On Sunday, May 15, Ukraine as well as countries all over the world marked the International AIDS Candlelight Memorial Day. According to the Ukrainian Center for Socially Dangerous Disease Control of the Ministry of Health of Ukraine, 3,032 people died of AIDS in Ukraine in 2015, and 969 – in four months of 2016. Overall, since 1987 AIDS took the lives of 39,426 Ukrainians.

Traditionally, activists gathered at the Red Ribbon Memorial to express their concerns about the current situation in HIVtreatment within the initiative of the All-Ukrainian Network of PLWH. Alliance for Public Health joined the campaign, makinga focus on the urgent need to provide access to treatment for vulnerable populations. Andriy Klepikov, Executive Director of Alliance, pointed out that “unfortunately, though in the recent years we see that due to implementation of HIV prevention programs in vulnerable populations the number of new infections, in particular among people who inject drugs, has been considerably reduced, death rate among the members of this population remains almost unchanged – 45%. First of all, it is caused by the limited access to antiretroviral treatment. For example, an HIV-infected person who injects drugs has muchlower chances to received ART than an ordinary citizen who is in need of such treatment – the share of such patients among those who receive ART is only 12.5%.” According to the official data, as of April 1, 2016 there were 128,455 officially registered patients in Ukraine, with 63,029 (49%) of them receiving ART. Among the drug users, only 7,563 persons were receiving thetherapy as of the end of 2015.

One of the key causes of death among people living with HIV in Ukraine is tuberculosis and the situation with treatment of patients with HIV/TB co-infection remains critical. Only every other patient (56%) has an access to ART. One of the priorities of Alliance is treatment of multidrug-resistant tuberculosis – since 2013, 9,936 patients received such treatment with financial support of the Global Fund. According to the data available, though the incidence of HIV-associated tuberculosishas remained almost unchanged in the recent years (14.5 cases per 100,000 people), the mortality related to co-infection goes down (2,522 cases in 2013 as compared to 1,994 cases in 2014), which is a proof of treatment success. However, thereare big concerns related to the fact that currently most patients rely on donor funding in the procurement of medical drugs – in future this should fall into the competence of the state.

Alliance for Public Health supports its partners’ initiative to appeal to the Prime Minister of Ukraine with a request to takeunder his personal control the question of full funding of the National Targeted Social Program for Countering HIV/AIDSand, in particular, public procurement of vital medicines (for ART, OST, TB treatment, etc.)

Alliance grieves for those who died and, in its turn, tries to do everything possible to finally break the sad death ratestatistics in Ukraine (currently Ukraine accounts for 25% of AIDS-related deaths in Eastern Europe and Central Asia) and to ensure the achievement of global UN targets in response to the epidemic.

Alliance congratulates Jamala on her victory in the Eurovision song contest! It was a great news for us as in November 2013 we had an honor to work with Jamala during our charity campaign “Inspired for Life”, which was aimed at raising private and business funds for the needs of people living with HIV. Following this collaboration, two video clips were produced promoting HIV prevention and anti-stigma messages as well as calling all stakeholders to shape the state policy in HIV prevention to make it a national priority – for their own future.

HIV is not transmitted through friendship

HIV prevention should become a national priority

The first and the second phases of the Project “Scaling up accessible and effective HCV treatment through community-based treatment model for most vulnerable populations in the resource-constrained Ukraine” (hereinafter – the Project) stipulated provision of hepatitis C virus (HCV) treatment to 750 patients. As of 1 May 2016, 782 patients received access to HCV treatment in 19 healthcare institutions of Ukraine. Planned indicators of the two phases have been achieved. Meanwhile, enrolment of patients for the second phase of the project is still in progress and it is expected that in May – in the beginning of June about 360 more patients will be enrolled.

The success of innovative treatment is proven by sustained virologic response, which has been achieved by 92% of patients. High treatment outcomes among the members of vulnerable populations is built on the social support of patients throughout their therapy, which is provided thanks to the successful cooperation of non-governmental organizations and healthcare institutions within the implementation of HCV treatment model at the community level.

Characteristics of Project participants are as follows: 84% have HIV-positive status, 96% of them receive ART. 80% of them are people who inject drugs, with 9% of them being OST program clients. 13% of the Project participants had previous treatment failures when using two-component regimens: pegylated interferon + ribavirin.

The list of eligibility criteria of HCV treatment project and the list of healthcare institutions to offer HCV treatment as well as NGOs providing social support to patients may be found here.

Besides, in April two trainings were conducted for doctors and social workers involved into the Project to enhance knowledge and improve skills required for the effective Project implementation. Overall, 45 participants from 17 regions of Ukraine took part in 2 two-day trainings. Participants of the trainings highly praised urgency of the topic, importance of the information received and the skills obtained.

