Ukraine risks losing USD 27 million due to failure of the Government to comply with its international commitments on funding of the substitution treatment programs!

On 22 August, the Global Fund to Fight AIDS, Tuberculosis and Malaria sent an official letter addressing the Vice Prime Minister of Ukraine, Pavlo Rozenko, emphasizing the real threat for Ukraine to lose non-repayable financial aid in the amount of USD 27 million (15% of the total amount of USD-134-million grant) in case if the Government of Ukraine does not comply with its 2015 commitments to gradually take over opioid substitution treatment (OST) programs.

In 2016, the Global Fund already made an exception for Ukraine and did not apply tough sanctions to reduce the amount of funding allocated to Ukraine, allowing reinvesting grant savings to procure the OST drugs. However, according to the letter, in 2017 the main international donor in the area of HIV/AIDS and TB response, which in the recent 12 years provided non-repayable financial aid of over USD 503 million to Ukraine, does not plan to make similar exceptions.

As per the commitments of the Government of Ukraine, starting from the second half of 2017 funds to procure the OST drugs for 7,000 patients are to be allocated from the state budget of Ukraine, and the Global Fund shall provide OST services to 2,300 patient.

According to the National Targeted Social Program to Fight HIV/AIDS in 2014-2018 approved with the Law of Ukraine N 1708-VII dd. 20.10.2014 and signed by the President of Ukraine Petro Poroshenko, OST programs were to be co-funded from the state budget back in 2014, and in 2017 they were expected to be fully covered by the state. However, in the 12 years of OST program implementation in Ukraine not a single pill was ever procured from the state budget.

According to the above-mentioned National Program, 16,204 people were to receive OST services in Ukraine this year, but in fact the OST program covers only 8,826 drug-dependent patients (54%). One of the key reasons of such failure is lack of support from the Government.

In mid-September 2016, representatives of the Global Fund will pay a regular visit to Ukraine, and during this visit government officials should provide documented evidence of their intention to comply with the previous commitments.

The amount involved: the estimated cost of the OST drugs to be procured within 2016 state budget is about USD 600 thousand, but, in case of failure to procure such drugs, Ukraine may lose USD 27 million to fight the epidemics of HIV/AIDS and tuberculosis!

Not a single meeting of the National TB/HIV Council has been carried out after formation of the new Cabinet of Ministers of Ukraine in April 2016. Officially the Council is still chaired by the former Vice Prime Minister of Ukraine, Viacheslav Kyrylenko, who has never taken part in its meetings even back when he held the post of the responsible Vice Prime Minister.

In 2015, obligations to the Global Fund on behalf of the Government of Ukraine were signed by the former Minister of Health, Oleksandr Kvitashvili.

As it turned out, on the same day, on 22 August 2016, the International Monetary Fund postponed consideration of the issue on disbursement of the next tranche of financial aid to Ukraine in the amount of about USD 500 million.

Letter from the Global Fund

Alliance for Public Health (Alliance) is delighted to inform that it has joined the International Drug Policy Consortium (IDPC) and became IDPC’s 1st member in Ukraine. Being responsible for the biggest harm reduction program in Europe and Central Asia covering 212,000 people who use drugs and 8,600 patients of opioid substitution treatment (OST) in Ukraine, Alliance is one of the key drug policy players/stakeholders from civil society. In order to abolish the repressive legal restrictions for Harm Reduction and OST programs, Alliance initiated and implemented numerous progressive changes in the national drug laws. Alliance has a long term history of productive cooperation with IDPC on the global drug policy reform.

The Alliance for Public Health became the Focal Point of civil society organizations to work with the Global TB Caucus in Ukraine.

The Global TB Caucus is a global network of Parliamentarians founded in 2014. This unique international network unites over 1,400 Parliamentarians from 130 countries committed to end the tuberculosis epidemic.

The goal of the Global TB Caucus is to scale up the response to the TB epidemic at the national, regional, continental and global levels. The Caucus helps to enhance the measures aimed at fighting the disease, supporting political representatives from different countries of the world and closely cooperating with civil society organizations.

Parliamentarians play a key role in eliminating TB as sustainable results may not be achieved without the political will. Parliamentarians approve budgets, choose leaders, define policies and make a significant public impact, which is needed to overcome stigma and raise the awareness of their constituencies with regard to the disease.

