PRESS RELEASE

On 16 September 2016, during the press briefing held within the international meeting aimed at ending the tuberculosis (TB) epidemic, competent experts offered evidence supporting implementation of the ambulatory model of TB care as one of the crucial components to reform the healthcare system to end the TB epidemic in Ukraine. This model stipulates treatment of patients with smear-negative TB in outpatient facilities, within primary health care and in home-based settings. It will account for the individual needs of patients and thus will contribute to improving the patients’ adherence to treatment, which will ultimately help to reduce the prevalence of the disease. Such care, more convenient for patients, is called patient-oriented care.

The need to shift to integrated, patient-oriented systems of ambulatory TB care is arising due to the critical situation with the spread of multidrug-resistant tuberculosis (MDR-TB) which is observed in Ukraine as well as in the region of Eastern Europe and Central Asia as a whole. In our country this situation has become a real catastrophe – Ukraine is one of the TOP 5 countries with the biggest burden of MDR-TB in the world! Unfortunately, our country still has the worst TB treatment success rates in Europe – only 71% new TB cases and 38.6% MDR TB cases are cured. According to WHO, in 2015 about 23% TB cases were not diagnosed. In 2015, prevalence of all active TB forms in Ukraine was almost 85 persons per 100 thousand people.

“In most cases, reducing the time of patient’s hospitalization, and sometimes even initiation of treatment at home (provided that there are appropriate conditions of infectious control) are more reasonable,” – said Andriy Klepikov, Executive Director of the International Charitable Foundation “Alliance for Public Health”. – “From the point of view of public health, inpatient treatment does not prevent the spread of TB as most cases of TB transmission take place before the patient is diagnosed with TB and hospitalized. The risk to transmit the infection is greatly reduced 14 days after initiation of the effective treatment. And staying in inpatient units often leads to hospital-acquired forms of drug-resistant (i.e. not sensitive to most TB medicines) forms of the disease.”

Hospitalization of people who do not need to stay in hospitals is, on the one hand, a waste of financial and human resources and, on the other hand, may have a negative impact on the employment situation or social life of the patient or his/her family. According to experts, reducing the time of patients’ hospitalization at least for 1 day during a year may help Ukraine save at least UAH 50 million.

“Currently we are finalizing the Concept of the National TB Program for 2017—2021 and the Strategy of sustainable response to TB, including drug-resistant TB, and HIV/AIDS for the period up to 2020. Those documents will be in line with the international standards and we will make our best to implement them”, – told Oksana Sivak, the Deputy Minister of Health for Public Health and European Integration.

 “Today there are 16 thousand beds in TB treatment facilities of Ukraine, but only 55% of such facilities meet the requirements of infection control, which leads to a high risk of the spread of hospital-acquired forms of TB in inpatient units,” – underlined Natalia Nizova, Director of the State Institution “Ukrainian Center for Socially Dangerous Disease Control of the Ministry of Health of Ukraine”. – “Patients with smear-negative TB may receive ambulatory care with no risk of transmitting the infection to other people. Such approach has been proven effective in European countries and is in line with the WHO guidelines.”

Currently, our state receives multilateral international support to reform the approaches to overcoming the TB epidemic and prepare the society to accept the new model of treatment. For such reforms to be successful, it is very important for the government authorities to be ready for resolute actions.

“I have a special attitude to resolving the issue of tuberculosis. My great grandfather, a world-famous scientist Oleksandr Bohomolets, acquired tuberculosis from his mother as a child and, as a result, passed away prematurely,” – told Olha Bohomolets, the people’s deputy of Ukraine, Head of the Verkhovna Rada Healthcare Committee. – “Today the state allocates money but there is a question if this money is used effectively. We should ensure a comprehensive approach to unite prevention and treatment programs.”

MPs play a significant role in ending TB as with no political will of the main legislative body of the country it is not possible to achieve sustainable results, approve relevant budgets and make a significant public impact necessary to overcome stigma and raise public awareness of this disease. In 2014, a unique international movement was created, which currently unites over 1,400 MPs – the Global TB Caucus.

“The Global TB Caucus is a network of parliamentarians from 130 countries of the world, who campaign for and work on ending the global TB epidemic both individually and jointly. The Caucus implements activities at the global, regional and national levels,” – told Baroness Alison Suttie, life peer in the UK House of Lords, member of the Global TB Caucus. – “We also work closely with partner civil society organizations to make sure that the TB response is sustainable through local leadership. In Ukraine, we work with the Alliance for Public Health, which is the Focal Point of the Caucus in this country.”