The COP/ROP16 review meeting took place in Bangkok from 30 April to 2 May 2016. The APH and EKHN representatives participated at the meeting representing Ukrainian stakeholders. The 3 days meeting goals were two-folds:

· Finalize any outstanding issues related to the submitted COP/ROP16 sp that it may be approved by the end of the meeting;

· Engage with key global and local stakeholders – community, multilateral, partner government – on shared innovative implementation solutions.

During the meeting, PEPFAR Ukraine team presented an overview of COP15 implementation using results and related systems with brief data review for prevention program and each 90. Following that, COP16 submission was presented confirming the “right places”, “right things”, “right now” and “right way”, includingstrategies for increasing yield and volume of new cases, budget allocation through program area.

PEPFAR Ukraine team presented also responses to issues identifies in headquarter desk review and proposed resolutions, including:

· approach to measuring milestones for above site level activities;

· proposed scenarios for commodity procurement to reach COP16 targets

· current status and future of the procurements

· short update on treatment optimization.

The meeting last day, Ukrainian team together with headquarter teams continued to work on final resolution of critical issues and actions required to obtain COP16 approval. The session was organized in a way that country (Ukraine) and regional (EKHN) programs together with US government, host country government, multilateral, community and civil society representatives can reflect and discuss how Ukraine will achieve epidemic control using shared implementation solutions. Based on structured discussion the COP16 for Ukraine was approved by the Ambassador Birx.

From the 2nd to the 6th of May in the framework of the “Eastern European regional platform on accelerated action for women, girls and transgender people in the context of HIV/AIDS” a specialist of gender-sensitive programs Iaremenko Kateryna, ICF “Alliance for public health”, visiteda partner organization of Eastern European network on key groups’ health “Gender and Development” (Azerbaijan).

 During the visit the analysis of gender component in the structure and activities of the organization, capacity building plan and strategy plan to improve the access of vulnerable groups to HIV treatment and prevention were made. With a view to further cooperation and development of partnerships there were held meetings with the representative of the WHO Jawahir Suleymanova and chairwoman of Clean World Aid to Women Public Union Mehriban Zeynalova

From April 18 to 28, the Director of the ” Eastern European Regional Platform for Accelerated Action for Women, Girls and Transgender in HIV/AIDS Context” project funded by RCNF conducted a field visit to Russia and Moldova based project partner organizations: Non-Profit Partnership “ESVERO” and Public Association “Union for HIV/AIDS Prevention and Harm Reduction in Moldova (UORN)” respectively.

The non-profit partnership to support public health social prevention programmes ESVERO (NP ESVERO) is a non-governmental organization uniting 39 legal entities and individuals from different regions of the Russian Federation involved in delivery of social prevention services to people using drugs and people living with HIV/AIDS. The main direction of our activity is developing integrated low-threshold services for drug users and other vulnerable groups aimed at prevention of HIV, viral Hepatitis and other harmful diseases, providing access to high-quality drug treatment services, HIV treatment, rehabilitation and resocialization.

UORN has over 10 years of experience of public healthcare programs coordination in Moldova. The association is based in Balti Municipality and has a mission to consolidate and coordinate of all the Union member organizations activity, for the developing and promoting of Harm Reduction strategies as an effective Public Health Care in Moldova.

The goals of the visits to the Russian and Moldavian partner organization were four – fold:

1. To get know about the partner organization Board, Staff, structure and key areas of the strategic programs.

2. To raise the RCNF funded project information and visibility both among the ESVERO / UORN membership and civil society/ community in Russia.

3. To conduct an internal assessment of the gender components, gender based approach and gender equality in ESVERO / UORN decision making bodies, programming, implementation, monitoring and evaluation systems.

4. To develop a set of recommendations to sharpen gender equality within decision making procedures and to improve gender based approach in ESVERO / UORN strategic development.

ESVERO and UORN strategy and programs assessment was conducted using a Gender Assessment Tool elaborated to get information on the organization 4 aspects: capacity, culture, accountability and political will. Representatives of the Board, Staff (top management, administrative, technical and supporting) participated in the assessment to ensure the holistic results of the outcomes. Based on the average scores, the set of recommendations was developed for all the 4 aspects and together with ESVERO and UORN management agreed time and responsibilities for the implementation if the recommendations. The Project National Coordinator Ms. E. Romanyak said “The idea to conduct a comprehensive assessment on our organization capacities and skillswas very timely and the outcome will help us to integrate gender based approaches in all steps of our organization undertakings starting from planning and ending by a follow-up planning”.