Thanks to its active joint efforts in many countries, the Caucus aims to ensure that TB is always agenda item at EU Presidencies, G20 meetings and G7 meetings and BRICS.

For Alliance, the proposal to become a partner of the Global TB Caucus became another acknowledgement of its professional and effective participation in the response to the epidemic of TB in Ukraine. The cooperation prospects and the coordinating role of the Focal Point open new possibilities to coordinate efforts in fight with tuberculosis not only in our country but also in Europe and in the world. The first steps in cooperation between Alliance and the Global TB Caucus have already been made within the regional TB-REP project, with our organization being one of the project partners on behalf of the TB Europe Coalition.

PRESS RELEASE

Hepatitis C – “Frozen War” with an Invisible Enemy.

Results of the national testing.

On 10 August 2016, Alliance for Public Health (Alliance) during its press briefing in the Ukrainian Crisis Media Center announced the results of the national rapid testing for hepatitis C among general population, which was organized together with partner civil society organizations in all regions of Ukraine on occasion of the World Hepatitis Day within the traditional all-Ukrainian “Demand Treatment!” advocacy and awareness-raising campaign.

The testing results raise serious concerns. In total, 3,844 individuals were tested in 26 cities in all regions of Ukraine (except occupied areas), with rapid tests showing the presence of antibodies to hepatitis C in 324 cases (8.5%).

It should be noted that testing was conducted among general public as the campaign was organized in parks and on central streets of cities and towns. For many of people who tested positive, their test results were totally unexpected as the trickery of hepatitis C is that it does not develop clinical manifestations for a long time.

There were both young and senior people among those who tested positive for hepatitis C. “Among those tested there was a guy of about thirty years of age, who decided to get tested only because it was free of charge, so he joined his friend – he was confident that he had no virus, but his result came back positive,” – told the campaign coordinator from Sloviansk, Mykhailo Karelin. “There was an elderly woman, who was just passing by on her way to the railway station with her suitcase. She had ten minutes of spare time, so she decided to get tested. She tested positive and it was a real shock for her. Her reaction was quite unexpected: “Why did I have to run into you? I don’t know how it could happen! What should I do now?” We invited her for a counseling session with an infectious disease doctor and referred her to a healthcare facility”, – told us the campaign coordinator in Poltava, Kristina Kryzhenko.

It is disturbing that most people who were tested within the campaign have never been tested for hepatitis C before (from 85 to 98% depending on the location); in particular, only one person out of 160 people tested in Severodonetsk had been tested before, and in Sloviansk none of 150 people tested went through such testing in the past (meanwhile 14 positive results were received there).

All previous national testing campaigns as well as this-year campaign confirm once again that the situation with hepatitis C is becoming more and more alarming! Hepatitis C diagnostics is still critical as hepatitis testing is not included to the list of mandatory medical examinations, so most patients (even the military who took part in the armed conflict in eastern Ukraine) become aware of their disease at advanced stages.

Since 2012, Alliance ran over 119,000 tests among the members of key affected populations (first of all people who use drugs), and during five years of all-Ukrainian campaigns over 13,500 people from among general public were tested, with the percentage of positive results always ranging from 8 to 12%.

The situation with treatment is still alarming. According to the chief consultant specialist on the infectious diseases of the Ministry of Health of Ukraine Olha Holubovska, MD, PhD: “Today there are at least 90,000 people in need of treatment in Ukraine, though due to the low level of primary diagnostics we still do not know the exact number of people living with the virus. With such approach and the level of government funding the epidemic is growing – and hepatitis C is turning into a real threat to the public security of Ukraine as later the government will have to spend enormous amounts of money in disability benefits and incapacity allowances due to the consequences of this disease. However, the problem of blood-borne infections may not be solved only with treatment. The WHO strategy stipulates reformation of the public health system as a whole.”

The situation with government funding is also critical. In 2016, the current National Targeted Social Program of Viral Hepatitis Prevention, Diagnostics and Treatment is coming to its end. In its official response to Alliance as for the development of a new program for the period till 2021, the Ministry of Health replied that in 2013 – 2016 only very limited amounts of budget funds were allocated to procure medical drugs; as for other activities – they were not financed from the budget at all! The total funding shortfall of the activities stipulated in the national program is 79% of the amount planned back in 2013.

