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.

On 13-17 April 2016, Barcelona hosts an annual meeting of the European Association for the Study of Liver (EASL) – International Liver Congress, ILC 2016.

 Every year, this Congress is attended by over 10,000 participants: doctors, hepatologists, scientists, representatives of pharmaceutical companies, microbiologists, and government officials of the member states. This event is a great opportunity to share professional achievements and develop effective strategies.

Ludmila Maistat, Senior Program Manager: Hepatitis, Alliance for Public Health presented the results of the effective work to expand access to HCV treatment in Ukraine and in EECA region. Significant updates and important comments to the presentation on the access to treatment were made by Professor Olga Holubovska, the main independent infectious disease doctor of the Ministry of Health of Ukraine, head of the infectious disease department of the Bogomolets National Medical University.

Tetyana Barnard, Project Manager: HCV Treatment, Alliance for Public Health also took part in the Congress as a part of the Ukrainian delegation.

Within the Congress, members of the Ukrainian delegation will take part in a number of meetings with key partners and international stakeholders with a view to expand Alliance programs in Ukraine, strengthen cooperation with partners and develop a plan of further steps.

Two advisory committees met in Copenhagen, Denmark, on 4–5 April 2016 to guide new action plans on HIV/AIDS and viral hepatitis for the WHO European Region.

The importance of this rigorous consultation process was highlighted, especially for the action plan on viral hepatitis, as it is the first plan on the prevention and control of viral hepatitis in the WHO European Region.

The aim of the new HIV/AIDS and viral hepatitis plans is to boost efforts to achieve zero new HIV and hepatitis infections, zero discrimination and zero AIDS-related deaths in the region.

52 experts, representing ministries of health, national HIV and hepatitis programs, civil society organizations, academia, United Nations agencies, major partner organizations, WHO headquarters, country offices and WHO collaborating centers took part in the discussions.

At the advisory committee, Ukraine was presented by Ludmila Maistat, Senior Program Manager: Hepatitis, Alliance for Public Health and Professor Olga Holubovska, the main independent infectious disease doctor of the Ministry of Health of Ukraine, head of the infectious disease department of the Bogomolets National Medical University. Alliance for Public Health cooperates with the Ministry of Health to expand access to the effective programs of treatment for members of key vulnerable groups as well as general population, to develop a new National Program of Hepatitis Treatment for 2017-2021 in line with the new WHO recommendations and to strengthen cooperation at the national and regional levels.

Ukrainian representatives were part on the advisory committee which prepared an action plan for the European region, which was developed at the World Health Assembly and will be adopted in May 2016.

You can learn more about the meeting here

http://www.euro.who.int/en/health-topics/communicable-diseases/hivaids/news/news/2016/04/europe-shapes-new-action-plans-on-hivaids-and-viral-hepatitis

In March 2016, the first phase of the Project “Scaling up accessible and effective HCV treatment through community-based treatment model for most vulnerable populations in the resource-constrained Ukraine” was successfully competed. Meanwhile, recruitment of patients for the second phase of the project is underway.

Since June 2015, 450 patients representing key populations got access to HCV treatment in 11 healthcare facilities within the first phase of the project, which is 80% more than the planned indicator. Increasing the number of treatment courses available was possible due to the use of pegylated interferon procured within the state budget, which allowed reducing the duration of treatment to 12 weeks and increasing the number of courses.

As of 1 April 2016, 183 new patients received access to hepatitis C virus (hereinafter – HCV) treatment within the second phase of the project, and thus the total number of patients covered with treatment is 633 people.

93% participants of the first phase had HIV, and 94% of them received ART. 80% were people injecting drugs, with 8% of them being OST program clients. 15% of project participants had previous treatment failures when treated with two-component regimen: pegylated interferon + ribavirin. The success of innovative treatment is proved with sustained virological response observed in 90% of patients.

List of criteria for enrolment into the second phase of the project, list of healthcare facilities offering HCV treatment and NGOs providing support to patients may be found here.

