The publication “Analysis and description of MAT models/approaches” was developed within the project “Improved quality and sustainability of medication assisted treatment in Ukraine” with support of U.S President’s Emergency Plan for AIDS Relief (PEPFAR) in collaboration with U.S. Centers for Disease Control and Prevention (CDC). It includes detailed description of six models/approaches on provision of MAT services, studying and implementing of which is significantly perspective for Ukraine in the context of ensuring the violability of the program.

As of shortage in the government budget, there is a need to find the alternative plan for implementing the most cost-effective models/approaches to MAT provision. The issue of ensuring the violability of the program is a serious challenge for the country and the only way to solve it is the rational reinterpretation of further program development, optimization of expenses and introduction of efficient approaches to service provision of national level.

The aim of this publication is going to be fulfilled through the implementation of the following objectives:

• To analyze the experience of MAT services from 35 countries (Pacific Rim, Near East, North Africa, Latin America, Europe, Caucasia) stressing out the countries with similar social and political background.
• To collect experts` opinion on the implementation of different models of MAT sustainability (it was questioned 11 national and 9 regional experts: medical personnel, government representatives, representatives of international organizations/projects, NGOs representatives that work on policy making in the area of MAT).
• To choose long-term MAT models/approaches for Ukraine in terms of program funding and service provision for supporting the sustainability, using the international experience and the results of expert questioning.
• To study and describe chosen models/approaches and develop the strategy in order to create conditions for further practical executing (it was involved experts with experience of practical implementation)

The full text of the publication and Annexes you may find by clicking the link.

July 19^th,  2017 stakeholders meeting, initiated by Alliance for Public Health (Alliance), was conducted with involvement of Ministry of health of Ukraine, Public Health Center, WHO office in Ukraine and non-governmental organizations, namely Alliance, All-Ukrainian network of PLHIV  and up to 30 NGOs from majority ukrainian regions.

Participants discussed general vision and action-oriented proposals on situation with viral hepatitis in Ukraine and steps required for hepatitis elimination in Ukraine.

As a result of discussions, participants approved the Resolution on viral hepatitis, which includes development and endorsement of National hepatitis elimination strategy and corresponding action plan.

Also development of surveillance system, immunization strengthening, development and endorsement of the donorship policy, prevention services for general and vulnerable populations, guaranteed inclusion of vulnerable groups into treatment programs, etc were included into the Resolution.

Ministry of health of Ukraine and Public Health Center attended the meeting as co-organizers.

In addition, Alliance announced new HCV treatment project for vulnerable groups with application of “test&treat” approach, which allows to shorten the time and number of test from the moment a positive HCV test results is received and before receiving treatment with the preservation of the therapeutic efficacy.

Full test of the resolution available here

Almaty signed Paris Declaration on HIV

On July 20, 2017 Akimat of Almaty signed Paris Declaration of  of commitment to Ending AIDS in the city.
Signing is carried out as part of the project of Alliance for Public Health (Ukraine) «Fast-track HIV/TB response for key populations in EECA cities» with the support of Joint United Nations Programme on HIV/AIDS in the Republic of Kazakhstan and AIDS Foundation East-West (AFEW) in Kazakhstan
The project is implemented for the funds of the Global Fund to Fight AIDS, Tuberculosis and Malaria during 2017-2019 in five countries.

Signing the Paris Declaration is an important and responsible task for all mayors of the world’s cities in order to support activities to improve the situation in their cities in identifying and treatment of HIV-infection, as well as reduce death cases related to HIV-infection and tuberculosis to 2020, and stop the AIDS epidemic by 2030.

Without any doubts, signing the Declaration will attract the attention of city residents to HIV-infection related issues, which will allow them to make testing on time and begin treatment. Almaty will become a direct participant of international healthcare activities and will have access to the most advanced achievements and developments in HIV and AIDS. The best world practices on the improvement of HIV/TB programs until 2023 will be included in Almaty City Plan, which will allow ceasing the growth of the HIV and AIDS epidemic and improving the health of the population.

The HIV epidemic in Almaty is kept in a concentrated stage. 5172 cases of HIV have been registered since the beginning of the epidemic. 448 new cases of HIV were identified based on the results of 2016. The parenteral route of transmission of HIV infection (through the blood) among new HIV infections in 2016 was 30%, the sexual way of transmission – 65%. Preventive programs are actively working in the city to fight the epidemic. Thanks to these programs, testing for HIV infection is the highest in the country.

