Twenty-eight members of the management of special unit of the fourth territorial office of the Drug Control Department in Vinnytsia, Kirovohrad and Cherkasy oblasts for the first time ever took part in a one-day workshop “National Police, Harm Reduction and Human Rights” recently held in Vinnytsia with support of Alliance for Public Health (Alliance), Law Enforcement and HIV Network (LEAHN), and local, CBO “Independence Center”.

Pavlo Skala, Alliance Associate Director: Policy and Partnership and representative of the international Law Enforcement and HIV Network in Ukraine, rationalized the priorities in protection of human rights of people who use drugs – clients of harm reduction and opioid substitution treatment (OST) programs – based on case studies as well as his own practical and professional experience, presented to law enforcers considerable national and international experience in implementation of such programs, and new regulatory documents, which substantially deregulate the procedures of medical narcotic drugs turnover, in particular for the OST needs. Special attention was given to safety measures which should be observed by policemen to prevent HIV, viral hepatitis C and other socially dangerous diseases.

Roman Panasiuk, Head of the local office of the the Drug Control Department, was present at the workshop and took an active part in the training together with his subordinates.

The participants actively discussed challenges in the access to prevention services and OST with Irina Veretko, drug treatment doctor, and Oksana Oryshchuk, head of CBO “Independence Center”.

The knowledge obtained at the workshop is important for law enforcers not only in terms of general re-orientation away from the repressive approaches to drug dependence in compliance with the new state strategy in drug policy, but also in the context of re-qualification which is to be held in the nearest weeks.

Alliance in cooperation with local partners already held similar workshops for law enforcers in Kyiv, Lviv, and Kharkiv. Alliance is ready to support local initiatives to conduct such training events for re-qualified law enforcers in other regions of Ukraine.

Contact person: Natalia Kravchenko (044 490 54 85, ext. 235, kravchenko@aph.org.ua)

In January 2016, the first TB in Eastern Europe and Central Asia Project on Strengthening Health Systemsfor Effective TB and DR-TB Control (hereinafter – the Project) waslaunched. The Project is implementedwith the financial support of the Global Fund to Fight AIDS, Tuberculosis and Malaria (hereinafter – GF) in the countries of Eastern Europe and Central Asia (hereinafter – EECA).

 Period of project implementation: 2016 – 2018.

Overall goal of the Project is to improve TB and DR-TB treatment outcomes in the target EECA countries[1]through health systems strengthening, resulting in wide implementation of the patient-centeredapproaches in the delivery of TB prevention, treatment and care services.

Project objectives:

– To increase political commitment to end TB and MDR/XDR-TB through regional cooperation and evidence sharing for better governance of the National TB Control Programs.

– To develop and disseminate evidence on effective TB services delivery systems for implementation of the patient-centered approaches and innovative models of care.

– To ensure sustainable financing in TB Control and efficient funds allocation mechanisms.

With technical leadership of WHO Regional Office for Europe, the Principal Recipient of the GF grant to implement the Project is the Center for Health Policies and Studies (hereinafter – PAS Center, Republic of Moldova). Besides, a wide range of partners is involved into project implementation, including TB EuropeCoalition, on whose behalf ICF “Alliance of Public Health” acts, the European Respiratory Society, other academic and service institutions of the region.

One of the Project components is support of the activities of civil society organizations (hereinafter –CSOs) in TB advocacy. To achieve this objective, in November 2015 a call for proposals “Establishingsustained advocacy for transition to the outpatient model of health care for the key groups of population affected by TB” was announced. Based on the competition results, ten winning bidders were defined for organizations representing EECA countries (Republic of Azerbaijan, Republic of Armenia, Republic of Belarus, Georgia, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan,Ukraine, and Republic of Tajikistan).

Within the performance of project proposals, CSOs in partnership with the wide range of stakeholders inthe relevant countries should develop advocacy strategies aimed at the support of efficient and cost-effective outpatient model of health care for TB patients.

ICF “Alliance of Public Health”, which acts in cooperation with TB Europe Coalition for the Project implementation, is responsible for providing general technical support to CSO projects, coordination of advocacy activities, monitoring and exchange of best advocacy practices in EECA region

[1] Republic of Azerbaijan, Republic of Armenia, Republic of Belarus, Georgia, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan, Ukraine, Republic of Tajikistan, and Republic of Turkmenistan.

