SITUATION REPORT ON THE STATUS OF HIV/TB/HCV/OST PREVENTION AND TREATMENT PROGRAMS IN THE DONETSK AND LUHANSK OBLASTS (AS OF 27 JANUARY 2016)

ICF “Alliance for Public Health” in partnership with Contact Network (Switzerland) and AIDS Foundation-East-West (AFEW, the Netherlands) have conducted the second meeting for development of a regional program to the Global Fund on HIV and Tuberculosis responses among key populations in the Cities of Eastern Europe and Central Asia. This meeting took place on the 21-22 January 2016 in Kyiv, Ukraine.

 The goal of this program is the achievement of the UNAIDS model of ’90-90-90′ for key populations in cities of the EECA region as well as the to follow the End TB Strategy and the new Global Plan to Stop TBthrough the development of a Regional City Platform with the twinning and mentoring of cities in Western Europe. This platform provides for the sharing of experiences/best practices, development of political leadership among city policy makers, sustainable scale-up of services by developing an enabling environment and a conducive regulatory framework in cities, including sustainable funding to NGO service providers from municipal budgets. Key topics are: development of city service models, policies for key populations and HIV/TB/Hepatitis; political and financial engagement and collaboration between city authorities and NGOs.

NGO representatives from 10 countries, international stakeholders (UNAIDS, Global Fund), key population networks (SWAN, ENPUD, SCN, ECOM, ECUO), Stop TB Partnership and cities municipalities’ representatives took part in this meeting.

Participants discussed and endorsed the main objectives of the Concept Note as well as interventions and expected outputs of the programme. Also criteria for final cities’ selection were agreed.

The cities selected for the intervention in EECA are: Soligorsk (Belarus), Sarajevo (Bosnia and Herzegovina), Sofia (Bulgaria), Tbilisi (Georgia), Almaty (Kazakhstan), Bishkek, Osh (Kyrgyzstan), Beltsi (Moldova), St. Petersburg, (Russian Federation), Bucharest (Romania), Kyiv, Odesa (Ukraine).

On 18–23 January 2016, Odesa hosted Winter School 2016 «Public Health in Ukraine». Target audience of the School included medical doctors, epidemiologists, public health managers, researchers, educators, and representatives of civil society organizations. Among teachers there were speakers from the USA, the United Kingdom, and the Netherlands. During the week, public health professionals gained knowledge, shared their thoughts and professional experience.

School format — two parallel sections, with morning plenaries and afternoon discussions for all participants. Speakers representing ICF «Alliance for Public Health» – Tetyana Salyuk, Project Director: M&E-related Technical Assistance and Improved Data Application in HIV (METIDA), Liudmyla Shulga, Head of Technical Support at Alliance for Public Health, and Dr. George Rutherford, University of California, USA — worked in Section 1«Public Health and Basics of Epidemiology». In this section, the participants studied the basics of epidemiology of infectious and non-infectious diseases, principles of evidence base formation, terminology as well as basics of establishing dialogue among all public health players (European experience and lessons for Ukraine).

The Winter School was organized by the School of Public Health of the National University «Kyiv-Mohyla Academy» and UNICEF. The project was supported by M&E-related Technical Assistance and Improved Data Application in HIV (METIDA) Project, ICF «Alliance for Public Health», which provided grants to 30 applicants to participate in the School.

Besides, partners of the School included International Renaissance Foundation, USAID Project «Improving HIV/AIDS Services for Key Populations in Ukraine» (RESPOND) implemented by Pact, Inc. in partnership with Family Health International (FHI360), Maastricht University and the Ministry of Health of Ukraine.

Follow the link to see the Winter School’s booklet.

Alliance for Public Health is happy to greet our employee, Anton Basenko who successfully completed the selection process and became a member of the Community Delegation to the Board of the Global Fund.

The mission of the Communities Delegation is to ensure the voices and issues of people living with HIV, TB and affected by malaria influence the deliberations and decisions on investments and programmes of the Global Fund to achieve greater and sustained impact for communities. The goal of the Delegation is to ensure that our participation on the Global Fund Board results in Universal Access to quality prevention, treatment, care and support for communities living with and affected by the three diseases based on the principles of equity and human rights.

