ consultants. After the campaign is held, its results will be analyzed, which would become a basis for recommendations on relevance of further PrEP introduction in the country.
It should be noted that the #SoS_projectis aimed to ensure sustainability of services for key populations in 14 countries of Eastern Europe and Central Asia. To achieve this ambiguous goal, the regional project team consolidates and distributes the best global experience among stakeholders in the countries of the region, as well as directly supports implementation of effective interventions like HIVST, PrEP and others.
Alliance for Public Health made an analysis and would like to present data on the real scope of legal and illegal circulation of opioid substitution therapy (OST) drugs in Ukraine.
Alliance has been implementing OST programs since 2005, regularly providing evidence of efficiency and safety of harm reduction approach as opposed to ungrounded accusations on allegedly high volumes of OST drugs leakage.
During 14 years of OST program implementation in Ukraine, around 1700 kilograms of OST drugs were purchased at the expense of international donors and of the State budget of Ukraine and delivered to licensed healthcare institutions to cover the needs of the program. The scope of OST drugs leakage recorded in court judgments does not exceed 0.002% of the total amount of OST drugs delivered.
The capital of Ukraine has become a focal point of new record setting and a venue to present an effective package of working interventions, highlight the strength of political will to support decision-making on HIV and TB and the leadership in the countries of Eastern Europe and Central Asia, as well as the Balkan region.
On December 6, 2019 in Kyiv, the International “EECA City Health Leadership Forum” 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.
The Forum showcased the results of operational research, practices and innovations with proven efficiency, approaches to HIV detection, testing and treatment, including new technologies and modern methods using network marketing, out-of-the-box decisions of the municipal government for cooperation with NGOs and other partners; the KP movement leaders shared their experience of protecting the rights of communities; moreover, the Forum speakers talked about financing programs and the cost of saving a person’s life, about the regional progress in the context of the fight against epidemics of AIDS and TB.
Andrey Klepikov, CEO of the ICF “Alliance for Public Health”:
“The EECA region in 2020 is already demanding results. And in this context, we are talking about a new dialogue between the state and civil society. Our focus on cities and collaboration with mayors is crucial for addressing HIV/TB. The Alliance team has been working with the regional municipalities teams for the fourth year already, and the cities’ eagerness to cooperate is also increasing. Therefore, the number of partner cities has expanded from 5 to 25 over the past year. As for the methodology, you don’t need to invent the wheel, everything has already been invented and tested. There are working principles on how to reach the level of accelerated response and achieve success. We described our work experience and effective work approaches in cities in a model delivering real results. Cities can make a difference in our countries, and these are not just some imaginary cities, but city leaders, mayors, you and me. For us, this is the way forward. This is #InYourPower, in our power!”
Presentation about the regional progress in combating epidemics, efficient approaches with the overview of the outlook for 2022.
Dialogue about the HIV/AIDS problem in the EECA countries on the highest municipal level
The top officials of the cities discussed good practices, innovations, out-of-the-box solutions of the municipal government and cooperation with non-governmental organizations and other partners.
Within the framework of the forum, a high-level dialogue took place in a panel discussion between the mayors of Kyiv and Odesa (Ukraine), Berne (Switzerland), Chisinau and Balti (Moldova), Svetlogorsk and Soligorsk (Belarus), vice-mayors of Bishkek and Osh (Kyrgyzstan), while Roman Gaylevich (UNAIDS) and Lucica Ditiu (Stop TB Partnership) moderated the discussion.
Vitaliy Klitschko, the Mayor of Kyiv: “HIV is a common problem, and we must join our efforts to stop it”
According to Mr. Klitschko, amid the global epidemics of HIV and TB, the city must create favorable conditions for public organizations fighting epidemics, taking active leverage, and actively engaging in it.
“It is very important that the mayors of many cities around the world would play a leadership role in overcoming diseases. The people’s health should be one of the key priorities of the municipal government, and therefore – a priority in the work of mayors. It is in our power to prevent the spread of HIV and TB, to introduce efficient treatment programs”, said Vitaliy Klitschko.