The results of competitive bidding to procure medical drugs for hepatitis C treatment in adults and children will be announced within the next few days.
For the first time ever, this important function was delegated to the United Nations Development Program (UNDP), which will make innovative treatment of hepatitis C (HCV) more accessible to several thousand patients in Ukraine. It depends on the final price of drugs which will be defined in the contract.

The price for a standard HCV treatment course with original direct – acting antivirals (including sofosbuvir) in developed countries varies from 30 to 80 thousand US dollars, but Alliance for Public Health (hereinafter – Alliance) back in 2015 was able to procure sofosbuvir at the lowest price for the original drug – USD 900 per standard 12-week treatment course. This price became a reference point of the “upper price limit” for the current UNDP tender within 2015 state procurement!

According to the data presented by the World Health Organization (WHO) last year, over 185 million people in the world are infected with HCV, leading to 350 thousand deaths per year. Only in WHO European Region, 84 deaths per year are caused by hepatitis C-related cancer and cirrhosis.

In Ukraine, the epidemic of HCV is growing every year. The main independent infectious disease doctor of the Ministry of Health of Ukraine, Head of theInfectious Disease Department of the Bogomolets National Medical University, Professor Olha Holubovska makes an emphasis on the critical situation with HCV in the country: “According to WHO, in Ukraine over 5% of people are infected with hepatitis C, in absolute numbers it is more than 2 million people. In certain populations, the rate of infections is much higher. Thus, based on the data of the Monitoring and Disease Control Center of theMinistry of Health of Ukraine, the level of infections among people who often stay in hospitals is around 12%, and among patients of drug treatment clinics – up to 67%.”

Back in 2009, Alliance initiated large-scale HCV screening in vulnerable populations, and since 2011such testing is offered to general populationduring mass campaigns held within the all-Ukrainian “Demand Treatment!” advocacy campaign. In 2013, the Ukrainian Government approved the first National Targeted Program of HCV Prevention, Diagnostics and Treatment. However, the state allocates funding only for the treatment component, covering only 20% of the existing needs, while other important components of the program, including diagnostics, are not covered from the state budget at all. As a result, we have a vicious cycle: not many people may afford quality diagnostics, which is quite expensive, and as a result the statecannot make a reasonable estimate of the need in HCV treatment, plus it is not really interested in it… due to state budget limitations.
In 2015, Alliance initiated the first program to offer treatment with a new-generation drug – sofosbuvir – which is expected to reach 2,000patients.According to the results of the first stage of the program, in over 90% out of several dozens of patients who already received treatment HCV was not detected! Based on our treatment experience, at the end of the previous year amendments were introduced to the Unified Clinical Guidelines “ViralHepatitis C”, and the drug was included into the State Register of Medical Drugs and the national list of drugs which may be procured with budget funds. It will allow to provide treatment to hundreds thousands of patients.

“Based on the practical experience of Alliance in expanding access to HCV treatment, we found that civil society and international organizations canmake an important contribution to the response to the epidemic. For this purpose, we consistently join our efforts with all stakeholders, – underlinesLudmila Maistat, Senior Program Manager: Hepatitis, Alliance for Public Health. – We anticipate that at the next session of the World Health Assemblymember states will approve the first Global Health Sector Strategy for Viral Hepatitis, into the development of which Alliance has also contributed.Provided that there is sufficient funding, reduced prices for direct-acting antivirals, and access to quality generic drugs, Ukraine has a good chance to successfully implement this strategy and radically scale up access to innovative HCV treatment.”

Due to the critical underfunding of the national hepatitis program, the drugs which are planned to be procured with state budget funds will cover thereal needs only in part. Alliance was able to launch treatment with support of the international donors, but the amounts and the timeframes of suchfunding are also limited.

Alliance implements its programs in close cooperation with the Ministry of Health of Ukraine, having developed a joint vision of eliminating theepidemic in the country – including only modern drugs into treatment regimens, in particular quality generics, holding further negotiations withpharmaceutical companies, reducing prices for diagnostics and expanding the network of diagnostic centers, training of doctors and patients, and making a special focus on most vulnerable populations, with large-scale preventive activities among the general population – those are the comprehensive measures which will help to eliminate the HCV epidemic!

