Alliance for Public Health with support of the Global Fund to Fight AIDS, Tuberculosis and Malaria launches a new pilot project “Result-Based Financing (RBF) for DOT Provision to TB Patients at the Ambulatory Phase”. The main aim of this project is to pilot new ambulatory treatment financing models to focus healthcare professionals on the results: bringing down the number of drop-outs and improving treatment success rates. Such approach will surely contribute to a higher transparency in funds utilization and will allow identifying challenges in directly-observed treatment (DOT) of tuberculosis. Involving primary health care institutions is equally important as it will be a good incentive for medical personnel of such institutions.

On 22–23 December 2016, presentation of this project was held in Odesa attended by chief physicians of primary health care centers, district TB treatment doctors and leading specialists of the Odesa regional TB treatment center. The participants discussed the prerequisites of transition to ambulatory TB treatment models, challenges existing in the region and the ways to overcome them.

The project will be implemented in 2017 in 14 districts of Odesa oblast. Districts to implement the pilot project were selected based on the high TB prevalence, the need to considerably improve the existing treatment success rates for patients with sensitive TB and multidrug-resistant TB (hereinafter – MDR-TB) and, at the same time, high commitment of the regional administration to fighting the TB epidemic, implementation of new projects, cooperation with international and non-governmental organizations and readiness of primary health care institutions to take upon the functions of directly-observed treatment of TB patients at the ambulatory phase.

The results of this pilot project may form a solid basis for the general strategy of ensuring sustainability of TB programs, contributing to the achievement of the goals set forth in the Global Plan to End TB.

Within this project, health care institutions will provide directly-observed ambulatory TB treatment within any format of care (DOT offices at TB treatment centers or primary health care institutions, home care, day care, etc.), keeping relevant records.

For the goals of this project, 380 patients with both sensitive and drug-resistant TB will be enrolled in treatment. This pilot project stipulates a new way of financing ambulatory DOT. Implementing partners will receive financing for each ambulatory patient, which will contribute to increasing treatment success rates (treatment completion with such results as “cured” or “treatment completed”) and working with patients to form adherence to treatment (the higher the adherence of a patient, the less funds are to be spent to retain such patient in treatment). If target indicators are met, incentive bonuses will be paid, which health care institutions will be free to spend at their own discretion within certain limits, which will boost their interest in this project.

On 27 December 2016, Alliance for Public Health (Alliance) delivered materials for the prevention of HIV, viral hepatitis and sexually transmitted diseases to the occupied areas of Donetsk and Luhansk oblasts. This delivery will cover the needs of community-based organizations, which continue implementing prevention programs in the occupied areas, for the first six months of 2017. The materials delivered included:

• 20,362 rapid tests for HIV, hepatitis and sexually transmitted infections;
• 1,240,000 condoms and lubricants;
• 5,300,240 sterile syringes and wipes.

In the areas not controlled by the Government of Ukraine, HIV prevention services continue to be provided to at least 20,000 members of key populations. However, program monitoring data show that the level of HIV infections in Donetsk and Luhansk oblasts in almost twice higher than the average rate in Ukraine. During 9 months 2016, within the Alliance-supported prevention programs 31,213 HIV tests were provided in the region, with 1.3% positive results in Donetsk oblast and 1.02% – in Luhansk oblast.

The same way as last year, Alliance ensured the delivery of drugs for multidrug-resistant tuberculosis, which will cover 4 months of treatment for 500 patients (34,440 packs). This is the first in a cycle of the planned deliveries. We expect at least one more delivery to be made to TB treatment facilities located in Donetsk and Luhansk in the nearest future.

Provision of the humanitarian aid was agreed with the Global Fund and the HIV/TB/OST Sub-Cluster.

Despite some initial barriers like challenging visa process and long distance 16 representatives from Kenya Red Cross Society and their partner organisations visited Alliance for Public Health (Alliance) to study experience of addressing HIV and Hepatitis C epidemic among key populations. On 12 December, 2016 our guests from sunny Kenya reached cold and snowy Kyiv and were welcomed by staff of Alliance.

During the visit to Alliance office participants of the site visit learnt about key interventions, implemented by Alliance for Public Health and its partners and recent programme innovations, policy and advocacy work. During 5 days of the visit they had a chance to visit healthcare settings providing integrated services to people who use drugs (PWUD), drop-in centres, secondary exchange site, learnt about the work of mobile ambulance observing services provided to sex workers, visited community centre for men who have sex with men.