The Kyiv Mayor is convinced that only joining efforts instead of silencing a common problem can solve it. In Kyiv, this approach is already yielding results.
“Kyiv is showing considerable progress in the fight against AIDS,” said Vitaliy Klitschko. “I am sure that common efforts over the past few years helped us to advance in the fight against this serious challenge for our city and increase the numbers of people who receive medical care and prevention”.
Vitaliy Klitschko signed the Zero TB Cities Declaration on the fight against tuberculosis on behalf of the city. This is the second city in Ukraine after Odesa, which signed the Zero TB Cities.
“Kyiv is taking the lead, and we are ready to extend the positive experience to all regions of Ukraine, the Kyiv Mayor said. – And as for the challenges, we, unfortunately, face a plenty of them”.
Ion Ceban, Chisinau Mayor: “We rely on partnership in combating HIV and TB”
According to the Chisinau City Mayor, Ion Ceban, one of the important tasks for the health care of any city is to ensure that people’s lifespan, in particular of people living with HIV, can be as long as possible. So that they have the opportunity to live to old age, women living with HIV can give birth to healthy children, and the townspeople have access to prevention and testing and undergo it regularly.
“We must consider both treatment and HIV prevention in a comprehensive manner, ranging from vulnerable groups to the general population of cities,” he emphasized.
According to Ion Ceban, special attention should be focused on youth. It is necessary to talk about the transmission methods, the importance of prevention.
A pre-exposure prevention program is already working in Chisinau, and a syringe exchange program is being actively implemented. “This is a very important step for those at risk to keep HIV at bay”, Ion Cebanemphasized. “Next, we have a lot to do about tuberculosis, and we really look forward to a partnership”.
Dmitriy Aleinikov, Svetlogorsk Mayor: “It is easy to achieve 90-90-90 indicators, if we speak up”
In a small Belarusian town Svetlogorsk there is a person who has been living HIV-positive status since 1997. Today his health is quite good and he can live the ordinary life. The reason for this, according to the City Mayor Dmitriy Aleinikov, is that the municipal authorities do not hush up the HIV/AIDS problem, but actively solve it.
“There are only 80 thousand people in Svetlogorsk, but problems such as HIV/AIDS and drug addiction still linger from the Soviet era”, said Dmitriy Aleinikov to the heads of cities of the EECA region at the EECA Cities Forum held in Kyiv on December 6. “And I am grateful that my predecessors did not sweep this problem under the rug”.
Signing of the Paris Declaration posed no additional problems for the city, because, as the Mayor of Svetlogorsk is convinced, achieving the 90-90-90 indicators will be quite easy, if we adhere to the principles of publicity, openness and a strategic approach.
“It will not be difficult, because we speak up, – he stated. – We are tacklingthis problem, it is not new for us, and I am certain that we will solve it”.
Gennadiy Trukhanov, Odesa Mayor: Combating HIV should start from philosophy
Odesa is the first city in Ukraine to commit to the Zero TB Cities initiative and systematically proceeding towards overcoming the TB and HIV epidemic. Today, all forces that used to withstand these challenges alone, became consolidated. Thanks to joint efforts, the effectiveness of treatment has increased from 53% to 72%.
However, as the Odesa Mayor Gennadiy Trukhanov, said at a meeting of mayors as part of the EECA Cities Forum, this was not easy for the city itself. Deputies engaged in heated debate over two sessions. The experience of other cities, in particular the Swiss municipality of Bern, helped to shift the obsolete views.
“We must start with philosophy”, Gennadiy Trukhanov is convinced. – PWID are people with drug addiction. They are dependent. They are not criminals, but people in need of treatment. And only when we socialize them, when they realize that society is not against them, they will look for opportunities for socialization”.
In addition to local, routine problems, the city authorities also have to solve global challenges, in particular, to help health workers in the fight against epidemics. After all, it is in everyone’s interests. “The mayor’s performance is assessed by the city condition: roads, roofs, heating, comfortable public space. That is all true. But we can make cities clean, however with the spread of all dangerous infections in the world, God forbid, the time may come when there will be nobody to walk along these tidy streets”, emphasized the Odesa Mayor.
