On April 3, a working meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria countries of the Eastern Europe and Central Asia region (EECA Constituency) was held in Dushanbe (Tajikistan) with representatives of the Ministries of Health and the National Coordination Councils of the five Central Asian countries: Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan.

Professor Natalia Nizova, Deputy Member of the Board of the Global Fund from the EECA electoral group, said that the focus of the meeting was on enhancing the participation of representatives of the public sector of Central Asian countries in the electoral group.

“The EECA Constituency is one of the seven Governors of the electoral groups in the Global Fund, whose leading members are representatives of state structures delegated by countries. It was important for us to hold a meeting on the territory of one of the countries of Central Asia – a region that is currently characterized by a rapid increase in new cases of HIV and tuberculosis, – said Professor Nataliya Nizova. – The objectives of the meeting were to provide additional information on the opportunities that, through participation in the Constituency, are opened up for the countries of Central Asia as well as in discussions with representatives of the regional offices of UNAIDS and WHO on the consolidation of available resources in the region for the successful preparation of countries for the transition period. The Constituency meeting was been prepared for more than a year with the assistance and support of the Ministry of Health of Tajikistan, which allowed the participation of both members of the delegation of the Global Fund electoral group and invited participants”.

During the meeting, Pulod Jamolov, Executive Director of SPIN Plus (Tajikistan) and a member of the regional team #SoS_project presented a three-year project strategy with the support of the Global Fund “Sustainability of Services for Key Groups in the EECA Region” (#SoS_project).

“The multi-country #SoS_project has a complementary structure design and clearly defined goals. In the whole EECA region, we plan to attract more than $10 million in prevention programs for key groups. And this is extremely important in the context of the transition to state financing. WHO representatives who attended the meeting expressed interest in the project strategy. I think, we will continue the new dialogue with WHO on the project implementation at other regional and country sites,” – Pulod Jamolov said.

“A regional project is another resource for Central Asian countries that cannot be implemented without the active involvement of Ministries of Health, CCM teams and an understanding of the prospects that are opened up for each country and region as a whole,” – noted Professor Nataliya Nizova.

From the speech of Natalia Nizova at the launch #SoS_project meeting (Kiev, Ukraine, March 26, 2019)

#SoS_project will focus on ensuring the sustainability of services for key populations in 14 countries of Eastern Europe and Central Asia. As a result of the project, by 2021, national funding for HIV/AIDS programs will be increased by $10 million from national, regional and municipal budgets in the countries of the EECA region. It is also planned to ensure $73.4 million savings in the countries budgets through optimised ARV procurement.

The implementation of the three-year project will be coordinated by the Alliance for Public Health, in a consortium with the 100% Life (All-Ukrainian Network of PLWH), the Central Asian HIV’ Association and the Eurasian Key Populations Health Network, with the participation of national governmental and non-governmental organizations, regional key populations networks , international agencies and organizations, as well as technical partners.

Text: Inna Gavrylova

14 countries of EECA and Balkan regions will be able to save more than $ 73.4 million thanks to optimized procurement of antiretroviral drugs and optimization of treatment regimens.

These funds will allow reallocation of funding and expansion of treatment programs and services for key populations in countries. This was announced by Andriy Klepikov, Executive Director of the Alliance for Public Health during the presentation of the regional project “Sustainability of Services for Key Groups in the EECA Region”, which was shortly named #SoS_project.

“The enormous savings at the regional level are very well and in details calculated,” – emphasized Andriy Klepikov. – “This is not a figure from the ceiling. Behind it, there are strategic calculations, analytics, which is confirmed at the level of each country as well as on regional level. There are some specific calculations that have already been transformed into a commitment format in some countries, because in all countries these applications were approved by the CCM – the national coordination mechanisms for HIV/AIDS”.

To achieve the expected savings, the project will develop strategies for optimizing the cost of ART regimens, which will lead to a decrease in the average cost of first-line ART. Advocacy activities will also be carried out aimed at reducing prices for ARVs and using savings to finance the needs of prevention and care services for the Key Groups and PLHIV. In addition, work to optimize clinical guidelines for ART, a list of drugs in accordance with WHO guidelines is planned, as well as advocacy to include countries in voluntary licensing and registration of generic manufacturers.