Alliance for Public Health has long-term collaboration with Kenya colleagues bringing harm reduction to Kenya and building capacity of local experts. As a result, needle and syringe exchange was launched and extended in the country under Community Action on Harm Reduction project www.cahrproject.org supported by the Dutch government and run by International HIV/AIDS Alliance together with their partner Kenya AIDS NGOs Consortium.

As a result of the visit representatives from Kenya delegation already started discussing the possibility of piloting new innovative approaches they saw in Ukraine in their home country. Some interventions like pharmacy-based intervention, peer driven intervention, using SyrEx cloud in HIV prevention programmes can be adapted taking into consideration Kenya context and piloted in the country.

Cosmus Maina from Teens Watch reflected on his experience: “I visited the needle and syringe exchange programme, opioid substitution therapy and sex workers programme. I have learnt very outstanding points. For example, the programme used very sustainable number of working staff and social workers, the sites were very friendly at the methadone clinic, the nursing were very welcoming to patienrs. All patients, all social workers are very friendly and outgoing. When I go back I will try to motivate my staff more and share what I have learnt during this site visit.”

Best practices of Alliance activities in the various aspects of TB programs are presented in the publication of the World Health Organization (WHO) Regional Office for Europe “Good practices in strengthening health systems for the prevention and care of tuberculosis and drug-resistant tuberculosis”.

Alliance represents Ukraine with its unique experience in supporting patients with multidrug-resistant tuberculosis (MDR-TB) at the outpatient stage of treatment. Within Alliance cooperation with the Ukrainian Red Cross Society with support of the Ukrainian Center for Disease Control of the Ministry of Health of Ukraine, great progress was made in significantly reducing the rate of treatment interruption among the patients with MDR-TB. To promote treatment adherence among MDR-TB patients treated with second-line drugs in outpatient settings, daily follow-up care was delivered by nurses of the Ukrainian Red Cross Society. The package of services included the arrangement of high-quality DOT services brought close to patients aimed at preserving the customary way of life for patients to the maximum extent possible. Such services included delivery of medications and control over their administration at home or in another place convenient for patients and distribution of food packages among all patients who adhere to treatment twice a month. Besides, all patients received medical and psychosocial support during the whole period of treatment, which increased treatment success rate up to 85.6% as compared to 37% among those patients who did not receive such support.

Another best practice of Alliance included into the Health Service Delivery section is dedicated to early detection of TB among vulnerable groups. Taking into account that TB incidence in vulnerable populations is 10 times higher than the estimated incidence among general population, in 2013-2014 Alliance launched services of early TB detection in vulnerable populations. In cooperation with regional NGOs, questionnaires to screen for TB symptoms were introduced among clients at the high risk of this disease, and also a referral system was developed to guide patients in the healthcare system. One of the significant factors defining the success of early TB detection thorough screening among vulnerable populations is relatively low cost of this intervention.

WHO Regional Office for Europe also marked Alliance practice of TB treatment concomitantly with opioid substitution therapy (OST). Considering that over 40% of patients who receive OST are HIV-positive and almost one third of them also have TB, Alliance opened OST sites in TB treatment clinics. It allowed improving the access of people who inject drugs to health care, treatment of drug dependence, HIV and TB. People who inject drugs require a special approach to the treatment of TB, especially MDR-TB, but not all TB treatment facilities were ready to open their doors to such patients. An advantage of this approach is that it ensures effective cooperation between the TB and drug treatment services, which, in its turn, allows using an integrated approach to providing services to patients.

Read more about those and other good practices in prevention and care of tuberculosis.

On November 28 – December 2, 2016 the study tour was held to learn the experience of Lithuania in ensuring of financially stable medication assisted treatment (hereinafter – MAT), methods and models of organization and realization of MAT program aiming to advocate its further development in Ukraine as well as implementation of new approaches and MAT models that will improve the sustainability and quality of MAT program in general.

The study tour was conducted within the ‘Improved Quality and Sustainability of Medication Assisted Treatment in Ukraine’ Project that is implemented by the ICF ‘Alliance for Public Health’ with the financial support of the Centers for Disease Control and Prevention (CDC) under the United States President’s Emergency Plan for AIDS Relief (PEPFAR).