Today, on April 6th, 2016, the Mayor of Kyiv Vitaliy Klitchko signed the Paris Declaration of commitment to fighting AIDS making Kyiv one of 60 cities globally that took this commitment. The declaration was initiated by the Mayor of Paris and UNAIDS in 2014 and sets the plan to achieve the 90-90-90 HIV treatment targets by 2020, which will rapidly reduce new HIV infections and AIDS-related deaths and put the world on the Fast-Track to ending AIDS by 2030.

Today the HIV situation in the city of Kyiv is critical. Out of the estimated 32 500 people with HIV in Kyiv only some 11 700 are registered with AIDS facilities, which is 1 in 3 HIV-positive persons knowing his/her status. Only 5000 are accessing ART in Kyiv.

‘There is a strong need to substantially improve case finding in Ukraine’s capital, broaden and decentralize ART and reinforce prevention programs for men who have sex with men – the group where the HIV epidemic is actively developing and where coverage of prevention interventions is low’, says Tetiana Deshko of Alliance for Public Health.

Alliance for Public Health applauds the initiative of the Kyiv municipality and of Mayor Klitchko. Alliance has been supporting AIDS response in Kyiv for decades through the Global Fund program providing annually 34 Million Hryvnias for HIV, Tuberculosis and Hepatitis C prevention, care and treatment programs using the network of HIV-service organizations and healthcare facilities. Annually, some 25 327 (81% of estimated PWID in Kyiv) PWID, 7 145 (67%) sex workers and 12 922 (36%) MSM are reached with these programs, with some 2.1 Million syringes, 2.9 Million condoms distributed for free annually.

Alliance together with Kyiv municipality led the predevelopment of the regional Concept Note to the Global Fund on HIV/TB responses among key populations in the cities of Eastern Europe and Central Asia. Mayors of the 12 cities of the 10 countries in the region joined Kyiv leadership in commitment to responding to AIDS in this funding request.

On 24 March 2016, activities dedicated to the World TB Day were held almost all over Ukraine with support of Alliance for Public Health, calling to Unite to End TB.

About 15 CSOs played an active role in the campaign. To draw public attention to the issues of TB, raise awareness in TB prevention and early detection, information materials were distributed thought mass media and awareness-raising classes were held, including lectures for students of professional and higher educational institutions, and individual counseling on early TB diagnostics was conducted.

About 3,500 copies of information materials “Tuberculosis” and “Tuberculosis is Curable” were distributed and about 2,500 people were screened with the help of special questionnaires for presence of tuberculosis symptoms. In case of detecting any people with tuberculosis-like symptoms, recommendations were given on the need to seek medical assistance in treatment facilities.

Alliance for Public Health was featured in a case study included in a new advocacy brief for community-led organisations ‘Advancing combination HIV prevention’, produced by the International HIV/AIDS Alliance and UNAIDS. The publication aims to support community-led organisations make the case for greater investment in HIV combination prevention at national, district and local levels.

The case study highlights how Alliance for Public Health supported Kenyan AIDS NGOs Consortium and its partners in Kenya harm reduction programme development within Dutch-government funded project Community Action on Harm Reduction in 2011-2015. The project improved access to HIV prevention treatment and care for people who use drugs, their partners and children; advanced their rights; and increased the capacity of civil society and government stakeholders to deliver harm reduction and health services to communities of people who use drugs.

‘Practical, effective tools that have proved efficient in Ukraine have been swiftly taken to practice in Kenya. When we are thinking about how fast-track can be achieved in AIDS, horizontal exchange is one of the most effective solutions. Alliance Centers* that accumulate technical knowledge is a good example of facilitating horizontal exchange’, says Andriy Klepikov, Executive Director of Alliance for Public Health.

Full publication is provided during Civil Society Hearing in New York this week, and can be downloaded here.

*Alliance Centres of Practice have been set up by International HIV/AIDS Alliance to bridge the gap between evidence and practice in order to end AIDS. All Centres are hosted by Alliance Linking Organisations. They draw on their individual expertise to connect, bring together and develop the Alliance’s collective knowledge, experience and community links on specific expert areas. Alliance for Public Health hosts the Centre on HIV, Hepatitis C and Drug Use. More information on Alliance Centres available here: http://www.aidsalliance.org/centres.