The formal reason of refusal to develop a new national program on viral hepatitis, which was supposed to come into force in 2017, voiced by public officials is the ban on the use of public funds approved with the resolution of the Cabinet of Ministers of Ukraine N 65 dd. 1 March 2014[1].

“Hepatitis C is a curable disease. Nevertheless, in our country the situation has turned into an epidemic. Under such conditions, freezing resources to fight hepatitis C means capitulation and betrayal from the side of the state towards its citizens who are in need of treatment. Keeping in mind the disturbing results of the national testing, we demand to lift the “veto” from the development of a new national program on viral hepatitis. Alliance appealed to the President and the Prime Minister with a request to urgently approve the National Plan towards Hepatitis C Elimination, the implementation of which will help Ukraine to eradicate this disease in our country and save the lives of millions of Ukrainians. The experience of Alliance, which two years ago launched the first in Ukraine treatment program using a new-generation drug, clearly demonstrates that this goal is achievable! We were able to access innovative drugs and have already treated over 600 patients with most complicated cases – and in 93% of those who received the treatment the virus is undetectable, which is currently the best treatment success rate for hepatitis C in Ukraine,” – said Andriy Klepikov, Executive Director of the Alliance for Public Health.

***

Over 150 million people are infected with hepatitis C globally, with up to 4 million people living with HCV in Ukraine. Most of them are not aware of their disease as in 80% cases the acute stage of disease is asymptomatic. One of the priority areas of activities of the Alliance for Public Health is fighting the spread of the epidemic of hepatitis C in Ukraine and providing HCV diagnostics and treatment for key affected populations. In 2012, Alliance initiated all-Ukrainian “Demand Treatment!” advocacy campaign primarily aimed at scaling up access to diagnostics and treatment of hepatitis C in Ukraine. Since 2015, the Alliance Center on HIV, Hepatitis C and Drug Use has been implementing a global campaign, Unite to Eliminate HepC: Know It, Test It, Treat It.

[1] Paragraph 16 of the Resolution of the Cabinet of Ministers of Ukraine dd. 01.03.2014 N 65 “On budget savings and prevention of budget losses” terminates the development of new national targeted programs or amendments to the approved targeted programs, which require additional budget funding.

Official press-release

On 5 August 2016, the Ministry of Health of Ukraine hosted the second meeting of the Interdepartmental Working Group on Medication Assisted Treatment at the MoH.

On 5 August 2016, the Ministry of Health (MoH) of Ukraine hosted the second meeting of the Interdepartmental Working Group on Medication Assisted Treatment at the MoH (hereinafter – IWG). The meeting was held with technical and organizational support of the Alliance for Public Health (within the project “Improved Quality and Sustainability of Medication Assisted Treatment in Ukraine”) together with the Ukrainian Center of Socially Dangerous Disease Control.

The key issue of the meeting was introducing the Methodology of calculating the need in drugs to provide medication assisted treatment to patients with mental and behavior disorders associated with the use of opioids for the purposes of drugs procurement within the state budget.

The above Methodology was developed in line with the resolution of the IWG as of 1 July 2016 by representatives of the Ukrainian Center of Socially Dangerous Disease Control and the Alliance for Public Health.

Other questions discussed at the meeting also included organization of an International center for substance abuse treatment and HIV prevention technologies in Ukraine; situation with introduction of the practice of MAT drugs delivery to patients for unsupervised administration in outpatient settings (prescriptions for drugs, delivery within “home care” or directly from treatment institutions), protection of the rights of patients.

During the meeting, information was presented on the current situation with issuance of a joint order of the Ministry of Health of Ukraine, the Ministry of Internal Affairs of Ukraine and the Ministry of Justice of Ukraine “On approval of the procedure of cooperation among healthcare institutions, departments and bodies of the National Police, National Guard of Ukraine, pre-trial detention centers, penitentiary facilities and criminal and executive inspections to ensure the delivery of medication assisted treatment to patients with opioid dependence”. According to the information presented, the draft order is currently in the process of approval by the MoH of Ukraine and will soon be published for public discussion.

Based on the results of the meeting, a decision was made to urgently finalize the developed Methodology of calculating the need in drugs to provide medication assisted treatment for its approval with an order of the MoH of Ukraine, with further steps defined to enhance the partnership in response to patients’ appeals related to violation of their rights and to provide clarifications to regions on the delivery of MAT drugs for unsupervised administration.