“In the recent years, Alliance implemented a number of innovations in TB diagnostics and treatment. The equipment supplied to all the regions of Ukraine allows finding out about the diagnosis in 15 minutes (instead of two weeks); and the quality medicines procured by Alliance with financial support of the Global Fund as well as the effective social support of patients allowed reaching the cure rate for patients with multidrug-resistant TB at 85% (as compared to the national indicator of 38.6%),” – added Andriy Klepikov. – “Now it is time to change the approaches to treatment in line with most up-to-date international standards, which include ambulatory treatment of patients with smear-negative TB. It will allow to save state funding, treat more patients and prevent the spread of TB. It’s a win-win situation!”

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Every year, TB is diagnosed in over 30 thousand people (4 new cases every hour) in Ukraine. Every eighth patient dies. TB situation is critical in the whole region of Eastern Europe and Central Asia (EECA): 14 out of 27 countries with high burden of drug-resistant tuberculosis are located in this region. In many countries, there is an urgent need to shift to integrated, patient-oriented systems of ambulatory care. TB in Eastern Europe and Central Asia Regional Project on Strengthening Health Systems for Effective TB and DR-TB Care (TB-REP), which is co-implemented by Alliance for Public Health on behalf of TB Europe Coalition, is aimed at reforming the system of TB care as a part of general healthcare reforms. Overall goal of the Project is 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 TB-REP Project is aimed at reforming the system of TB care and providing technical support to TB projects implemented by civil society organizations. The project is implemented with financial support of the Global Fund to Fight AIDS, Tuberculosis and Malaria and covers 11 EECA countries (Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Turkmenistan, Ukraine and Uzbekistan). In the nearest future, advocacy strategies to develop ambulatory models of TB care within healthcare system reforms will be developed in Ukraine and other countries participating in the Project.

Alliance for Public Health in collaboration with the International Treatment Preparedness Coalition (ITPCru) and more than 17 partner organizations updates the third edition of the report “Hepatitis C in Eastern Europe and Central Asia: Civil Society Response to the Epidemic”.

The third edition of the report was published only 2 month ago, but the changes that have taken place during this time cannot remain unnoticed. So we invite you to get acquainted with the dynamic development of treatment access in the region:
– New national protocols of hepatitis C treatment with interferon-free regimens were endorsed in Ukraine and Moldova.
– Direct-acting antivirals were registered in Moldova, Azerbaijan and Kyrgyzstan. The newest DAAs sofosbuvir+velpatasvirandelbasvir+hrazoprevir were registered in the Baltic states.
– The cost of hepatitis C treatment in Azerbaijan can be reduced by almost 20% due to the appearance of cheaper generic drugs on the market.
– Updated information on patents and patent opposition.
To learn more interesting facts, recommendations to countries on how to scale up the access to treatment, and the best practices in advocacy, read our report.

The meeting of the National Supervisory Committee on Hepatitis C Treatment was held on 2 September 2016 within implementation of the third phase of innovative hepatitis C virus (HCV) treatment program in Ukraine. Previous meeting of the Committee was convened over twelve months ago, so it was a great opportunity to discuss the effectiveness of the existing treatment programs and plan further steps to overcome hepatitis C epidemic in Ukraine.

Alliance remains an agent of change and progressive innovations in HCV treatment in Ukraine, in particular within the new phase of the treatment program:

• For the first time in Ukraine, the program will use a new direct-acting antiviral, which has higher treatment success rates as compared to sofosbuvir.
• The existing treatment program will be scaled up by 750 more courses.
• The program will cover 17 oblasts – it will include Khmelnytskyi and Donetsk oblasts it has not reached before.
• A separate quota of treatment courses will be allocated for the population, which in the recent years became a new important risk group from the point of view of HCV, with the coverage of this group with national budget funds currently being extremely low.
• A joint project of several international organizations will be launched at the oblast level, which will allow establishing a unique model of the impact on epidemic through the example of a rather small cohort of patients localized in one oblast.

During the meeting, results of the innovative sofosbuvir-based treatment program implemented by Alliance were presented. In particular, the project covers a much bigger group of patients than initially planned – 1,150 (153% of the planned number). 705 persons have already completed their treatment. Based on the laboratory diagnostics results, 12 weeks after treatment completion the virus was not detected in 93% of patients. Besides, within the project almost 100 doctors acquired knowledge on the use of innovative direct-acting antivirals. You can get more detailed information on the results of Alliance program and distribution of the treatment courses here.

To get more about eligibility C criteria of the Hepatitis C Treatment Program, please follow the linkwww.aph.org.ua/hepc_en

In 2015, Alliance for Public Health changed not only its name but also the approach to preparing its traditional Annual Report.

The released 2015 report contains detailed information on the results of numerous Alliance projects implemented in Ukraine and abroad and statistics on the biggest scope of harm reduction, TB and hepatitis C treatment services in the region we are proud to present.

The new report defines the strategic goals of Alliance up to 2020 and prospective areas of its further growth. In addition to numbers and graphs, here you will find real stories of clients and staff members of implementing organizations as well as a lot of other interesting information.

You can download Ukrainian version of the report here.

English version will be released later.

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.

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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”.

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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