Representatives of leading governmental institutions of Ukraine, involved in the implementation of MAT, in particular Ministry of Health of Ukraine, the SI ‘Center for Public Health’, the National Police of Ukraine, the State Service of Ukraine for Drugs Control, and employees of the ICF ‘Alliance for Public Health’ participated.

During the study tour representatives of Ukraine learned about the organization of the national healthcare system with a focus on the experience of Lithuania on the development of public health, the forming of the national strategy on treatment of drug addiction, prevention and treatment of HIV/AIDS, studied the organization, regulation and monitoring of MAT as well as provision of psychosocial support to MAT patients. Delegates visited the Ministry of Health of the Republic of Lithuania; the Center of infection disease and AIDS; the Drug, Tobacco and Alcohol Control Department; Corrections Department at the Ministry of Justice; the Police Department; the Vilnius Center for Addiction Diseases; the State Center for Mental Health; the Centro polyclinic; the Society of social and psychological rehabilitation. Gained knowledge on MAT program implementation, as Lithuanian best practices in the context of ensuring its sustainability and quality improvement, will be used in Ukraine. Well-established partnerships will ensure cooperation and exchange of experience on MAT program development in future.

On 1 December 2016, at 12.00, Kyiv Shevchenko Park hosted a campaign dedicated to the World AIDS Day, MUSIC FEST – TAKE A TEST, organized by the Alliance for Public Health together with its partner civil society organizations.
During the campaign, the longest 20-meter ‘red ribbon’ was spread out in front of the red building of Taras Shevchenko National University of Kyiv within the flash mob #PutRedRibbonOn #ПовяжиЧервонуСтрічку – for the first time in Ukraine!
The campaign was simultaneously held in Kyiv, Kharkiv, Odesa and Poltava and was targeted, first of all, at students. Participants of the groovy Music Fest had an opportunity to get free condoms and awareness-raising materials on HIV prevention as well as participate in the flash mob and take ‘red ribbon’ selfies.

This year, as opposed to the campaigns traditionally held on the World AIDS Day, the participants could not just get tested for HIV free of charge, but were able to get single-use rapid tests accompanied with pre-test counseling and information leaflets for self-testing at home. Taking a rapid test is as simple as putting a condom on – it can be done without other people’s assistance, quickly and safely. 

Today, rapid tests for HIV are already available to the wide public through pharmacy network, and their use is recommended in the recently published WHO guidelines. Every person can buy such a test and do self-testing following the instruction, which is also available at the website of Alliance for Public Health. Besides, you can read a special brochure on self-testing and watch an educational video.

“Artificial barriers in access to diagnostics led to a situation when only every second Ukrainian knew about his or her HIV status. – underlined Andriy Klepikov, the executive director of Alliance for Public Health. – Even if we wanted to, we could not do self-tests for HIV. Today – on 1 December 2016 – in line with the newest guidance of the World Health Organization, we initiate the first in Ukraine self-testing program. People in Kyiv were the first to take advantage of such an opportunity”.

If you have any questions about self-testing or its results or in case you would like to get more detailed information on HIV prevention, diagnostics and care, please call our doctors at +38 (050) 425 00 46 or +38 (050) 425 00 36. Healthcare professionals will be available to provide their consultations on a daily basis from 1 to 30 December 2016 (9.00 – 21.00).
Our campaign supports the key messages of the global UNAIDS campaign on the World AIDS Day, HANDS UP FOR #HIVPREVENTION.

Alliance for Public Health is a leading Ukrainian non-governmental organization, co-implementer of the National HIV/AIDS Program and recipient of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Though the main activities of Alliance are aimed at HIV prevention among the most vulnerable populations, significant efforts are made to also work with the general public, especially young people, as according to the official statistics the parenteral route of HIV transmission, which was typical for Ukraine in the first decade of the epidemic development, is no longer prevailing – according to the latest data, over 70%  of people are infected with HIV through sexual contacts. Only in the first 9 months of 2016, 189 thousand people in all regions of Ukraine were tested for HIV within Alliance programs, with 2.9 thousand positive test results (1.5%)!