The experience of Georgia may be used as an example of efficient approach in the response to HCV epidemic. Government of the home country ofcurrent Ukrainian Minister of Health covers 70% of the cost of HCV treatment in most disadvantaged populations, with the remaining 30% provided by the municipal budgets. For other categories of patients, the state compensates 30% of the cost of treatment, with the remaining 70% allocated between the local budget and the patient, depending on the income of the latter. Such funding scheme functions like a certain social guarantee for low-income citizens. Free treatment of the members of vulnerable populations was defined as a paramount and top-priority task as this approach, according to WHO recommendations, is one of the key factors in making an impact on the epidemic. In Georgia, where the population is much smaller than inUkraine, the Government reached an agreement with the manufacturer on allocation of 20,000 HCV treatment courses and financial donations to improve the system of patient registration and effective medical support of the project.

The results of HCV screening held among over 4 thousands of those conscripted to the military forces, those involved into the military operations in theEast of Ukraine and demobilized soldiers, held by Alliance in 2015, demonstrated a rather high level of infections – about 4%, and in the main military hospitals – even up to 10%, which made the Ministry of Defense of Ukraine and mass media finally turned their attention to this burning issue.

In the time of military conflict in the East of our country and long-term economic crisis, we need to join our efforts in response to the epidemic. Sharp reduction in the cost of diagnostics and treatment with advanced drugs, their procurement at adequate prices (taking into account the price already achieved by Alliance in 2015) will become crucial and prominent steps on this way, which will prove the commitment of the state to care about the health of its citizens and will allow saving thousands of lives even in 2016!

On February 17, Brussels hosted the EU HCV Policy Summit.

The Summit was attended by over 100 participants, including members of the European Parliament, national policymakers, representatives of the ministries of health from European countries. The Summit was aimed to define the global WHO strategy for viral hepatitis as well as discus and develop a joint Manifesto and call for active actions to eliminate the epidemic of hepatitis C. European best practices, including extended prevention services, treatment access for vulnerable populations, and effective harm reduction programs may play a key role in reducing the number of new infections.

At the Summit, Alliance for Public Health was represented by Ludmila Maistat, Senior Program Manager: Hepatitis C/HIV Policy and Advocacy and the Ministry of Health of Ukraine – by Professor Olga Golubovska, MD, PhD, Head of the Infectious Disease Department, Bogomolets National Medical University, Chief Infectious Disease Doctor of the Ministry of Health of Ukraine. Alliance and the Ministry of Health share a common position and vision of the strategy of elimination of HCV epidemic in Ukraine and in Europe. Ludmila Maistat read out the joint Manifesto “Our vision for a Hepatitis C-free Europe”. You can follow the link to read and sign the Manifesto:

http://www.hcvbrusselssummit.eu/elimination-manifesto

Name of the project: Improved Quality and Sustainability of Medication Assisted Treatment in Ukraine

Period of the project: 01 February 2016 – 31 January 2021

Total Project Cost: 2 500 000 USD

Number of grant agreement identification (FAIN): U2GGH001338

Legal background: The Agreement between the Government of the United States of America and the Government of Ukraine on Technical Cooperation and Assistance of May 7, 1992.

Donor: Centers for Disease Control and Prevention (CDC) under the United States President’s Emergency Plan for AIDS Relief (PEPFAR)

The purpose of this Project is to provide targeted technical assistance to medication assisted therapy programs (MAT) in Ukraine and stimulate its development in order to improve sustainability and quality of programs and long-term health and social outcomes of MAT clients.

The purpose will be achieved by meeting key objectives:

1. Development, testing, piloting and evaluation of financially sustainable MAT models in selected regions with the aim to replicate nationally,

2. Improvement of quality of care and increase MAT effectiveness by training program personnel on up-to-date guidelines and approaches and facilitation of the cascade trainings to the regions,

3. Implementation of Integrated Care Models of services to increase TB, ART and MAT provision to patients to improve health outcomes and quality of life,

4. Development and implementation of post-MAT service models to decrease the relapse rate among clients who discharge from MAT program.

The Project implementation strategy is based on the extensive and effective cooperation with State Institution “Ukrainian Center for Socially Dangerous Disease Control of the Ministry of Health” (UCDC) and Ukrainian Institute for Public Health Policy (UIPHP) therefore the project will benefit from synergy of input from key partners.