In framework of the visit to Russia, the project director and project national coordinator visited 2 organization providing services for girls and woman- E.V.A and working with TG – “Transgender” Foundation. These visits had an initiative to boost a cooperation between ESVERO and E.V.A. / “Transgender” Foundation as an community based organizations, as well as to get general overview about the situation of the girls, woman and TG in Russia in terms of the access to the HIV prevention, treatment, care and support programs and public healthcare in general.

In Moldova, the team visited one of the partner organization based in Chisinau and providing services for girls and woman- Mothers for Life. The visit had an initiative to boost a cooperation between UORN and MfL as an community based organization, as well as to get general overview about the situation of the girls, woman and TG in Moldova in terms of the access to the HIV prevention, treatment, care and support programs and public healthcare in general. During the visit round-up, the UORN Board member and the Director of Falesti District Hospital of the MoH of Moldova, Mr. I. Osoianu said: “The project initiative to tackle the gender equality issues into HIV/AIDS programs will help our organization to become one of the leading advocates in overcoming existing barriers in achieving the goal90/90/90 in Moldova”.

The project team met also with the representatives of WHO office in Moldova and agreed to get a legal copyright for the translation and using of the WHO document “Transgender Policy Brief” into Romanian language. WHO office agreed also to print the document in several copies for our project partners which is good start of the collaboration between the project and UN agencies.

During 26-28 April 2016 the intercountry high level meeting on health systems strengthening for enhanced tuberculosis prevention and care: Regional Eastern European and Central Asian Project (TB-REP) is taking place in Copenhagen, Denmark. This meeting is jointly organized by WHO/Europe and the Global Fund to Fight TB, HIV/AIDS and Malaria, and involves other project partners and supporters such as the London School of Hygiene and Tropical Medicine, and the London School of Economics and Political Science.

The meeting gathered decision-makers from 11 countries of EECA region. On the first day of the meeting the stakeholders received information about the project and the strategic benefits for countries, as well as an understanding of the vital importance of high-level political commitment. The second and third days will address technical aspects of the project, including health financing, TB prevention and care service delivery, and human resources’ development.

ICF “Alliance for Public Health” is a Partner of the TB-REP project which acts on behalf of the TB Europe Coalition in coordinating the high level advocacy efforts with the grass root advocacy of the CSOs in the EECA countries of the TB-REP. Alliance for Public Health at this intercountry high level meeting represented by Director of the Treatment Procurement and Supply Management Department, Dr. Sergii Filippovych, and Manager on TB advocacy, Yuliya Chorna.

Ukrainian delegation includes also representatives of Ministry of Health of Ukraine, namely Deputy Health Minister, Dr. Ihor Perehinets, Director of the Department of Public Health, Dr. Svitlana Ostashko, Deputy Head of the International Department, Ms. Olesia Tsykaliuk.
Read more about meeting objectives, Tuberculosis action plan here

On 26-27 April 2016, the Global Fund Board held its 35th meeting in Abidjan, Côte d’Ivoire. The Board approved a new strategy “The Global Fund Strategy 2017-2022: Investing to End Epidemics” aimed at maximizing impact, strengthening systems for health, promoting and protecting human rights and gender equality, and mobilizing additional resources. Also the Board approved several key documents reflecting the main decisions made at the meeting: eligibility policy, new policy on sustainability, transition and co-financing, challenging operating environments policy and methodology for the 2017-2019 allocations.

The three civil society delegations – Developing Countries NGOs, Communities and Developed Countries NGOs – worked hard to defend their positions, in partnership with Eastern Europe and Central Asia, Latin America and Caribbean as well as other constituencies. The Alliance for Public Health (Alliance) was represented by its Executive Director Andriy Klepikov, who is a member of the Developing Countries NGOs delegation. Natalia Nizova, Head of the Ukrainian Center for Socially Dangerous Disease Control of the Ministry of Health, also participated in the meeting as a member of the Ukrainian delegation.

Essential changes:
– Key population adjustment was added, namely the “Adjustment factor for populations disproportionately affected by HIV and TB, and in low endemicity malaria settings” to the list of qualitative factors to calculate the country allocations.
– During the clarification process, participants received assurance that sustainability & transition policy will be applicable to those countries currently transiting. Besides, to ensure successful transitions a greater emphasis was put on the transition readiness report. According to the changes introduced to the policy, for the greater assurance that transition process is going right, regular updates will be provided to the Strategy Committee.

– At this stage, the catalytic funding was approved for $800 million in addition to the country allocations. In case of successful replenishment exceeding USD 13 billion, there is a commitment that the Strategy Committee will review and increase the catalytic investments.