Andriy Klepikov from Alliance for Public Health said: «Almaty again sets the tone to the response to HIV-infection in Central Asia region. This is the first city in the region to sign the declaration. This is not surprising, as the city is already taking real steps in response to the epidemic – harm reduction programs among risk groups are financed from the city budget».

The ceremony gathered representatives of Republican Center on Prevention and Control of AIDS, Almaty health department, Almaty AIDS Center, UN agencies, other international and public organizations, ambassadors, people living with HIV.

Paris Declaration was signed in 2014. Mayors pledges to include their cities in the fast-track programmes to end the AIDS epidemic through the implementations of a number of obligations.   These commitments include the achievement of AIDS targets of 90-90-90, so that 90% of people living with HIV will be aware of their HIV status; 90% of people who are aware of their positive HIV status will receive antiretroviral treatment; and 90% of people receiving treatment will have a suppressed viral load that will allow them to stay healthy and reduce the risk of HIV transmission.

On June 29th, 2017, in Balti, Moldova, the Vice Mayor of Balti Igor Sheremet and Executive Director of the Stop TB Partnership Dr. Lucica Ditiu signed the ‘Declaration of Interest: Alignment with the Zero TB Initiative’. Balti becomes the second city in the region of Eastern Europe and Central Asia joining the initiative after Odesa joined it on May 30th, 2017.

‘Signing Zero TB Declaration is of great importance for the Balti municipality taking into account extremely high TB burden, and success of the TB response depends first of all on the efforts of all stakeholders. Here the role of local authorities is paramount both in terms of implementation of the municipal TB Program and in terms of support of civil society associations. I consider that signing this Declaration provides for the extended involvement of the local administration in the TB response and opens possibilities to engage international expertise. I would like to express my gratitude to all the parties who contributed to achieving this result.’ – pointed out Vice Mayor, Igor Sheremet.
Along with other Eastern European countries Republic of Moldova faces high burden of Tuberculosis. Although TB rates are gradually declining for the past decade, the situation is still challenging. According to WHO in 2015 Moldova had more than 4 000 new TB cases. About 32% of new TB patients are multidrug resistant and 9% of them have TB/HIV co-infection. The number of TB/HIV cases is continually growing and reached 13 per 100 000 in 2015.
TB burden in Balti is much higher comparing to the general country situation. In 2015 TB notification rate in Balti and in Moldova was 103,7 and 88,7 per 100 000 population accordingly. In 2015 Balti had 152 new TB cases. Every 3 days 1 person develops new TB disease and every fourth TB patient has HIV in Balti. TB mortality rates in Balti are about 45% higher than countrywide for past several years. TB/HIV incidence is also higher in Balti than in Moldova in general (25,3 vs. 13 per 100 000 in 2015) as well as TB/HIV mortality (11,3 vs.4,5 per 100 000 in 2015).
The Declaration was initiated within the Fast Track TB/HIV responses for key populations in EECA cities project operating in 5 cities of EECA region. Operational research that will start in mid-2017 as a part of the project will focus on strengthening linkages between TB and HIV programs to reduce HIV/TB mortality in the city of Balti.
‘I am pleased to see the increasing role of cities in EECA region in response to TB epidemic. I am very happy that Balti is joining the initiative today,’ stated Dr. Lucica Ditiu, Executive Director, Stop TB Partnership.
Sergey Filippovych, Director: Treatment, Procurement & Supply Management, Alliance for Public Health said: ‘Patient-centered approaches stipulate not only integrated medical care but also necessary social and psychological support. Such comprehensive support significantly increases the treatment success rates. Our experience shows that using these approaches increase treatment success rate in patients with multidrug-resistant tuberculosis to 86%. It is two times more than the average rate in EECA.’

Background information
The Zero TB Cities project, a collaborative initiative geared towards significant, accelerated reductions in tuberculosis mortality and prevalence in high-burden metropolitan areas. To date, Odesa, Ukraine; Chennai, India; Durban, South Africa; Karachi, Pakistan; Kisumu, Kenya; and Lima (Caraballyo), Peru have moved swiftly to design comprehensive programs, create new partnership models, and begin resource mobilization for this effort.