Alliance core efforts will be targeted at the general project implementation and coordination including selection of regions, development and implementation of MAT models, organization of integrated care, implementation of MAT completion/discontinuation model, advocacy of effective MAT models at the national and regional level.

UCDC involvement will be especially beneficial in organizational and methodological support, facilitate institutionalization of MAT models, policy changes.

UIPHP will assist in assessment, protocol development and implementation, clinical guidelines update and trainings conduction.

To ensure sustainability of the project activities and expanding of MAT Alliance will procure MAT drugs, supported by UCDC in the form of MoH Orders issuance. Strategy for project implementation will be in line with Healthy People 2020, PEPFAR priorities and strategies for Ukraine, SUNRISE and METIDA projects’ achievements.

Outcomes for development of new financial viability MAT models will include:

1. Gaining and dissemination of knowledge on at least three new and effective models with sustainable MAT financing, piloting and evaluation of those models and using data to scale-up effective models at national level for at least 1 000 patients.

2. Improving quality of care in existing MAT programs will result in training of at least 90 healthcare professionals, increased capacity and skills among them to provide MAT according to the updated guidelines, development and implementation of the quality monitoring and improvement systems in MAT programs.

3. Integrated treatment approaches will be enhanced by training of at least 50 health administrators on organizational aspects, as well as training of at least 60 health care professionals on knowledge and skills in providing integrated care, this will result that at least 25 MAT sites will provide key services (ART, TB) at the same location as well as increase in integrated services coverage in other MAT sites.

4. The outcomes of service delivery models after post-discharge treatment will be improved through refining knowledge and skills among program medical staff on current guidance on dose tapering and indications for MAT treatment completion and through increasing capacity of health care professionals to prepare patients for discharge and link them to rehabilitation programs will be implemented nationally.

Contact persons:

Filippovych Sergii, Director: Treatment, Procurement & Supply management, filippovych@aph.org.ua

Kolomiets Victor, Project Coordinator, kolomiets@aph.org.ua

It has not been long since Ukraine first started recognizing sofosbuvir as a highly effective drug for the treatment of hepatitis C virus (HCV); and only several months ago sofosbuvir was included into the National Drug Register and finally was listed in the tenders for the procurement of medicines within the state budget, which are first carried out through international organizations (in particular though the United Nations Development Programme (UNDP)).

While the state sector is only getting prepared for the long-awaited treatment with sofosbuvir, the Alliance for Public Health (hereinafter–Alliance) reports on the first successful results of treatment with this innovative drug.

In 2015, Alliance was the first in Ukraine to launch the program of sofosbuvir-based HCV treatment for 1,500 members of vulnerable populations, mostly for people with HIV/HCV co-infection and people who use drugs. Thanks to the cooperation with the Ministry of Health and support of international donors, as of 1 February 2016,379 patients, including 366 those with HIV/HCV co-infection, already accessed the effective treatment.

203 patients have already completed their treatment courses! As per the set standard, 12 weeks after completion of the therapy patients are to go through a follow-up examination – and it shows that in 90% of those who receive treatment HCV is undetectable. This is a huge step forward as compared to the old treatment regimens (peginterferon + ribavirin), when the indicator of successful treatment outcome was no more than 50%. After sofosbuvir proved to be effective in the pilot HCV treatment program implemented by Alliance, in 2015 the drug was included into the Unified Clinical HCV Treatment Guidelines.

Within the Alliance treatment program, Ukrainian doctors have a chance to consult with international experts and participate in trainings on the innovative international practices of hepatitis treatment. As for the patients, they get not only drugs, but also social support of non-governmental organizations, which allows ensuring higher adherence to treatment and increases the probability of successful treatment outcome.

In January 2016, the second phase of Alliance HCV treatment program started, which will cover at least 500 patients. We hope that the recently announced tender for sofosbuvir procurement with state budget funds through international organizations (UNDP) will be held in a transparent and effective manner, and the price for the drug will not exceed Alliance procurement price for 2015! In 2014, Alliance managed to negotiate significant price reduction with the manufacturer, which allowed for the first time in Ukraine to procure sofosbuvir at the price of USD 900 per course (in some countries the price for such treatment course may exceed USD 80,000 (!)). It should be noted that it were the activities initiated by Alliance, such as the all-Ukrainian “Demand Treatment!” advocacy campaign and the innovative treatment program, which encouraged not only concerned civil society advocates but also public officials and doctors to talk about the HCV epidemic, with the National Targeted HCV Treatment Program finally approved.