The Community Delegation has one vote in the Board of the Global Fund and is one of the 3 Delegations, comprising the advisory bodies to the Board of the Global Fund.

Anton Basenko as a representative of the international and regional PUD networks, OST clients and people living with HIV will bring his strong voice and support to the solving of problems connected to access to Global Fund programs for these communities.

The year 2015 was challenging both for the state and for non-governmental organizations providing
humanitarian aid and social support in Ukraine, nevertheless significant results have been achieved.

President of Ukraine Petro Poroshenko, speaking at the UN Sustainable Development Summit, noted
that the country was able to reduce HIV/AIDS incidence rates and make progress in combating tuberculosis.
To a great extent, those results were obtained through the coordinated efforts of government
and civil society, and Alliance for Public Health is proud that it has made its contribution into achieving
these results.

Here are our five highlights of the outgoing year which have formed a solid ground for 2016:

/1

New program ‘Investing for impact against tuberculosis and HIV’ helped to achieve major
country targets and avoid TB and HIV treatment interruption. In 2015 the prevention services
were provided to 192,000 people who inject drugs, 32,000 sex workers and 29,000 men who
have sex with men. This is 8% or 17,600 more than in 2014. The Global Fund awarded
Alliance the highest performance rating A1.

/2

Alliance has directed the largest part of its 2015 funding to stopping TB. Procured by Alliance
molecular genetic tests allowed to identify 80% of all new TB cases in Ukraine in 2015. Every
second MDR-TB patient receiving treatment in Ukraine is treated with drugs that were
procured, donated and delivered by the Alliance.

/3

We have made DAA Hepatitis C treatment a reality in Ukraine! Alliance procured Sofosbuvir
at the lowest price in the region, making the treatment available for the most vulnerable – over
300 HIV/HCV co-infected people who inject drugs. Based on this experience the Ukrainian
Ministry of Health has changed the treatment guidelines and re-oriented state procurement
prioritizing up-to-date DAA treatment.

/4

Thanks to Alliance support and dedicated efforts of social workers and physicians, prevention
and treatment projects are still operating in the areas temporarily not under control of the
Ukrainian Government. Humanitarian aid procured and delivered by Alliance to Donbas
during 2015 contained over 8.3 million pieces of tests, condoms, syringes and other
commodities, as well as 48,182 packs of TB drugs which made possible to maintain
uninterrupted MDR-TB treatment for 773 patients.

/5

Ukraine became a model for other countries requesting to learn from us. By the end of
2015 Alliance has provided technical support to 40 countries. In addressing a great demand
from different continents the Alliance Centre of Practice for HIV, Hepatitis C and Drug Use was
established in Kyiv combining Ukrainian and international expertize.

It was a year of transformation for Alliance: following 15 years of experience we evolved to become the
Alliance for Public Health to be in a stronger position to address the AIDS, Tuberculosis and Hepatitis
epidemics. As the Alliance for Public Health we will bring into 2016 our broader public health
commitment and our expertise in driving innovations and taking programs to scale to impact
the epidemics and to ensure sustainability. By working in partnership with you all, we will work hard
to change Ukraine and the world for the better!

On the World AIDS Day, Alliance for Public Health in collaboration with the State Administration of Railroad Transport of Ukraine, the Trade Union of Railway Workers and Transport Constructors of Ukraine, Convictus Ukraine, Eney Club Charitable Foundation and other civil society organizations conducted HIV testing on the main railway stations: in Kyiv, Dnipropetrovsk, Kharkiv, Vinnytsia, and Kryvyi Rih. According to preliminary estimates by 3.30 p.m. among 544 individuals tested over 3% were found to be HIV positive.