More than 390 refugee and IDP OST patients from the Crimea and the ATO area can continue the life-saving treatment!

The Alliance of Public Health (the Alliance) completed the humanitarian project on support of the OST patients – refugees from the Crimea and internally displaced persons from the ATO area, which had been funded by the international organizations for more than 2 years. From May 2014 to June 30, 2016 more than 390 opioid substitution therapy (OST) patients being the refugees from the Crimea and the ATO area, were able not only to relocate in the safe regions of Ukraine, but continue the life-saving treatment and start over again at the new place. (Based on the survey results, 95% of the clients after the completion of the project are planning to stay in their new places of residence and receive OST services on general conditions.

The essence of OST as drug dependence treatment is that a patient regularly takes an OST drug under doctor’s control, being able to quit criminal activities, find a job, improve their health, fully integrate into the society. Currently there are 8,152 OST patients in Ukraine. Before the occupation of the Crimea and a part of Donbas there were about two thousand persons on treatment, and only a third of them was able to continue the treatment on non-occupied territories. Others were deprived of this opportunity, having their life and health threatened. Based on the data by the UN Secretary-General’s Special Envoy Michel Kazatchkine, after OST program discontinuation in the Crimea about 100 patients died, official statistics for the uncontrolled territory of Donbas is not available, but the patients’ situation there is no better.

The Alliance had always held the protection of OST patients’ interests as a cornerstone of its activities and in this critical situation launched active advocacy, awareness and fundraising campaign to protect their rights, laying the foundation for the humanitarian project. The patients were offered to relocate to one of 16 cities in 8 oblasts where they were able not only to continue treatment, but obtain an interim 24-hour social support to help them adapt at a new place, which included the payment for accommodation rental at the expense of the project, organization of meals and providing for household needs, assistance with employment, obtaining documents, etc. Considering that the majority of OST patients are persons with severe chronic diseases, the uninterrupted treatment was ensured for HIV, TB, or, if necessary, the possibility of medical examination and timely prescription of treatment for these diseases.

Oleksandr, OST patient from Horlivka, who is now living in Kramatorsk, tells, “We knew that the drug stock is running low, but then out of a sudden they brought us together and said that the site is closing. OST hotline told me that there is a possibility to relocate, thus I contacted the project coordinator and moved to Kramatorsk. I like this city, they rented me a comfortable apartment and were always ready to help. It’s hard to believe, but while this seems an ordinary city, even the sun is brighter here, there is a friendlier environment of sorts… I have pity for those who stayed on the occupied territory. People understand that they were not right, but not everybody would dare to leave. I was lucky enough…”

From the very beginning the project aimed not only to support the patients in the first months after relocation, but comprehensively facilitate their integration in the local communities. As the result, 99% of the project clients were registered as IDPs and receiving the governmental allowance, 19% were receiving disability allowance, 5% received childcare support. As of the moment of project completion 41% of patients have full-time or temporary jobs helping them to pay for accommodation on their own after the project completion.

According to the project participants currently residing in Dnipro, “The assistance program organized by the Alliance allowed us to survive and adapt in the new unfamiliar city. At this stage of our life we were not left alone, Alliance staff was helping us so much, that’s why we successfully started adapting to the life in the new city rather than sink into despair”.

The Alliance aimed to achieve the sustainability of services even after the completion of the project funding, that’s why key attention was paid to seven healthcare facilities, on the basis of which OST services were provided on the controlled territory of Luhansk and Donetsk oblasts (Slovyansk, Kramatorsk, Mariupol, Krasnoarmiysk, Lysychansk, Severodonetsk, Rubizhne), because they were the most demanded by the relocated persons, concentrating 51% of all project clients. The project budget funded the procurement of equipment, repairs of the site premises which allowed, among other things, to open the new OST cabinet in Rubizhne city where as of the moment of project completion 44 OST patients were serviced, including 6 IDPs.