The regional project “Sustainability of Services for Key Groups in the EECA Region” is the largest and most comprehensive regional project of the Global Fund to Fight AIDS, Tuberculosis and Malaria in Eastern Europe and Central Asia. It brings together 14 countries of the EECA region and southeastern Europe and the 23 cities with the highest burden of prevalence of HIV/AIDS.

“Unfortunately, we cannot work at the same time everywhere,” – says the executive director of the Alliance for Public Health. – “Therefore, we have chosen 23 cities with the largest number of HIV-cases. This is a reasoned choice when, effectively working in cities, you can influence the effective response of the HIV/AIDS epidemic and at the state level”.

The main goals of the project are to increase the financial sustainability and effectiveness of HIV programs, remove the most significant barriers to accessing prevention and care services for PLHIV, and increase the effectiveness and accessibility of HIV services delivery models for key populations.

To achieve these goals, the Global Fund provided financial support in the amount of $ 13 million. Andriy Klepikov said that almost half of these funds ($ 5.6 million) will go to the advocacy of the reduction of prices for ARV drugs and optimization of procurement mechanisms.  Another quarter of the project budget ($ 3.2 million) is planned for budget advocacy. $ 1.6 million is provided for the removal of legal barriers, the same amount for project management. Another $ 1 million will go to operational research.

The #SoS_project team will actively cooperate with all those who can provide, and/or affect the necessary changes, both from civil society and government agencies. It is also planned to interact with recipients of country GF grants to achieve common goals and successful experience in introducing innovations in some countries of the region will be extended to other states. All actions to introduce innovations will be accompanied by operational research, which will become the evidence-based research for launching new initiatives.

“The idea is not only to throw in some initiatives, but simultaneously with such interventions to launch operational research, which will help identify and prove their effectiveness,” explained Andriy Klepikov. – “It worked, in particular, in Ukraine. But we would not want other countries to take it on faith. In each country for advocacy, before the Ministry of Health will start funding, it is important to get a serious evidence base, which is collected through operational research”.

According to the plans, budget advocacy within the project will consist of the following elements: development/updating of the functional mechanisms of public procurement of prevention and care services and support services from NGOs; increasing the capacity of NGOs and government representatives on budget advocacy, reallocation of financial resources, relations with government structures; support for the development of national social contracting guidelines; advocacy for the adoption of municipal programs and funding related activities.

Moreover, as part of the project, it is planned to attract $ 10.250 million in prevention programs for key groups from savings made through the project.

The implementation of the three-year The Global Fund project will be coordinated by the Alliance for Public Health, in a consortium with the 100% Life (All-Ukrainian Network of PLWH), the Central Asian HIV’ Association and the Eurasian Key Populations Health Network, with the participation of national governmental and non-governmental organizations, regional key populations networks , international agencies and organizations, as well as technical partners.

Text: Inna Gavrylova

Foto: Julia Nikolenko

On March 21, 2019, on the eve of the World TB Day, public campaign “It’s time” was organized in front of the Ukrainian Parliament building with support of Alliance for Public Health. Within the campaign, a four-meter installation of a clock was set up at the Constitution Square near the Parliament, with the key messages of TB response in Ukraine put on the clock dial instead of the numbers, together with the slogan “It’s TIME to end TB.” This event was held within international awareness-raising campaign “It’s time” initiated this year by the Stop TB Partnership to draw the attention of general public and government officials to the problem of TB.

At the press briefing, campaign organizers said that every year approximately 3,700 people die of TB in Ukraine, which is about 10 people every day. This situation leads to the annual indirect losses of more than $12 million. Although in the recent years there has been certain improvement of the situation, Ukraine remains one of the countries with the highest burden of multi-drug resistant tuberculosis – the most severe form of TB, which incurs longer-term, more expensive and less effective treatment. Besides, according to the WHO about 23% of TB cases in Ukraine are missed.

To improve the situation, the Cabinet of Ministers developed a middle-term strategic document – National TB Program – which is currently reviewed by the Parliamentary committees.