Media coverage of event:

Kyiv:

http://24tv.ua/kiyan_bilya_vokzalu_pereviryali_na_snid_n636…

Dnipropetrovsk: http://www.dnepr.com/…/20621-na-vokzal-bazhayuch-mogli-proy…

Kryvyj Rih: https://www.youtube.com/watch?v=9OWhZao2hA0

Vinnytsia: http://www.myvin.com.ua/ua/news/health/38614.html

On December 1st Alliance for Public Health together with Ukraine Railway Administration, Trade Union of Railway workers and partner NGOs will conduct HIV testing among railway passengers on the major railway stations of Ukraine: Kyiv, Dnipropetrivsk, Kharkiv, Vinnitsia, Kryviy Rih.

Passengers can undergo free HIV rapid testing and receive information materials and condoms right at the stations between 10:00 and 13:00 on December 1st.

Traditionally, on the World AIDS Day the Alliance for Public Health as a co-implementer of the National Targeted Social Program for Countering HIV/AIDS in Ukraine and co-recipient of the Global Fund to Fight AIDS, Tuberculosis and Malaria, would like to present the recent trends in the spread of epidemic and its achievements in the response to it.

The year 2015 was a hard year both for the state and for non-governmental organizations providing humanitarian aid and social support. The President of Ukraine, speaking at the UN Sustainable Development Summit, noted that the country was able to decrease HIV/AIDS morbidity indicators and make progress in countering tuberculosis. To a great extent, those results were obtained through the coordinated efforts of non-governmental organizations, civil society, social workers and volunteers. Alliance is proud that it has also made its contribution into achieving the above results.

Meanwhile, we do not have time to rest on our laurels. Ukraine continues suffering from the HIV/AIDS epidemic, and the year 2015 was not an exception. Currently, there are 127,400 people living with HIV officially registered with AIDS centers in Ukraine, though the estimated number of such people is over 217,500 (almost 0.5% of the general population). As a result of tough economic situation, military conflict in the East of Ukraine, humanitarian crisis and large-scale internal migration, the risks of spread of infectious diseases increase tens times. The most critical situation is observed in Donbas, which turns into a “black hole” of uncontrolled spread of dangerous epidemics!

Though the war has not influenced the official HIV statistics yet, the indicators among key populations are already aggravating. Thus, according to a recent biobehavioral study conducted by Alliance, HIV prevalence among people who inject drugs in Donetsk grew by 30% (from 26.5 to 34.7%), and in Luhansk – more than twice (from 3.2 to 7.3%).

Despite all the difficulties, thanks to Alliance support and dedicated efforts of social workers, prevention projects are still operating in the areas temporarily out of control of the Ukrainian Government. Within the challenging context, Alliance together with its international and local partners has already effected 6 deliveries of supplies to the areas in the East of Ukraine not controlled by the Ukrainian Government, in particular over 8.2 million units of medical goods, including 50 thousand tests for HIV, hepatitis, STI, 23 thousand packs of tuberculosis drugs, etc.

On the background of considerable intensification of sex work in the areas of military operations on the both sides of the war zone, special attention should be paid to the situation with unprotected sex. The results of a recent TNS study carried out at the Alliance initiative, 61% of over 3.500 respondents from among soldiers who came back from the war zone in the East of Ukraine or were conscripted to the military forces did not use condoms during the most recent sexual contact, and 18% had sex with casual partners. Such situation is due to the lack of condoms in military units and in individual aid kits and due to the insufficient awareness-raising activities in the military forces. Recently, Alliance initiated cooperation with the Ministry of Defense of Ukraine to arrange effective preventive activities among the troops.

Over ten years of prevention activities demonstrate a real impact on the epidemic in Ukraine, in particular among people who inject drugs (PWID). According to the official statistics, a reduction in the number of new HIV cases is registered on an annual basis. Thus, in 6 months 2015 1.900 cases of HIV were registered among PWID, which is almost twice less than in the same period of 2008 (3.500 cases). This trend in the PWID population starts leading to the reduction in HIV indicators among the general population: HIV prevalence went down by 15%, from 877 cases per 100 thousand tests in 2008 to 739 cases per 100 thousand tests in 2014.

The key area of Alliance activities – HIV prevention and treatment in the most vulnerable populations – remains the most effective strategy of HIV response in Ukraine.