Fast-track HIV/TB responses among key populations in cities of Eastern Europe and Central Asia is the Global Fund funded EECA regional project of Alliance for Public Health (Ukraine), AFEW International (The Netherlands), licit (Switzerland) and Stop TB Partnership under technical guidance of UNAIDS EECA office which is there to support city responses to HIV and TB in key populations in the five cities of EECA, including Balti. The project will be implemented throughout 2017-2019 and plans to develop efficient and sustainable city models of HIV/TB responses that would allow to reduce AIDS and TB mortalities in the project cities as well as increase the allocation of city funding to HIV/TB interventions for key populations.
The Stop TB Partnership is leading the way to a world without tuberculosis (TB), a disease that is curable but still kills three people every minute. Founded in 2001, the Partnership’s mission is to serve every person who is vulnerable to TB and ensure that high-quality diagnosis, treatment and care is available to all who need it. Together our 1500 partners are a collective force that is transforming the fight against TB in more than 100 countries. They include international and technical organizations, government programs, research and funding agencies, foundations, NGOs, civil society and community groups and the private sector.
Alliance for Public Health is a leading non-governmental professional organization established in 2000 making a significant impact on the epidemics of HIV/AIDS, tuberculosis, viral hepatitis and other socially dangerous diseases in Ukraine and providing support on responses globally.
TB in Eastern Europe and Central Asia Project on Strengthening Health Systems for Effective TB and DR-TB Control funded by the Global Fund is there to decrease the burden of tuberculosis disease and halt the spread of drug resistance in target EECA countries through increasing political commitment and translating evidence into implementation of patient-centered TB models of care. The Principal Recipient of the Global Fund grant is PAS Center (Moldova). Alliance for Public Health is an implementing partner of the project on behalf of TB Europe Coalition, responsible for the civil society advocacy in support of the people-centered TB care in the region of Eastern Europe and Central Asia.

On 26 June the central square of Kyiv hosted an illusion performance “The Rake of Ukrainian Drug Policy”, where drug users, civil society activists and human rights advocates presented real pictures and imaginary characters associated with the “war on drugs” and tortures of people who use drugs in Ukraine.

The most popular among the numerous “characters” of this illusionary performance were:

• Skeleton wearing a militia officer’s uniform who died after constantly stepping on the same “rake”;
• Policeman who is walking on the pavement wearing wooden skis;
• Drug user wearing a gas helmet, with his feet locked in a tub with concrete;
• Doctors and nurses who treat people of drug dependence with electric current and hypnosis;
• Officers of “special services” who plant drugs on people.

Participants of the performance called to give up the senseless “war on drugs”, which in many countries, including Ukraine, is reduced to criminal prosecution of people with chronic drug dependence.

“Stepping on rakes is a national tradition in Ukraine! The repressive drug policy is a failure, and the law enforcement agencies, including the new police, keep on “skiing on the pavement” wearing old Soviet wooden skis or just smashing sick people with a repressive “road roller”. In Ukraine, every tenth prisoner is incarcerated for “drug crimes”, and in 2016 over 5 thousand people were convicted for possessing drug in amounts, which in most European countries are not even considered as a criminal offence. At the same time, nobody interferes in the organized drug business. Due to inadequately low “thresholds” of criminal prosecution for illegal possession of drugs (“tables of drugs amounts” approved by the Ministry of Health of Ukraine), the level of criminalization of drug dependent people in Ukraine is 200-600 times higher than in Germany, Czech Republic, Spain or Portugal”, – said Pavlo Skala, representative of Alliance for Public Health, expert in drug policy and national coordinator of the Support. Don’t Punish campaign in Ukraine.

“We have got visa-free travel but we have still got no humane drug policy! As a result of longstanding war on us – people who use drugs – hundreds of millions hryvnias collected from tax payers continue to be wasted on conservation of the repressive model, with prisons turning into incubators of infectious diseases, where convicts die mostly of AIDS and tuberculosis, and the country continues fighting epidemics of social diseases, for the response to which the state has not got enough money. Today dozens of drug dependent people take part in this performance with open faces or wearing masks. In total, there are almost 350 thousand such people in Ukraine, and over 12 million in the world”, – told Anton Basenko, co-coordinator of the national campaign and leader of the Ukrainian Union of People Who Use Drugs (UkrPUD), with a second category of disability and over 20 years of drug use history, who was one of the first patients of opoid substitution treatment in Ukraine.