“The National TB Program that we are discussing today is not only the document setting the direction and creating the grounds of TB response in the country, but should also be part of the accountability system to monitor compliance with the commitments, which Ukraine undertook at the UN General Assembly High-Level Meeting on TB in September 2018. It’s time to start implementing those commitments on detecting, treating TB and overcoming stigma against people with this disease. I think that to achieve this goal it is crucial to establish cooperation of the responsible governmental authorities with the civil society and with MPs. Our joint efforts can become the driving force, which will allow the country to turn the tide in TB epidemic,” pointed out Serhii Kiral, MP, Chair of the Parliament Platform to Fight TB.

During the national round table in the Parliament, which was held before the press briefing, MPs, heads of the government bodies, international experts, and representatives of civil society and patient organizations discussed the situation with tuberculosis in Ukraine and pointed out that for the third year the country has been functioning without a valid National TB Program approved by the Parliament, which has an extremely negative impact on the efficiency of TB response. For our country, resolving this problem is a matter of national security, which requires comprehensive and interdepartmental approach at all levels.

“Ending TB by 2030 is a joint intention of the humankind. Currently, Ukraine demonstrates a persistent trend towards reduction of the incidence of new and repeated TB cases. Last year, this number was 800 less than in 2017. Today Ukraine fully funds the procurement of TB drugs, and by procuring those drugs through international organizations, we were able to increase the quantity of the drugs purchased almost 40-fold. For instance, last year Linezolid was procured by international organizations for $0.27, while in 2014 the Ministry of Health procured it for $2.85,” told Dr Ulana Suprun, Acting Minister of Health of Ukraine.

“With support of the Global Fund and other donors, Ukraine made a big progress in fighting tuberculosis. In the context of transition from donor to domestic funding of TB response, it is crucial not to lose our achievements. Draft law No. 9467 stipulates implementation of a patient-centered approach to TB care, compliance with the rights of patients and their family members, involvement of communities to end the epidemic of TB in line with international strategies and recommendations,” outlined Zahedul Islam, Director: Treatment, Procurement and Supply at Alliance for Public Health, which is the focal point of civil society organizations in Ukraine in working with the international movement of parliamentarians, the Global TB Caucus, and provides technical support to the Parliament Platform to Fight TB.

Besides, the participants discussed the issues, which people with TB currently face. Olga Klymenko, Chair of TB People Ukraine, who defeated TB and now helps other people in fighting the disease, told about her own experience of TB and the challenges that other patients are exposed to: “It is crucial to make sure that people who receive treatment can rely on all the required human and professional support to successfully complete their therapy. In 25 years of the epidemic, we never had a stronger support at the national level than we have today. Just a couple of years ago, the main treatment rule was “total isolation.” In the last two years, we have seen effective positive changes in the system, which stayed rigid for many years. Outpatient treatment, procurement of social support services with local budget funds, access to new drugs. However, to make such changes systematic, we need a National Program, which would recognize them at the legislative level. Thousands of patients are awaiting such changes. I hope that all those who have the power to make decisions will remember that they are responsible for thousands of human lives.”

Many developed countries have already given up the practice of long-term hospital stay due to the high risk of cross infection and due to the problems, which patients face if they have to leave their social environment for a long time. Patient-centered approaches currently introduced in Ukraine stipulate, in particular, transition to outpatient treatment if there are no special reservations.

“The biggest danger for people around is a patient with undiagnosed TB, while the best TB prevention in this case is detecting the disease as soon as possible and prescribing TB treatment,” emphasized Victor Liashko, First Deputy Director of the Public Health Center of the Ministry of Health of Ukraine.

Information statement

on the World Tuberculosis Day

On the occasion of the World Tuberculosis Day commemorated annually on March, 24, the Alliance for Public Health report on our achievements in solving the problem of detection and treatment of tuberculosis (TB) in a difficult epidemiologic context.

According to the World Health Organisation (WHO), tuberculosis ranks among the top-10 mortality reasons around the world, and is the main mortality reason in HIV-positive people. In Ukraine, tuberculosis kills over 3700 people a year, which is about 10 persons a day. Despite certain improvement of the situation observed in the recent years, in 2018 alone, 21.3 thousand new cases of tuberculosis were registered in Ukraine. At the same time, about 23% new cases in our country go undetected, and drug-resistant TB insusceptible to conventional medications requires more prolonged and expensive treatment with lower chances of a successful outcome.