We realize that it is only the beginning. The patients who receive or are expected to start the therapy represent only a small share of patients who urgently need treatment. But the first steps have been taken, and it gives hope to thousands of patients with hepatitis C in Ukraine. The Alliance for Public Health continues systematic efforts to advocate for the interests of people who are in need of life-saving treatment both at the national and international levels.

Contact person: Myroslava Andruschenko 095 271 09 31, andrushchenko@aph.org.ua

On the eve of St. Valentine’s Day, Alliance for Public Health (Alliance) would like to remind you about the importance of “individual protection means” – condoms, which present a universal and effective way to prevent sexually transmitted infections (STI).

Condoms are an integral part of prevention services, which with support of Alliance are provided by non-governmental organizations to members of most vulnerable populations, including sex workers.

In 2015, 13.7 million male condoms and almost 41 thousand female condoms were distributed free of charge within Alliance programs. Over 285 thousand people were reached with HIV and STI prevention services, including almost 37 thousands of commercial sex workers. Over 203 thousand people got tested with rapid tests for HIV, and 67.6 thousand – for other sexually transmitted infections. As a result of screening among the members of vulnerable populations, 4.2% tested positive for Chlamydia, 2.6% – for hepB, and 2% – for gonorrhea and syphilis. Almost 2% of those tested for HIV received positive results.

According to the official statistics, 126.6 thousand people living with HIV were registered in Ukraine as of January 2016. If in the beginning of the century the main route of HIV transmission in Ukraine was through blood (up to 70%) and HIV was mostly spread among the members of vulnerable populations, since 2008 there has been a steady tendency towards the increase in the sexual route of transmission. According to the Ukrainian Center for Socially Dangerous Disease Control of the MoH of Ukraine, in 2015 only 22% of cases of HIV infection were related to drug use, with 60% being related to sexual contacts (with no account of data from the occupied Crimea and the Donbas areas temporarily not controlled by Ukraine).

It is an evidence of the significant change in HIV transmission trends and stable prevalence of the sexual route of transmission, which increases the thread of the infection going out of the concentrated circle of vulnerable groups to their sexual partners and more general population.

HIV is no longer the problem of vulnerable populations only. Today anyone who has unprotected sex is in the risk group!

Current situation in our country brings new risks. In the context of armed conflict in the Eastern Ukraine, humanitarian crisis and mass internal migration, the danger of the spread of HIV and other sexually transmitted infections becomes almost 50 higher. The most critical situation is observed in Donbas, which is becoming kind of a “black hole” in terms of uncontrolled spread of dangerous epidemics! Considering significant intensification of sex work in the areas of military operations on both sides of the conflict line, the issue of unprotected sex in the military settings deserves special attention. According to the results of a recent study by TNS conducted in cooperation with Alliance, 61% out of over 3.5 thousand respondents from among the military did not use condoms during the most recent sexual intercourse, while 18% had sex with casual partners. Currently, negotiations are underway between Alliance and the Ministry of Defense on transfer of several hundred thousand condoms in the places of troop disposition, rotation and training centers.

If you are in love, protect yourself and your loved ones, enjoy safely, remember about risks and try to avoid them!

Contact person – Natalija Kravchenko, (044) 490 54 85 (ext. 235), kravchenko@aph.org.ua

Web: www.aph.org.ua, Facebook: www.facebook.com/AlliancePublicHealth/

13 February

International Condom Day

ENPUD member, INPUD Board member, Global Fund Advocates Network Speakers Bureau member and Alliance for PublicHealth employee, Anton Basenko, has, with technical support of Regional Platform, successfully nominated by Alliance and ENPUD for participation in Stakeholder Task Force for the 2016 High Level Meeting and received an invitation from the head of UNAIDS Michel Sidibe to take part in preparation of High Level Meeting on AIDS/HIV 2016 as a representative ofStakeholder Task Force of UN General Assembly President.