“Not all the changes we proposed have been accepted, there are still some serious concerns in regard to the new allocation model. The new methodology shifts primary focus to the countries with the highest burdens of the diseases and least economic capacity. The new formula will unavoidably lead to reduction of funding for middle-income countries with concentrated epidemics. Unfortunately, the new allocation formula will result in reduction of funding for two regions with the most rapidly growing HIV epidemics – Eastern Europe and Central Asia, and Middle East and North Africa. In comparison with the previous allocation approach for 2014-2016, the new allocation model in practice will lead to reduction of the share of funding for Eastern Europe and Central Asia from 4.7% to 2.4%, and for Middle East and North Africa – from 8.3% to 5.7%. Latin America and Caribbean will be given the smallest allocation in the new model – 2%. That is why the qualitative adjustments to the formula, up to $800 million catalytic funding, and another up to $800 million to ensure scale-up, impact and pace reduction, are critical to ensure for adequate response to the three diseases in our countries”, – summarized Andriy Klepikov, member of the Developing Country NGOs Delegation to the Global Fund Board, Executive Director of Alliance.

On April 21, 2016 in Ministry of Health of Ukraine was held the working meeting of all the stakeholders involved in the development of a national targeted social program to combat tuberculosis in the 2017-2021. The program of the working meeting included discussion the development of the outpatient treatment system of TB patients in Ukraine.

The meeting was attended by Director of the Public Health Department of the MOH of Ukraine S. Ostashko, representatives of the WHO Office in Ukraine, Chairman of the commission to terminate the SI “Ukrainian Center for Social Disease Control of the Ministry of Healthcare of Ukraine” N. Nizova, managers of international projects in the field of combating tuberculosis USAID, PATH, ICF “Alliance for Public Health”, Abt Associates, representatives of TB services in Donetsk, Vinnitsa, Poltava, Sumy, Dnepropetrovsk region, Kiev city, which introduced the pilot model of outpatient treatment of TB patients, representatives of the National Institute of Tuberculosis and Pulmonology of F. Yanovsky and representatives of the public organization “Social movement “Ukrainians against TB”.

With a welcoming statement to participants of the meeting appealed: Director of the Public Health Department of the MOH of Ukraine S. Ostashko, Director of the treatment, procurement and supply management department of ICF “Alliance for Public Health” S. Filippovych, medical adviser for TB, MDR-TB, TB / HIV activities of the WHO Country Office in Ukraine A. Slavuckij. Each of the speakers emphasizes the importance of joint efforts by all stakeholders for the preparation of high-quality national program.

The participants discussed the concept of health financing reform in Ukraine and the preliminary results of development of the new system of TB services’ financing.

Project Manager: TB Advocacy Y. Chorna, ICF “Alliance for Public Health” presented the aims and objectives of the regional project “TB in Eastern Europe and Central Asia Project on Strengthening Health Systems for Effective TB and DR-TB Control » (TB-REP).

The head of the public organization “Social movement “Ukrainians against TB” V. Rudenko acquainted all participants with the objectives of the advocacy strategy for the implementation of outpatient TB treatment models in Ukraine within the framework of the regional project TB-REP.

Representatives of TB services in the pilot regions of Ukraine presented the results of the implementation of outpatient treatment models of TB patients, the basic steps, barriers and suggestions to overcome them.
Participants of the meeting expressed their understanding of the need for determination and establishment of best practices experiences and their reflection in their national target social program to combat tuberculosis in the 2017-2021.

Presentation of the TB-REP project at the national level

Discussion of the experience of implementing the outpatient TB treatment models in the regions

In April 2016, the World Health Organization issued the updated Guidelines for the screening, care and treatment of persons with chronic hepatitis C infection.

The first version of the Guidelines was published in 2014. Since then, new direct acting antivirals (DAAs) have been introduced, allowing to improve cure rates up to 90% or higher, minimize side effects and shorten the duration of treatment.

In the updated version of the Guidelines, the peginterferon and ribavirin regimens were replaced with regimens using new-generation DAAs (taking into account specifics of certain patient groups). Telaprevir and boceprevir, as well as their combinations with peginterferon and ribavirin, are no longer recommended for the treatment of chronic hepatitis C.

Ludmila Maistat, Senior Programme Manager: Hepatitis/HIV Policy and Advocacy in Alliance for Public Health, who is a member of the WHO Strategic and Technical Advisory Committee for Viral Hepatitis, participated in the development of 2014 Guidelines as well as their updated version.

It is expected that the Guidelines will be regularly updated with the introduction of new drugs and regimens.

You may find the policy brief here.