The situation is further complicated by the fact that it is now the third year that the Parliament fails to adopt the National TB Program, which reflects the lack of proper political will in the legislature.

Alliance for Public Health (APH) continues implementing comprehensive measures to fight tuberculosis in Ukraine. In 2018, screening surveys under APH’s programs reached almost 308 thousand people of the key populations, and 16.7 thousand people tested TB positive during a screening received diagnostic services at health care facilities. For the first time, 3190 clients from the key populations underwent high-quality diagnostics — molecular genetic testing — at the screening stage. 811 TB cases were identified, with 93% of the TB-positive people starting treatment.

APH introduces new effective approaches to identification of TB cases and further immediate beginning of treatment. Screening of exposed persons strengthened with an innovative result-based funding (RBF) model enabled increasing the number of detected TB cases in exposed persons in 2018 by 3.4 times compared to 2017! And thanks to patient-centered models of care and integration of treatment and social support, treatment success rates of drug-susceptible and drug-resistant TB in 2018 reached as high as 90.9% and 88.7% respectively![i]

In 2018, APH consistently made efforts to restore control of the TB epidemic on the uncontrolled territories in Eastern Ukraine. These efforts have already brought substantial results. Thanks to the work of APH, as of early 2019, as many as 1405 patients were provided with a quality multidrug-resistant tuberculosis (MDR-TB). They comprise 100% of all MDR-TB patients receiving treatment on the uncontrolled territories of Donbass region.

As the coordination center for civil society organisations of Ukraine in the context of collaboration with the Global TB Caucus — an international movement uniting over 2000 MPs, APH provides technical assistance to the interfaction Ukrainian Parliamentary Platform against Tuberculosis. The Platform established in October 2017 includes 47 MPs of Ukraine. In the year and a half, the Parliamentary Platform have held 4 national round tables in the Parliament and, together with their partners, organised several major campaigns commemorating the World TB Day in 2018. Besides, the Parliamentary Platform took an active part in coordination of Ukraine’s participation in the UN General Assembly High-Level Meeting on TB in New York in 2018, and the report “Drug-Resistant TB in Europe” presented by the Chair of the Platform has enabled adoption of the corresponding PACE resolution. The activities of the Parliamentary Platform have been included in the WHO’s Compendium of good practices in the implementation of the Tuberculosis Action Plan for the WHO European Region 2016-2020 as a good example of advancing partnerships to end TB.

We would like to thank all our partners and donors, as well as representatives of civil society, communities, professional and governmental organisations. It is time to stop tuberculosis, and, together, we shall definitely do it!

[i] 90.9% — preliminary data on treatment success rate in patients with drug-susceptible TB who started the treatment in 2017.

88.7% — preliminary data on treatment success rate in patients with drug-resistant TB who started the treatment in Q2 and Q of 2016

The WHO Compendium of good practices in the implementation of the Tuberculosis Action Plan for the WHO European Region 2016–2020 published the article on the results of the work of Parliamentary TB Caucus, technical support to which is provide by the Alliance of Public Health. The WHO appreciated the activity of the Parliamentary Caucus as a successful example of consolidation of the efforts of all stakeholders and development of the efficient partnership to overcome the disease.

As the coordination center for civil society organizations in Ukraine to work with the Global TB Caucus – the international movement uniting more than 2,000 MPs of different countries of the world. The Alliance worked on the idea to establish a multi-faction association of MPs to counter TB since 2016. And thanks to the support from MP Serhiy Kiral, who engaged 47 other MPs to cooperation, the Parliamentary TB Caucus started operating in Ukraine since October 2017.

Currently this platform considerably influences the TB legislation changes and facilitates strengthening the multi-sectoral approach to solving the important challenges in the area of combating TB.

From October 2018 to March 2019, the ICF “Alliance of Public Health” within the project “Accelerating the efforts on combating HIV/AIDS in Ukraine” (HealthLink) funded by the United States Agency for International Development (USAID), launched the implementation of a full-time supervisory system for medical and social workers.