Support. Don’t Punish With the rhythmic sounds of improvised rap music on the background, the main square of Ukraine was hosting performance of costumed characters and activists calling to hold a course for liberalization of the drug policy approved within the government strategy back in 2013, decriminalize (cancelling criminal responsibility for) possession of drugs for personal use, use the money of tax payers effectively, fundamentally revise the thresholds of drugs allowed for possession and bring them in line with the European level.

***

The global campaign calling for changes in the repressive drug policy Support. Don’t Punish was initiated in 2013. Back then Ukraine joined this global initiative taking place in 41 cities of the world. This year campaign is a follow-up of the 2015 performance “Special Operation to Fight the Drug Business”. In 2017, events within the campaign were held in 190 cities in 80 countries of the world, including Kyiv and Kropyvnytskyi.

The International Day against Drug Abuse and Illicit Trafficking  is marked since 1987 at the decision of the UN General Assembly.

The International Day in Support of Victims of Torture was established in 1997 by the UN General Assembly following recommendation of the UN Economic and Social Council to speak out against torture and to support the United Nations Convention against Torture and Other Cruel, Inhuman and Degrading Treatment or Punishment, which came into effect on 26 June 1987.

Organizers of the national Support. Don’t Punish campaign: Ukrainian Union of People Who Use Drugs (UkrPUD)  and Alliance for Public Health.  Partners: Eurasian Network of People Who Use Drugs (ENPUD) and Kyiv civil society organizations: (Club Eney NGO, All-Ukrainian Charitable Organization “Convictus Ukraine”, Vertical NGO, All-Ukrainian League “LegaLife) and other non-governmental organizations from many regions of Ukraine.

On 13-16 June, EQUIP project team is on a working visit to Ukraine. This project is aimed at scaling up access to innovative diagnostics and treatment of hepatitis C for key populations.

Leadership and expertise of Alliance for Public Health in the treatment of hepatitis C in key populations in Ukraine may serve as an illustrative example of how implementation of programs by non-government organizations may be a progressive mechanism to ensure access to treatment.

On 14 June, Alliance representatives and international experts of the EQUIP project made a first joint site visit to the Institute of Epidemiology and Infectious Diseases named after L.V. Gromashevsky. Considering that the EQUIP project stipulates scaling up access of key populations to hepatitis C treatment with direct-acting antivirals, the experts were interested in getting acquainted with the experience of treatment with a combination of sofosbuvir/ledipasvir, which was provided to the institution within the project “Scaling up Accessible and Effective HCV Treatment Through a Community-Based Treatment Model for Most Vulnerable Populations in Resource-Constrained Ukraine” implemented by Alliance. Sergiy Filippovych, Director: Treatment, Procurement and Supply Management (Alliance) also told about the integration of hepatitis diagnostics and treatment services into the prevention programs implemented by Alliance and ensuring sustainability of HIV and hepatitis prevention interventions for key populations.

It is planned that in the nearest future Alliance together with the Ministry of Health (MoH), Public Health Center of the MoH and All-Ukrainian Network of PLWH will take part in implementation of the EQUIP project supported by the United States Agency for International Development (USAID).

The goal of the EQUIP project in Ukraine is implementing demonstration projects to:

– Scale-up rapid HCV/HIV testing among key populations in PWID

– Simplify pre-treatment diagnostics and treatment monitoring of HCV

– Provide concurrent HIV testing of all individuals testing for HCV

– Ensure immediate link of HIV positive patients to treatment

– Determine the cost-effectiveness and investment case of applying best clinical practice in HCV/HIV treatment

On 6-7 June 2017, within the working visit of representatives of the French international technical expertise agency, Expertise France – project manager Mari Martin and health expert Lisa Huang – to Ukraine, meetings were organized with representatives of the Alliance for Public Health and pilot projects from five cities of Ukraine implementing the project “Capacity Development for Quality Assured Gender Sensitive Harm Reduction Interventions in Ukraine”.

On 6 June, guests took part in the working meeting of Alliance implementing partners – Convictus (Kyiv), Victoria (Khmelnytskyi), The Way Home (Odesa), Public Health (Kryvyi Rih) and Return to Life (Kropyvnytskyi). At the meeting, the participants discussed the interventions implemented within the project, their linkage with the Global Fund project, OST program, their impact on the lives of clients as well as prospects of institutionalization and long-term implementation of project interventions.