Stakeholder Task Force mission is to provide guidance to UNAIDS and the OPGA in key decisions relating to the effective and meaningful participation of civil society and all relevant stakeholders in the High Level Meeting on AIDS to be held in New York in 2016.

The Goal of Task Force members is to provide guidance to the OPGA for, among other things:

● Designing the Civil Society Hearing (CSH), including format, topics, messages, speaker selection & preparation, and provide input to President’s CSH Summary Report.

● Devising selection criteria and the call for nominations for civil society and all relevant stakeholder speakers

● Identifying, recommending, preparing and briefing civil society and relevant stakeholder speakers for all CSH and HLM interventions

● Briefing civil society and relevant stakeholder participants during the High Level Meeting.

Participation of Anton Basenko in preparation of the meeting guarantees that voice and needs of people from PUDnetwork, OST clients and people living with HIV in the world and EECA region will be heard on Civil Society Hearing andconsidered on the High Level Meeting on AIDS to be held in New York in 2016.

Within the efforts aimed at expanding the access to hepatitis C (HCV) treatment in vulnerable populations, Alliance for Public Health holds a working meeting and a training for 70 healthcare professionals and representatives of NGOs from 15 oblasts of Ukraine, involved into implementation of the second phase of Alliance DAA-based HCV treatment program. In January 2016, a new phase of program implementation commenced, allowing 500 more patients to access effective HCV treatment.

On 3 February 2016, members of the working meeting in Kyiv, including representatives of the Ministry of Health, the Ukrainian Center for Socially Dangerous Diseases Control, chief doctors of healthcare institutions, NGO managers, doctors, civil society activists, and patients with HCV, discuss the ways to reinforce partnership and improve the efficiency of HCV treatment in Ukraine within the second phase of Alliance treatment program.

The training for healthcare professionals and social workers of NGOs on 4-5 February 2016 will include presentation of theoretical materials and development of medical and social support skills in HCV treatment in vulnerable populations using multidisciplinary approach, prevention of re-infections, use of innovative drugs in HCV treatment, and treatment monitoring.

Alliance expands access to hepatitis C treatment for vulnerable populations in Ukraine

Starting from January 2016, Alliance for Public Health launched the second phase of program for vulnerable populations, which stipulates treatment of hepatitis C virus (HCV) with innovative direct-acting antiviral agent, Sofosbuvir.

Thanks to the National Campaign “Demand Treatment!” initiated by Alliance and persistent advocacy activities in cooperation with partners from all regions of Ukraine, in October 2013, for the first time in Ukraine, Peginterferon and Ribavirin-based HCV treatment program was launched, and since2015, also for the first time in the country, Alliance initiated treatment with Sofosbuvir. As of 1 January 2016, there were 320 patients involved into the program, with 161 of them having already completed their treatment courses (mostly all of them demonstrated undetectable HCV at their final tests). Before the end of the year, at least 1,500 patients will have access to such treatment. Advocacy efforts of Alliance as well as confirmed treatment success of Sofosbuvir allowed including it to the State Register of Medicines and the Unified HCV Treatment Guidelines, opening the way for government procurement and inclusion of the drug into the state-funded treatment programs.

This year, HCV treatment will become available in five more regions of Ukraine (the total of 14 oblasts will be reached), with planned coverage of at least 500 patients. The list of healthcare facilities which offer treatment and NGOs providing support to patients is available here.

According to the updated criteria of patient selection, the treatment will be accessible not only to people with HIV/HCV co-infection, but also to members of other vulnerable populations, in particular opioid substitution treatment patients, people who inject drugs, commercial sex workers, etc. with no HIV.

Important notices for the patients who comply with selection criteria:

• In oblasts, which offer treatment only in AIDS centers, such treatment will be accessible only to people with HIV.

• Alliance, supporting I Speak Out Now! anti-corruption campaign of the Global Fund (http://www.ispeakoutnow.org/home-page-ru/), draws attention to the fact that one of the priorities of HCV treatment program is protection of the rights of patients from among vulnerable populations, in particular their right to free treatment. If any corruption situations occur when enrolling patients into the program or if there are any unreasonable proposals from the project staff to receive illegal rewards from patients, please write the details of such situations to Alliance e-mail porada@aph.org.ua.

Alliance does not rest on its oars, but continues its advocacy and treatment efforts to make an impact in response to the HCV epidemic in Ukraine.