This initiative is being implemented in 12 oblasts of Ukraine: Dnipropetrovsk, Kirovohrad, Zaporizhzhya, Donetsk, Odesa, Chernihiv, Poltava, Cherkasy, Kherson, Mykolayiv, Kyiv oblast and Kyiv city. In September, 16 supervisors from among doctors and psychologists were selected. From September 2018 to March 2019, three trainings were provided to the team for the development of working materials, practicing of skills and supervisory skills. The curriculum consisted of 72 hours of theoretical and practical training, exchange of experience and mastering of new forms and methods of work.

The key goal of supervision is to improve the quality of health services provided to HIV-positive people by health care facilities. Supervisors in their work pay special attention to the development of professional skills of doctors to counsel and test patients for HIV, optimize their HIV diagnostics route, interact with social workers and case managers, etc. If necessary, supervisors conduct mini-trainings on the use of rapid HIV tests, teach effective communication with patients from target groups, and find the right motivation for HIV-positive patients for enrolment on the dispensary record and forming adherence to treatment. A lot of attention in the work of supervisory groups is provided to discussing confidentiality issues, reducing the level of stigmatization and discrimination of HIV-positive patients and representatives of risk groups by health staff. Another important and relevant aspect that supervisors focus on during meetings with medical and social workers is prevention of professional burnout.

Supervision system is gaining momentum and improving. Supervised physicians become more loyal to HIV-positive patients and more knowledgeable about HIV. During the meetings, the existing problems encountered by healthcare professionals in their practice are discussed, first of all, “inefficient” mechanisms for the redirecting HIV-positive patients, “delayed” and/or ineffective patient routes, fears, stereotypes, knowledge gaps, etc.

Currently, the following achievements of regional coordinators may be identified:

• From November 2018 to February 2019, 81 supervisory meetings were held in 11 regions, 21 of them were held in HIV-service NGOs and 60 were held on the basis of HCFs. In total, supervisory meetings were attended by 385 medical workers (doctors, nurses, medical assistants) and 162 social workers;
• In the Kirovohrad oblast, after conducting supervisions, three medical staff achieved the dispensary enrolment and ART indicators and received incentive packages from the project.

At the start of the pilot area “Support and Management of HIV Pre-Exposure prevention (PrEP)”, from February 18 to February 26, the Alliance of Public Health organized a series of training sessions for its implementers. 59 social workers and project managers from 25 partner organizations, who won the open competition for the 26A component (PrEP), took part in the events.

Participants got acquainted with the best world experience and innovative practices of the NGO “Alliance.Global” implementing PreP in Kyiv, mastered the medical aspects and conducted practical workshops on effective dismantling of existing myths regarding the PreP intake, elaborated in detail the functions of NGO specialists at all three stages of the implementation of this activity and mechanisms of interactions with regional AIDS Centers.

This activity is being implemented by the Public Health Alliance in cooperation with the Center for Public Health of the Ministry of Health of Ukraine and aims at reducing the rate of spread of HIV among MSM, HIV-negative partners from discordant couples and those reporting high-risk behavior (including sex workers) by introducing PrEP as an element of a combined prevention and care program in Ukraine.

Today in Odesa, the Fast Track Cities partners meeting took place, showcasing impressive results in the fight against HIV/AIDS in the city. Two years ago, in the framework of the regional project “Accelerated response to the HIV/TB epidemic among key populations in Eastern Europe and Central Asia” of the ICF “Alliance for Public Health”, the Odesa Municipality joined the Fact Track Cities Global Initiative to overcome the HIV/AIDS epidemic by 2030. The synergetic work of the Alliance, Odesa City Council, partner NGOs and key populations has led to an increase of 50% in the number of ART patients. For comparison, in Kyiv, which is also a city of Fast Track Cities initiative, the progress made for the same period amounted to 43%, and is even less throughout Ukraine – 37%.

“Two years ago, Odesa decided to make a pivot point decision to become the Fast Track city, that is, implement accelerated action in the fight against HIV and tuberculosis. The Alliance for Public Health supported the Odesa city authorities all the time, and today the city, in partnership with non-governmental organizations and key populations, reported convincing results – by 50%, the number of people receiving ARV therapy in comparison with 2016 has increased. Significant results in the fight against tuberculosis – the implementation of patient-oriented programs has improved the TB treatment coverage from 56% in 2016 to 77.4% in 2018, and even up to 82.8% in the framework of the observed treatment pilot”, noted Executive Director of the Alliance for Public Health Andriy Klepikov.