Meanwhile… On June 23, 2016 the treatment on the uncontrolled territory of Donetk and Luhansk oblasts was completely discontinued. Due to depletion of the stock of drugs the last OST site which had still been functioning in Donetsk got closed. 23 HIV-positive patients for the last time received a minimal dose of methadone (5 mg). Not everybody managed to relocate on the territory controlled by Ukraine to continue treatment, the majority faced harsher fate. Based on the information available to the Alliance, during the involuntary decrease of OST dosage 20 patients, most of them HIV-positive, died in Donetsk only. This further emphasizes the importance of the project implemented by the Alliance, as it was saving lives rather than just simply providing treatment.

The project was a challenge for the Alliance, because it was quite unique. According to Tamara Tretska, project manager, “It was a complicated project. Many activities were developed and changed in the course of the project. Sometimes we had to start virtually from zero; we had to provide patients with clothes, footwear and other necessary items, because the first patients from the ATO area sometimes arrived without any possessions, having just escaped the bombing. Due to successful cooperation with the healthcare facility managers and OST doctors we could promptly solve the issues of admitting the patients who often had no medical documentation with them. We greatly respect the doctors’ attitude, who treated the clients as first and foremost people in need of help. There were no refusals to admit patients. However, all the difficulties and barriers the project team had to overcome are fully rewarded, when we realize that we were able to fully change people’s lives, and did not abandon the patients, making them face all the problems of therapy interruption on their own. The patients had a real possibility to fit in the new conditions”.

***

Reference: the project for the support of OST patients who were refugees from the Crimea or IDPs from the ATO area was funded by different donors:

· International Renaissance foundation (08.05.2014 – 31.03.2015)

· Elton John Foundation(1.10.2014 – 25.12.2014)

· Pompidou Group of the Council of Europe (1.02.2015 – 31.05.2015)

· Global Fund to Fight AIDS, Tuberculosis and Malaria (1.06.2015 – 30.06.2016).

The total amount of funding exceeded USD 750,000

On July 25-29, 2016 the Alliance for Public Health (METIDA project) in collaboration with the State Institution “Ukrainian Centre of Socially Dangerous Disease Control of Ministry of Health of Ukraine” carried out the International Summer HIV Modelling School in Odessa. This event was a unique opportunity to meet the highest level national and international experts on HIV modelling. During the meeting were discussed algorithms of HIV/AIDS epidemic projections in four major modelling tools: SPECTRUM, AEM (AIDS Epidemic Model), Optima and ECDC HIV modelling tool.

  The international trainers of summer school were:

• Ard van Sighem, PhD, developer of ECDC HIV modelling tool, Senior Researcher at Stitching HIV Monitoring Foundation (Netherlands)

• Wiwat Peerapatanapokin, East-West Center / Thai Red Cross Society Collaboration on HIV / AIDS Modelling, one of the developers of AEM, international expert in SPECTRUM (Thailand)

• Clemens Johannes Benedikt, The World Bank, modelling consultant at Optima (Austria)

The following representatives of national partner organizations working on HIV in Ukraine participated in the International Summer HIV Modelling School: CDC, UNODC, UNAIDS, The World Bank, State Organization “Institute for Economics and Modelling, Ukrainian National Academy of Sciences”, State Organization “Institute of Epidemiology and Infectious Diseases named after L. Gromashevskyi of the National Academy of Medical Sciences of Ukraine”, regionals AIDS centers and other national partners.

During the event all the participants developed projections in different modellingtools, compared the projections with each other and concluded the further steps in HIV modelling at the national and regional levels, first of all, to identify and approve the data about PLHIV size estimation and key groups, main epidemic indicators (incidence, prevalence, mortality) among the general population and key groups.

On July 28, 2016 the Alliance of Public Health jointly with partner organizations carried out the traditional all-Ukrainian information and awareness event within the framework of “We Demand Treatment!” campaign in all the oblasts of Ukraine. The key message of this year’s event was the request to ensure efficient treatment with direct-acting antivirals.

The following speakers participated in the press briefing at the all-Ukrainian public event in the city of Kyiv:

– Executive Director of the Alliance of Public Health Andriy Klepikov.

– Chief consultant specialist on the infectious diseases of the Ministry of Health of Ukraine (MoH), Head of the Department for Infectious Diseases of O. Bohomolets National Medical University Olha Holubovska, MD, PhD.

– Representative of the World Health Organization (WHO) office in Ukraine Oleksiy Bobryk.

– Patients with HCV who currently completed the treatment or are still waiting for it.