Next day, the guests visited Convictus NGO and learned about the practical aspects of implementing the gender project, talked to staff members and clients of the project.

Besides, the French guests invited their Ukrainian colleagues to present the results of project activities at the symposium within the IAS Conference (IAS2017) to be held in 23-26 July 2017 in Paris.

You can learn more about project here.

On 8 June 2017, Alliance for Public Health (Alliance) hosted a meeting with representatives of the WHO assessment mission on viral hepatitis, attended by representatives of Alliance, the Ministry of Health of Ukraine, the Public Health Center of the Ministry of Health, and the US Centers for Disease Control and Prevention (CDC). The assessment mission is carried out on 6-9 June 2017 at the invitation of the Ministry of Health of Ukraine.

At the meeting in Alliance office, WHO experts were presented with the developments in testing members of key populations for Hepatitis B and C, results of Hepatitis B vaccination and outcomes of awareness-raising campaigns.

Sergey Filippovych, Director: Treatment, Procurement and Supply Management, presented the unique experience of Alliance in ensuring control over the spread of Hepatitis B and C in key populations, told about the achievements in reducing the prices for direct-acting antivirals and results of the Alliance project aimed at Hepatitis C treatment in key populations using Sovaldi and Harvoni.

The Executive Director of Alliance, Andriy Klepikov, marked out fruitful cooperation with the Public Health Center of the Ministry of Health of Ukraine and interest of Alliance in implementing modern health care technologies to control the spread of viral hepatitis in Ukraine.

Besides, at the meeting Alliance announced its support of the National Viral Hepatitis Hotline.

The WHO mission members highly appraised sustainability of Alliance initiatives and efforts, consistency of the approaches and interventions in response to hepatitis as well as the uniqueness of the treatment project. They recognized high quality of analysis of the data presented based on the results of Hepatitis C treatment with direct-acting antivirals in key populations.

Martin Donoghoe, representative of the WHO Regional Office for Europe, pointed out that during the work of the mission in Ukraine Alliance was the organization which voiced the vision of overcoming the problem of hepatitis in the country which is in line with 2016-2021 WHO Global Health Sector Strategy on Viral Hepatitis – elimination of viral hepatitis as a major public health threat.

Meeting participants discussed the issue of the national response to Hepatitis in Ukraine and priority of resolving the issues based on public health approaches to building the patient-centered health care system.

On May 31^st, 2017 Ministry of Health of Ukraine hosted the meeting with the international guests – Baroness Alison Suttie, Member of House of the Lords of UK Parliament, Lucica Ditiu, Executive Director of the STOP TB partnership, Colleen Daniels, Human rights, gender and TB/HIV advisor.  Ukrainian stakeholders were represented by the Deputy Minister of Health, Oxana Syvak, Head of the National Center for Public Health, Nataliya Nizova and Andrey Klepikov, Executive Director of the Alliance of Public Health with the Alliance’s TB team on board.  The WHO has been presented by Head of Country office to Ukraine Dr. Marthe Everard.

The issues of success and challenges of Ukraine in TB Control and care have been discussed, as well as the ways on how to enhance the partnerships between all the stakeholders on the country level.

Baroness Alison Suttie said: “I see my role as trying to provide a bridge between Parliament, Government and civil society. We should all try to work with each other, rather than against each other to make this triangle work – with the legislature making the laws, civil society bringing in expertise and Government making the changes happen.”

Lucica Ditiu underlined, that on a way to transition for people-centered care, everyone should try to feel himself/herself in the patient’s shoes – to imagine how hard it is to take a medicine for such a long treatment and how brave one should be to move on.

The role of the Ministry of Finance on the ongoing medical care reform and promotion of the public health approaches has also been discussed – there should be effective reallocation of money in the TB care – with savings used effectively, for example on provision of the social support measure for the patient.

One of the existing platforms for ongoing communication between all Ukrainian stakeholders is the current #TB_REP National working group.  Under the leadership of the National TB-REP Coordinator, effective working group with patients and diverse stakeholders on board will have a potential to provide a consolidated response for positive changes towards people-centered TB care.