Thus, in 2015 the minimum package of prevention services (in particular in the occupied Crimea and areas in the East of Ukraine not controlled by the Ukrainian Government) was provided to 192,000 people who inject drugs, 32,000 sex workers and 29,000 men who have sex with men. This is 8% or 17.600 more than in 2014. Preventive materials were distributed, including 14 million disposable syringes and needles and 10.2 million condoms. In 2015 Alliance through 84 local partner NGOs implemented prevention programs in the total amount of UAH 125 million and procured medical goods and health products for over UAH 380 million.

Rapid testing for HIV, in particular in mobile clinics of Alliance, which work in all regions of Ukraine, proved effective again: each further testing reduces the risk of infection by 36-52%. In 2015 the number of key population members who were tested with rapid tests within Alliance projects, was increased 2.2 times (168.600), which allowed detecting almost 40% more positive results, leading to 1.400 people with HIV getting registered with AIDS centers and 634 initiated on ART.

Four times more members of key populations were covered with screening testing for tuberculosis as compared to 2014. As a result, 10% of positive results were received, which is 2.4 times higher than last year. There were 405 people diagnosed with TB, with 350 of them initiated on treatment.

With support of Alliance, almost 8.400 people with drug dependence currently receive opioid substitution treatment (OST) with methadone or buprenorphine in Ukraine.

Advocacy activities of Alliance aimed at scaling up access to Hepatitis C diagnostics and treatment in key populations resulted in the launch of the first in Ukraine free treatment program for people with HIV/HCV co-infection with a new direct-acting antiviral agent, Sofosbuvir. Over 200 patients currently receive (or have already completed) their treatment, with 1,250 more patients to be provided with treatment next year.

War in the East of Ukraine, financial and economic crisis and corruption in state procurement this year nearly for the first time in the history of independent Ukraine endangered uninterrupted treatment for tens thousands of people living with HIV. In this context, prevention programs which were not funded from the state budget even in stable times may only count on the support of the Global Fund, which presented a clear requirement to the Ukrainian Government as early as in the beginning of the year: develop and implement an effective plan of gradual transition of prevention programs to state funding.

But so far Alliance together with its reliable partners continues withstanding the blow in the tough fight with the epidemic!

On November 30, 2015 Alliance of Public Health and the Ministry of Social Policy of Ukraine signed an agreement on cooperation in the framework of the project “Capacity development for Quality Assured Gender Sensitive Harm Reduction Interventions in Ukraine“, which is implemented with the support of Expertise France 5% Initiative.

During the project activities will be focused on development and implementation of training programs on delivery of gender-sensitive public health services. Particular attention will be given to HIV/AIDS prevention services and delivery of social and medical services to key risk groups. Training programs will be used as a Continuing Professional Development of the state social services working with families, children, youth and social workers of the non-governmental sector. This partnership is one of the best examples of cooperation between state and non-governmental sectors.

One the eve of 15th anniversary we are changing name to Alliance for Public Health. We are continuing to be the Alliance, the name we are known to nearly everyone working in our sphere, at the same time the new name corresponds to the real scope of our work and correlates with our vision of the future.

Determination to address HIV/AIDS remains in the core of our work, but no longer as a stand-alone issue. With the new name we are in a stronger position to address HIV/AIDS epidemics as well as Tuberculosis and Hepatitis. It reflects our broader public health commitment and our expertise in driving innovations and bringing programs at scale to impact the epidemics and to ensure sustainability.

Our new logo transmits multiple meanings. It may be associated with the three diseases we are focusing on, it can be interpreted geographically, keeping in mind Alliance work in Ukraine, in the region and globally. The colors resonate with Alliance family colors. It is a clear and solid logo, which reflects our 15-years’ organizational experience. It is forward looking logo.

We have refreshed our web-site showing who we are today to serve as a reliable resource in our dynamic world. It is in the test mode, you can access it at www.aph.org.ua

As Alliance for Public Health we will continue to support communities, to work in partnership with donors, civil society, governmental and international agencies to fulfill current tasks and effectively address future public health challenges.