On 1 December 2015, we held a rapid testing campaign at the railway stations of Kyiv, Dnipropetrovsk, Vinnytsia, Kharkiv and Kryvyi Rih, with 544 persons tested and over 3% of positive results.

National HIV/AIDS Hotline: 0-800-500-451

Links

Inter TV Channel

http://podrobnosti.ua/2147439-den-borotb-z-sndom-v-ukran-zapustili-proekt-samotestuvannja.html

NTN TV Channel

http://ntn.ua/uk/video/news/2016/12/01/22840

Espresso TV

https://www.youtube.com/watch?v=wF83vpRRwrY

STB TV Channel

https://www.youtube.com/watch?v=lgYC19SR2oc

UBR

https://www.youtube.com/watch?v=nDZAlsYTZis

Street testing campaign in Poltava

https://tribuna.pl.ua/news/znati-svij-vil-status-maye-kozhna-lyudina-u-poltavi-vidbulosya-bezkoshtovne-testuvannya/

Street testing campaign in Kharkiv

Video: http://www.visti.tv/new.aspx?newsid=43940

Street testing campaign in Sumy

https://www.youtube.com/watch?v=jnuunJ-ZmCU

Street testing campaign in Ternopil

https://www.youtube.com/watch?v=0pvaV7oLxog

Ukraine is still suffering from the HIV/AIDS epidemic, though lately we have seen a trend towards its stabilization, with forecasted reduction in the number of new HIV cases. The recent trend is a decreasing share of the parenteral HIV transmission (mostly though sharing injection equipment) which used to be prevailing – according to the official statistics, in 10 months 2016 it was only 21% – and a growing share of the heterosexual route of transmission. As of October 2016, 132,714 people living with HIV were officially registered with healthcare institutions in Ukraine, though it is estimated that their real number exceeds 217,500 people (almost 0.5% of the total population). The increased share of HIV transmission through unprotected sex defines new challenges in the activities of those organizations, which work in HIV prevention. Based on the modelling data, almost 80% of sexual transmission cases are related to sexual contacts with the members of vulnerable populations, which is why there is an urgent need to elaborate new, innovative approaches to prevention – and that’s what we focus on.

Alliance shares the priorities of UNAIDS, which on the eve of the World AIDS Day underlined the key role of prevention, – in his statement, the Executive Director of UNAIDS, Michel Sidibé, pointed out that “prevention should be central to our effort in the future”. UNAIDS campaign Hands Up for HIV Prevention is based, in particular, on the great work done by our country.

We continue working with the populations vulnerable to HIV – in 2016 in cooperation with partner NGO about 300 thousand clients were covered with our programs (69% of the estimated number of people who inject drugs, 43% of sex workers and 27% of men who have sex with men, representatives of other vulnerable groups including adolescents with risky behavior). We distributed almost 11 million condoms, 21 million needles and syringes and offered over 1 million consultations with social workers.

Over the recent 10 years, prevention projects allowed providing 1.3 million rapid HIV tests, with 55,630 positive results detected. The biggest number of positive results was found in Dnipropetrovsk, Donetsk, Odesa regions and Kyiv. As of today, the rate of HIV case finding among new clients who have not received prevention services before, is 16 times (!) higher than among the regular clients of prevention projects, which demonstrates effectiveness of the years-long operation of Alliance-supported projects.

In 2016, Alliance continued implementing the approach of assisted self-testing for HIV, which allowed extending the range and increasing the number of clients covered. As compared to 2014, the number of tests performed grew by 250%, which has already allowed detecting over 3.2 thousand clients with positive results and referring them to healthcare institutions.

Alliance continued its efforts to scale up access to opioid substitution treatment (OST): in October 2016, a new benchmark of 9 thousand patients was achieved. This is the biggest OST program in the countries of Eastern Europe and Central Asia, within which 9,073 drug-dependent people received OST (as of 1 November 2016), with each fifth patient receiving OST drugs based on an alternative model, with such drugs handed out for several days for self-administration by clients (based on prescriptions, from healthcare institutions, “home care”). This component was implemented in cooperation with Center of Public Health of Ministry of Health of Ukraine. Such alternative models contribute to sustainability of the OST program, its scale up and create more comfortable conditions for the program clients. Alliance developed effective models to deliver OST, which in 2017 will be provided to most patients within budget financing.

