April 24, 2020

Alliance for Public Health conducted two online interactive trainings on “Motivational Counseling and Social Support (Case Management)” on April, 14-15 and 22-23, 2020.

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

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

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

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

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

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

April 16, 2020

Alliance procures Personal Protective Equipment for its partner NGOs!

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

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

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

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

March 24, 2020

Statement on the occasion of the World TB Day in the context of COVID-19 pandemic

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

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

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

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

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

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

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

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

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

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

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

#ItsTimeToEndTB  #FightCOVID19

TB hotline: 0800503080

COVID-19 hotlines:

Government hotline: 1545

Ministry of Health of Ukraine: 0800505201

Public Health Center of the MoH of Ukraine: 0444254354

Ministry of Foreign Affairs: 0442381657

February 25, 2020

Great news!

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

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

February 18, 2020

The Fourth Regional Digest Has Been Released by #SoS_project Team

Announcement of materials of the #SoS_project regional digest  #4

2020 is the year of sustainable leadership and effective partnerships!

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

Read full Digest #4 on your browser.

Thank you for your attention and enjoy the reading.

January 13, 2020

«Alliance Online supervision» – effective and available professional support of specialists

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

Aims of the projects:

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

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

Supervisees highly appreciate results of the supervision session:

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

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

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

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

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

January 09, 2020

Mayor of Skopje signed the Paris Declaration to end AIDS

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.

January 02, 2020

Andrii Yarovyi is back home after being captured!

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!

In April 2019, at the opening ceremony of the 26th Harm Reduction International Conference in Porto (Portugal) Andrii Yarovyi was presented with a prestigious Carol and Travis Jenkins Award as a victim of daring human rights violations related to the illegal imprisonment for possession of the legally obtained opioid substitution drug.

Photo from the official website of the President of Ukraine

Information about illegally convicted Andrii Yarovyi

December 21, 2019

Solid results set high standard for transition in 2020


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.

There are 8 highlights from APH perspective (download statement in .pdf):

  1. 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

  2. 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.
  1. 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.

  1. 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.

  1. 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.

  1. 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).

  1. 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.


  1. #InYourPower campaign launched

APH with partners launched the information campaign “It’s #InYourPower to end AIDS” – https://inyourpower.life.

“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.


December 18, 2019

Broad implementation of self-testing and PrEP will fast-track the EECA region progress in combating AIDS


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.

It is interesting that, according to the report on Assessment of accessibility and major barriers in introduction and scale-up of PrEP in the EECA region held by ЕСОМ in 2018, the major conclusion mentioned that «there were no impassable barriers identified which would make PrEP implementation impossible in any of the countries. When the needed support is available … it seems realistic to resolve the issues of PrEP introduction and scale-up in the EECA region in the immediate future».

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_project is 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.

Implementation of the #SoS_project is coordinated by the Alliance for Public Health in consortium with the 100%Life (All-Ukrainian Network of PLH), Central Asia Association of People Living with HIV and Eurasian Key Populations Health Network with participation of 14 national, governmental and non-governmental organizations as well as regional networks representing key populations, international agencies and organizations, and technical partners. Funding of the regional project is supported by the Global Fund to Fight AIDS, Tuberculosis and malaria.