In addition, in 2018, 27,378 representatives of key populations were covered with prevention services in Odessa. Of these, 17,430 are injecting drug users (84% of the estimated number), 4,962 are sex workers (58%), 4,667 are men having sex with men (60%) and 419 are transgender people. 26,825 representatives of key populations were tested with rapid HIV tests and 1,204 positive results were found. HIV mortality in Odessa decreased by 19% – from 117 in 2017 to 95 in 2018.

“Odesa’s success in the fight against HIV/AIDS is the great achievement of a joint, and most importantly, a concerted effort of city authorities and non-governmental organizations. We are very grateful to public organizations, including the Alliance of Public Health, which is one of the key organizations in the fight against the HIV/AIDS and TB epidemic, for sharing their experience with key populations not only at the local, but at the European level, which gave us an opportunity to consider the things familiar in our work from a different perspective and become even more effective in achieving the goals of the Fast Track Cities initiative”,  said Deputy Mayor of Odesa Svitlana Bedrega.

Moreover, within the framework of this program, since December 2018, 2 211 injecting drug users received harm reduction kits procured from the municipal budget and distributed through municipally-owned pharmacies for a total of UAH 100,000. In general, for the period 2017-2018, UAH 419,000 were allocated from the municipal budget to non-governmental organizations in the framework of competitions of social projects for HIV prevention and expansion of access to substitution maintenance therapy.

“The Fast Track Cities Initiative envisages the mutual responsibility and accountability of local government and civil society under the strong leadership of the Mayor. We observed this in Kyiv, and now we are seeing this in Odesa, where the Mayor and civil society are jointly reporting to the City Council on achievements and work together to find the most effective way to achieve the 90-90 -90 goals”, says UNAIDS in Ukraine Director Roman Gaylevich.

After 25 years on the frontline of the HIV response, the International HIV/AIDS Alliance has changed name to Frontline AIDS.

Below is an official statement from the organization:

Our new era as Frontline AIDS is about breaking down the legal, political and social barriers that marginalise people and increase their risk of acquiring HIV or dying from AIDS-related illness.

Through our renewed purpose and focus, we will build new links with local, national and global health organisations and social justice movements. Because no one person or organisation can end AIDS alone.

Why Frontline? Because –

• We work with people on the frontline of the epidemic, including people living with HIV, marginalised people and communities, and those at increased risk of acquiring HIV.
• The frontline can be anywhere – from a health centre in La Paz to a needle and syringe exchange in Kyiv or a court building in Delhi to an activist march in Soweto. Wherever innovation, ideas and action are harnessed to help address the epidemic.

Why AIDS? Because –

• AIDS is not over. Last year, almost 1 million people lost their lives as a result of AIDS-related illnesses. More than half of those who died were from sub-Saharan Africa.
• We are at a critical moment in the epidemic, both epidemiologically and politically. The AIDS movement has driven astonishing progress over the past three decades but if the international community becomes complacent and slows down, or even stops, then we risk going backwards.

As Frontline AIDS we’re redoubling our efforts to tell the hidden story of AIDS, one often ignored or rejected by governments and health services. This means challenging the status quo, sharing difficult truths and working across borders and specialisms to bring the epidemic to an end.

The difficult truths are unpleasant to hear. 47% of new HIV infections are among marginalised people, including sex workers, people who use drugs, transgender people and men who have sex with men and their sexual partners; less than half of children under 15 living with HIV worldwide receive treatment; and people living with HIV are significantly more likely to be affected by chronic depression.

Some things at Frontline AIDS won’t change. We will continue to support and deliver high quality programming on HIV prevention, harm reduction, sexual and human rights. But, we plan to work differently: to be agile and flexible enough to work with new collaborators, on projects that drive the change that the world needs for a future free from AIDS, for everyone, everywhere.

So here’s our invitation to you:

Join us. End it.

Alliance for Public Health congratulates colleagues with a new brand identity!