Comprehensive approach to HIV prevention and care stipulates detection and treatment of concurrent infections, including tuberculosis (TB) and viral hepatitis. In 2016, Alliance greatly intensified its efforts in those areas: over 138 thousand members of vulnerable populations were screened for TB; about 14 thousand people were referred to clinical and laboratory TB diagnostics. Out of 435 clients of prevention projects, who were diagnosed with TB, 92% started treatment. 2016 was marked with acceleration of the first in Ukraine hepatitis C treatment program with direct-acting antivirals (sofosbuvir), allowing more than 1,200 patients – members of vulnerable populations – to get access to HCV treatment with innovative regimens. Based on the diagnostic tests performed 12 weeks after the completion of treatment, hepatitis C virus was undetectable in 94% of patients – which is the best outcome in all the history of viral hepatitis treatment in Ukraine!

We are proud that during all the years of our activities we consistently support and involve communities into program development and bidding processes (to procure OST drugs and consumables for harm reduction projects) as well as into research activities, program monitoring and evaluation, in particular – on the temporarily uncontrolled areas. Thus, members of vulnerable communities are not only beneficiaries of our innovative and efficient services, but also equal partners and meaningful participants of their development and implementation.

Prevention and treatment are equally important to stop the HIV epidemic in Ukraine and ensure fast tracking to 90-90-90 targets. However, it should be noted that major part of government funding is aimed at the procurement of medical drugs. Thus, curbing the growth of the new HIV cases is possible mainly thanks to the international donors and civil society organizations. Innovativeness and effectiveness of such programs are recognized at the international level. Ukraine is currently among the world leaders – those several countries, which were able to overcome the artificial barriers in HIV testing, initiating self-testing programs based on recently published WHO guidelines. Now HIV testing will be more accessible for millions of Ukrainians.

We welcome the steps done by the Government of Ukraine to increase financing of the response to AIDS, TB and hepatitis, in particular to significantly scale up treatment. Nevertheless, financing of prevention programs from state and local budgets is still disproportionately low, so those programs still depend on support of the international donors.

We hope that in 2017, prevention will be a priority of the national healthcare policy, and the state will start to make targeted investments to reduce the number of new HIV infections.

Together we will be even more effective!

The First Regional Winter School «Women, Girls, Transgender (WG/TG) Empowerment and Advocacy on Gender and HIV/AIDS» was held on 17 – 19 November, 2016 in Tbilisi, Georgia. This event was conducted in the framework of Robert Carr civil society Networks Fund funded Project “Eastern European Regional Platform for Accelerated Action for Women, Girls and Transgender in in HIV/AIDS Context”. The winter school was conducted for 23 participants from 7 project implementing partners from Azerbaijan, Armenia, Belarus, Georgia, Moldova and Russian Federation. The goal of the school is to strengthen the capacity of HIV-service NGOs to provide gender-sensitive services to representatives of PWID, CSW, MSM and transgender.

According to Karen  Badalyan, Project Director, “It was great to have had this Regional Winter School for the first time ever. This School managed to bridge personal experience, clinical perspectives and community responses, offering views from various perspectives, mixing scientific background with the community experts, practices with examples, theories with participatory approach. The variety of organization represented and open and frank discussions of not only the speakers but the audience members, gave us the optimism about work in gender area in the future in EECA. Discussions on political implications and homophobia, differencing gender-oriented services from gender sensitive ones, gender mainstreaming, gender equity, gender budgeting, gender based M&E, etc. were in our focuses in order to provide holistic Information and ideas about community responses on gender in HIV/AIDS context. I hope that we will have a continuum for this, since it is an absolute best practice for EECA region”.

 The number of new infections in Eastern Europe  among WG has grown over the last few years, indicating a shift in the nature and trajectory of the epidemic. Every hour 50 young women are newly infected with HIV in the world (UNAIDS Gap Report 2014). For women in their reproductive years (ages 15–49), HIV/AIDS is the leading cause of death and in 2013, almost 60% of all new HIV infections among young people occurred among adolescent girls and young women (UNAIDS Fact Sheet 2014). The region is dramatically missing any data on TG both biological and behavioural. MSM programs with no sensitized and special needs based approaches mostly cover them.

WG/TG from key populations, especially those of drug users, sex workers and transgender women are particularly likely to experience violence. Studies in different countries have detected the high prevalence of rape, physical violence, etc.