195 people passed hepatitis C screening tests, 15% of results were positive. All people who have received positive results of rapid test were consulted by doctor and received information on further steps in the diagnosis.

The action received wide coverage in the media:

First National Channel.

5th Channel.

Hromadske TV.

TV Channel ‘Ukraina’.

24th Channel.

NTN.

‘Kyiv’ TV company (was on news programm at 21.00).

Hromadske Radio.

Radion Era.

Official press relealse of the action.

#AIDS2016

Alliance for Public Health (Ukraine) is implementing one of the biggest key populations response programs that reversed the pace of HIV epidemic in Ukraine. Its experience informed the development of a number of EECA programs as well as responses to drug use driven epidemics in East Africa and Asia. We will be sharing our experiences during AIDS 2016: oral presentations, workshops, poster presentations, 2 booths will be ran during the conference:

SATURDAY, JULY 16

11:30 – 13:00. Oral Presentation: Leaving No One Behind – Prioritizing Key Populations. (Pavlo Smyrnov)

Place: International Conference Center (PEPFAR, pre-meeting).

TUESDAY, JULY 19

12:30 – 14:30. Poster presentation: Economic analysis of effectiveness of investments in HIV prevention services among key population groups in Ukraine (Tetyana Salyuk)

Place: Poster Exhibition area, First Level (by the Arena Entrance)

14:00 – 15:00. Oral presentation followed by moderated discussion: Harm Reduction Academy learning course: How to learn the decades of experience in harm reduction in 3 weeks? (Tetyana Deshko)

Place: HIV/AIDS Alliance Exhibition Booth at AIDS 2016 (#374)

15:00 – 16:00. Oral presentation followed by moderated discussion: SyrEx Cloud: Leave the paperwork behind! Client tracking software (Pavlo Smyrnov)

Place: HIV/AIDS Alliance Exhibition Booth at AIDS 2016 (#374)

18:30 – 20:30. Oral Presentation: Leaving No One Behind: How to Bring Key Population HIV Services to Scale (Tetyana Deshko)

Place: International Conference Center, Session Room 7

WEDNESDAY, JULY 20

9:00-10:00. Workshop “EECA Regional Platform: TA needs of PLWHA in Eastern Europe and ways to address them for better decision making”. Discussion of Assessment results (Kateryna Maksymenko).

Place: Global village: the European Networking Zone

12:30 – 14:30. Poster presentations:

· EECA Regional Platform: building regional civil society partnership for better decision making in HIV/TB response (Kateryna Maksymenko).

· Using mixed-methods to understand HIV treatment cascade among opioid agonist therapy (OAT) patients and people who inject drugs (PWIDs) in five Ukrainian cities (Alyona Mazhnaya)

Place: Poster Exhibition area, First Level (by the Arena Entrance)

12:50 – 12:55. GV Film screening. Lost Childhood: urgent response needed in order to save lives of adolescents who use drugs (Iryna Zharuk)

Place: GV Film screening room.

16:30 – 18:00. Oral Presentation: The Development and Pricing of HIV Medications and Diagnostics: Recent Controversies and Priorities for the Future (Andriy Klepikov)

Place: International Conference Center, Session Room 6.

18:00 – 20:00. Oral Presentation: Development Assistance for Health in the Age of Inequality: What does it mean for the AIDS response? (Andriy Klepikov)

Place: The Southern Sun Elangeni & Maharani, 63 Snell Parade

THURSDAY, JULY 21

12:30 – 14:30. Poster presentations:

· HIV counseling and testing decreases risk of HIV seroconversion among people who inject drugs in Ukraine (Tetyana Salyuk)

· Implementation and validation of PIMA CD4 program in Ukraine (Alyona Shost)

Place: Poster Exhibition area, First Level (by the Arena Entrance)

14:30 – 16:00. Oral Presentation: Community’s Role in the Health System. (Andriy Klepikov).

Place: International Conference Center, Session Room 11.

14:00-14:45. Session “TA needs and ways to address them for better involvement of key affected communities into decision making in the area of HIV/TB response in EECA: Assessment results”. (Kateryna Maksymenko).

Place: Global Village: Global Fund Networking Zone

We will be present in 2 booths during the entire conference:

· International HIV/AIDS Alliance Exhibition Booth #374

· Alliance for Public Health, Booth №518

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