Inspired by the Bern experience and changing the philosophy of the attitude towards PWID, Odesa promises to take further steps to combat the spread of infections and ensure socialization of PWID. In the near future, the opening of a safe injecting drug use room is planned.
Alec von Graffenried, Bern City Mayor: “Our goal is 100-100-100”
“Bern accumulated solid experience in this area, not because we are better than other cities in any way, but rather because we faced huge problems with drug users. In the 80s, there were hundreds of them right in the center of the city, they wandered around the streets, threw syringes right in the parks and it was terrible”,Alec von Graffenried recalls. “Since then, city mayors had to solve this problem quite effectively, because PWID is one of the most vulnerable groups, and the most problematic in terms of HIV prevention”.
The first step of the city authorities was the free distribution of syringes on the streets. The second step – the authorities went to the places where people sell drugs.
“It turned out to be a lot harder than just distributing syringes. We had to talk to people, and do not arrest them, because drug addiction is a disease. They need to be treated and receive care like patients”, said Alec von Graffenried.
After drug users got used to people who do not blame them, but are willing to help, the city offered them a safe space, free from crime, in the very center of the city. There they could get syringes, take an injection, meet with peers.
Further, the city began to offer PWID medical assistance, social support, so that they could leave the street where everyone could see them.
“We were not telling people, “Come along, we will cure you, you will no longer be addicted”, but simply accepted the fact that they will continue to take drugs. We want to help them so that people could live in normal conditions. – says the Mayor of Bern. – What did we achieve in the end? We have methadone and heroin programs in Switzerland, so that drug users can live a normal life, avoid involvement into crime, to buy drugs. We provided them a possibility to live as an ordinary citizen, and as a result, the number of people with drug addiction decreases, the number of people with HIV decreases even more, tuberculosis is not a problem for Switzerland at all. If we talk about indicators, then Switzerland has come a long and arduous way in 30 years, and now it has reached the goal of 100-100-100”.
Effective HIV strategies that worked well in the cities of the region
The Forum showcased the best municipal practices such as the Harm Reduction Program in Bern, the state-funded Opioid Substitution Treatment Program in Kyiv, new approaches to increase the effectiveness of tuberculosis treatment in Odesa, the promotion of the VCT program in Chisinau, the work on improving the HIV cascade in Almaty and others.
Thus, two years ago, an Almaty citizen had to go to the clinic to get a blood test to get to know their HIV status and wait two days for the result, which again had to be received from the clinic. Obviously, this was far from the best way to identify all people in need of treatment. AFEW Kazakhstan radically changed the approach and improved the situation with HIV detection in the city. In 2018, key innovations were introduced for the first time in Kazakhstan.
First, rapid saliva tests were introduced in the outreach conditions.
This approach is unique, because outreach workers travel to the necessary places to provide testing and counseling. The test itself is very easy to use. It is only necessary to hold a special spatula between the lip and the gum and dip the spatula into the liquid. And after 20 minutes the result is ready.
Secondly, the index testing approach was implemented.
Initially, outreach workers tested those clients whom they knew. Then they asked those of them who had positive HIV status, to refer 3 people from their close circle with whom they practiced risky behavior in the context of HIV to undergo a test. To motivate customers, special coupons were issued with QR codes and outreach worker contacts, which a client could hand out to friends. Everyone who passed the test or attracted another person received 1000 cell phone payment units or a grocery package, upon their choice.
This is a network marketing in action!
Therefore, for a year and a half, 6,000 people were tested. 145 Almaty residents first learned about HIV! For comparison, this is about a third of all identified cases per year in the city!
Third, the efforts of the project team were aimed at increasing treatment coverage.
When the HIV test result turned out to be positive, the client was provided with social support for testing at the AIDS center. If the result was confirmed, the client received assistance to get enrolled for a dispensary registration and immediately start antiretroviral treatment.