On June 1, 2017, Dr Lucica Ditiu, the Executive Director of the Stop TB Partnership with support of Alliance of Public Health held series of meetings with stakeholders and the community representatives on current challenges for TB response in Ukraine, successes and obstacles in achieving the objectives of the strategy END TB, collaboration with government agencies and civil society organizations in the sphere TB. As the visit took place in the International Children’s Day, the traditional appeal of the Partnership is dedicated to Ukraine. Public Health Alliance contributed to this appeal.

1st June, 2017, Ukraine – Today we celebrate International Children’s Day and it’s time to think of the one million children who are suffering with or are affected by TB and TB/HIV. Many children who live with parents, guardians and others who have confirmed TB do not receive preventive therapy. Many more thousands are sick with TB and do not have access to proper diagnosis or treatment, and 200,000 children’s lives are taken annually by TB – an unacceptable tragedy for a curable disease.

Today we celebrate International Children’s Day and it’s time to think of the thousands and thousands of children who are suffering with or are affected by TB and TB/HIV. Many children who live with parents, guardians and others who have confirmed TB do not receive preventive therapy. Many more thousands are sick with TB and do not have access to proper diagnosis or treatment.

In many countries, children whose parents or guardians have TB are removed from their care and placed in orphanages or foster care. Their parents are often hospitalized for months and children pay the price of isolation policies that are not people-centered and do not consider the hardship on the families.

During a high-level mission in Kyiv in collaboration with Alliance for Public Health for the “Regional Cities Project,” the Stop TB Partnership discussed with Partners including the Ministry of Health, the National TB Program Manager, and the WHO Country Office, the achievements and challenges faced by country programmes in offering appropriate packages of care to all those affected by TB. The discussion evolved around the need for a paradigm shift in the TB work, ensuring that people affected by TB and especially children are at the core of all our interventions.

Ukraine National TB Program reports 100% coverage with preventive therapy of all child contacts of people who have confirmed TB. In spite of preventive therapy being a cost effective, proven intervention, globally, only 77 countries in 2015, reported coverage with preventive therapy in children contacts of bacteriologically positive people with TB – translated into 87,200 child household contacts out of 1.2 million (estimated to be eligible) receiving preventive TB therapy. Ukraine is among the few countries globally reporting 100% coverage.

Oksana Syvak, Deputy Ministry of Health of Ukraine on European Integration

“By introducing patient-oriented approaches in providing services to people affected by tuberculosis today we can significantly improve the quality of medical care. Also, it enables us to come closer in achieving ambitious goals of the global strategy towards ending TB epidemic in Ukraine.

However, today in Ukraine it is critical to implement approaches of public health. First of all, we have to protect people, especially children, from the possibility of getting sick from the vaccinated-driven infections, which includes tuberculosis. In addition, the Ministry of Health of Ukraine is currently engaged in complying to the approaches of detection and case management of TB in children with WHO recommendations, which will significantly improve the quality of medical care. ”

Nataliya Nizova, Director General of the Public Health Center of the Ministry of Health of Ukraine

“As of today, the treatment of TB in Ukraine is free and generally available. But we should not forget about effective means of prevention which can save thousands of lives.  I refer here to preventive therapy and BCG vaccination at birth in endemic countries. In Ukraine, TB morbidity in 2016, new cases and relapses, of children (0-14 years) is 8.8 per 100, 000 population (571 cases).

Only through the joint efforts of both on national and international levels, providing professional patient-oriented medical and social care and implementing effective preventive and information interventions we are able to overcome TB epidemic.”

Andriy Klepikov, Executive Director of Alliance for Public Health.

“Civil society should guard the interests of children and demand that governments and donors make investments in research to develop effective vaccines, diagnostic and treatment tools and child-friendly care. After all, it is the question of child’s rights protection.”

Lucica Ditiu, Executive Director of the Stop TB Partnership

“I hope the world will pay attention to the great steps forward that Ukraine is making towards ending TB: increased domestic financing for TB and HIV, bold public health reform, increasing partnership with civil society and declaring Odesa and Kyiv as fast track Zero HIV and TB cities, and a specific focus on all those vulnerable, including children with TB. I am glad we can support our colleagues and friends here as only by working together under the leadership of the Ukrainian government, can we hope to end TB in Ukraine before 2030.”