There is generally a growing recognition of and attention to gender equality – including Gender Based Violence (GBV) and harmful gender norms – as a cause and consequence of HIV. Despite this greater understanding, programming and policies to address the intersection have not yet reached the scale, depth, or breadth required to reverse the overlapping epidemics of GBV and of HIV.

In the EE there is a general lack of evidence related to the linkages between human rights/gender equality and HIV and approaches to ensuring regular documentation of cases with a platform for the voices of persons experiencing human rights violence, gender inequalities in the context of HIV.

This Winter school is developed in response to the pressing need to address the persistent gender inequalities and human rights violations that put Women, Girls and Transgender (WG/TG) at a greater risk of, and more vulnerable to HIV.

One of the participants – L. Norenc, Board member of WFCE – mentioned: “In the 3 days of the school, I liked the variety of themes. It was useful to have such an extent prospective about the different parts of the gender phenomenon, because only in this way you can get a chance to better understand it and to approach it. I found it really useful to know that I am part of a wider community dealing with gender stereotypes and GBV. It provided a clear message of hope and community leadership, that I’m proud to be part of!”

Interactive map of all OAT sites in Ukraine (as of September 1, 2016) was developed by the team of Expanding Medication Assisted Therapy (MAT) in Ukraine (ExMAT) research project implemented within the partnership with the Yale School of Medicine (USA).

The map contains information on each region of Ukraine (estimated number of people with opioid addiction; % coverage with OAT program from the estimated number of people with opioid addiction etc.) as well as information on each of the 176 AOT sites countrywide: address and contact information of the site; number of patients on methadone (both liquid and tablet forms) and buprenorphine; average dosages of AOT drug per site; number of patients on prescription/home-care type of OAT drug intake; number of patients with HIV/HCV etc.

The link to the map is: http://arcg.is/1CqOcgE

On 21-25 November 2016, Kyiv hosts the Second School for Trainers “Tolerance and Non-Discrimination” (School) in partnership with five organizations – International Charitable Foundation “Alliance for Public Health”, USAID HIV Reform in Action Project (Deloitte), Eurasian Coalition on Male Health (ECOM), All-Ukrainian Charitable Organization “Initiative for Life” and the Coalition for Combating Discrimination in Ukraine.

This School is organized to train the regional activists of HIV service organizations, who are interested in the development of trainers’ skills and plan to hold trainings on Tolerance and Non-Discrimination.  Among 27 participants of the School there are representatives not only from Ukraine but also from other countries of the Eastern Europe: Georgia, Armenia, and Kyrgyzstan.

Such School for Trainers is held for the second time already, with the participants of the first cycle invited as trainers to conduct some sections. Such format allowed alumni of the first training cycle to improve their professional competence and qualification six months after their “graduation”, with an opportunity to receive supervision as well as feedback. As for organizers and the trainer team of the School, they could see the results of their work.

There were 70 applications to take part in the School, with participants selected among those candidates who demonstrated high level of motivation and willingness to implement the knowledge and skills acquired in their further activities.

The participants learn to raise awareness and change attitudes among such challenging groups as public officials, healthcare workers, enforcement officers, educators, and mass media representatives.  Future trainers have an opportunity not only to be participants of the training and learn the theory of Tolerance and Non-Discrimination, but also to conduct their own sessions and get feedback from their supervisors.

Elena German, organizer and trainer: “Often HIV service organizations have to prove that their activities are important and high-priority. After graduating from our School, the participants will not only be able to conduct trainings but also, through formation of tolerant attitude among public officials, to contribute to the sustainability of their organizations.”

Nina Verbitska, trainer: “At the training, we unite people who think and care, who do not want and are not ready to remain silent.”

Armen Aghajanov, PINK Armenia: “I saw the information about the School for Trainers on Facebook. I applied as I have been an activist for a long time, but have never took part in trainings for trainers. What I appreciate about the School is that it gives practical skills and knowledge. This School combines theory and know-how which may be used in the trainers’ activities.” 

Aleksey Rulev, Kryvyi Rih branch of All-Ukrainian Network of PLWH: “Participation in the School allows coming to a single conceptual framework of tolerance and non-discrimination. I want to start a career of a trainer to deliver trainings on non-discrimination for doctors and educators in my home town.”