At the same time, outreach workers cooperated with healthcare staff to bring back clients who discontinued treatment, the so-called “lost-to-follow-up patients”. Thus, the project team worked with each patient step by step, returning people to treatment and support programs.
As a result of the project 538 people who were diagnosed with HIV now have the right to life! The efforts of outreach workers and a personalized approach helped to provide people with treatment upon learning about their HIV status for the first time or returning to the program.
For comparison: an average of 400 people in Almaty start ARV treatment annually. It turns out that only the efforts of the pilot project team managed to exceed the average annual rate.
Political commitment to ending HIV and TB epidemics and signing of the TB and AIDS Declaration by the six cities at once, a groundbreaking event for the EECA
The groundbreaking ceremony of simultaneous signing the Political Declaration on AIDS and TB: Declaration to Fight against the TB by the six EECA cities: Kyiv (Ukraine), Chisinau (Moldova), Svetlogorsk (Belarus), Bishkek and Osh (Kyrgyzstan), and the Paris Declaration signing by the Balti city (Moldova) was the cornerstone event of the Forum.
Roman Gaylevich, UNAIDS Director in Ukraine: “We welcome and warmly support the personal leadership of the mayors of the cities that have signed the Paris Declaration and the Declaration to Fight against the TB, I would like to put special emphasis on the fact that all these cities have coordinating councils on HIV/AIDS and TB, which include key communities. The joint work of the city authorities and communities, in my opinion, is the core and the driving force behind positive changes”.
We would like to note that the team of the ICF “Alliance for Public Health” and the #SoS_project partners will provide expert, technical and financial support to Svetlogorsk, Osh and Chisinau at all stages of fulfilling their commitments under the Paris Declaration and the Zero TB Declaration.
Key population communities in the focus of attention
Of course, declarations are signed for a reason, and all programs, foundations, public figures and experts are working not just for the statistics, but solely for the sake of saving human life and improving people’s health.
At the beginning of the session, a video presentation of the leaders of the LGBT, PWID, TG, and SW community networks was presented with a perspective on regional problems and challenges that are most relevant in Eastern Europe and Central Asia.
Four leaders of their communities of Almaty, Sofia, Tbilisi and Minsk shared from the Forum stage their experiences and real stories about how they manage to represent the interests and protect the rights of their communities at various levels, be it international or local city platforms. They presented their vision, their strategies and examples of results that can be achieved and how a person’s life can dramatically change in a comfortable social environment.
The emotion was undoubtedly the most intense during this panel with real heroes in their field, people who inspire and adamantly go forward. Kevin Osbourne, Director of the International AIDS Community, moderated the panel.
#InYourPower awards handed to the winners
The Forum culminated in holding the first #InYourPower award ceremony for political leadership in combating HIV/TB in the special nominations and based on the voting results.
Mayors, vice-mayors and representatives of mayors of 13 cities of Eastern Europe and Central Asia received awards: Kyiv, Odesa, Bishkek, Chisinau, Almaty, Tbilisi, Sofia, Osh, Balti, Svetlogorsk, Bar, Bielo Pole, Podgorica.
The prize was awarded to cities for the following achievements:
– Significant successes in the fight against HIV/TB at the city level,
– The political leadership of mayors and city teams in the fight against HIV/TB, as a symbol of commitment to ending the AIDS epidemic, as well as a sign of support from international partners.
A special award based on the results of voting on the site inyourpower.life was presented to Irina Kutsenko, a deputy of the Odesa City Council.
Dr. Michel Kazatchkine, UNAIDS Special Envoy in Eastern Europe and Central Asia, stated, “We need to change policies to save people, and the ownership of city leaders plays a crucial role!”, greeted the mayors on occasion of awards, significant promotion and commitment to ending the AIDS epidemic and TB.
The participation of the journalist and TV presenter Yanina Sokolova as the host of the event was symbolic; the is the ambassador of the Sustainable Development Goal 3, related to the health and well-being, within the framework of the UN national campaign on promoting the SDGs in Ukraine.