Component Overview Overcoming HIV AIDS Epidemic in Ukraine National

Component Overview Overcoming HIV/AIDS Epidemic in Ukraine National programme supported by GFATM Presentation by I. Borushek, L. Shurpach, L. Hyde and P. Smyrnov at the Stakeholders’ Meeting on the GFATM Grant to Ukraine, Kyiv, April 8, 2004

Components of the Programme 1. Improving and Scaling Up Treatment, Care and Support for PLHA 2. Focused Prevention in Vulnerable Communities 3. Enabling Environment through Information, Education, and Advocacy 4. Guiding Performance through Improved Surveillance and Evaluation System

1. Treatment, care and support • ARV procurement and supply management • Treatment planning, implementation and monitoring • Fine-tuning of treatment protocols • Building capacity of treatment facilities through comprehensive training programs

Treatment, care and support (continued) • Procurement and delivery of medical equipment and medications for OI management, post exposure prophylaxis, PMTCT, substitution therapy • Broad package of non-medical care and support services • Implementation of substitution therapy programs for HIV+ IDUs

ARV drugs procurement and management • Treatment, care and support component will be implemented in collaboration with Mo. H • Memorandum of Understanding between Mo. H and International HIV/AIDS Alliance is to be signed soon • Oleg Zalata is appointed to coordinate the GF project on behalf of the Ministry • Ukrainian AIDS Center has been appointed the recipient of ARV medications • Mo. H has approved the list of medications to be procured for treatment of 2100 people • Negotiations with IDA regarding the procurement are completed, conditions agreed, the contract is in progress

Procurement and delivery of non. ARVs and medical equipment • To be implemented with the help of PATH (Program for Appropriate Technologies in Health) • Procurement based on international tenders • Terms of reference developed jointly with Mo. H

Treatment planning, implementation and monitoring Implementer: Ukrainian AIDS Center • Methodical support of the treatment • Building capacity of AIDS centers / treatment sites • Introduction of a treatment and monitoring database • Development of national treatment protocols for pregnant and breastfeeding women, protocols of non-medical and palliative care • Monitoring the use of diagnostic equipment • Research on introduction of HIV drug resistance testing

Technical assistance in treatment planning, implementation and monitoring Selection criteria for TA providers: 1. Extensive treatment implementation experience (including in resource limited settings). 2. Experience of TA provision, building partnerships and introduction of treatment in other countries. 3. Training program. 4. Comprehensive disease management system. 5. Willingness to contribute to the Program implementation.

Building capacity of treatment facilities through comprehensive training program Selection criteria for training providers: 1. Experience of work in HIV/AIDS 2. Extensive partnerships with various agencies (national, international, governmental, non-governmental, Mo. H, and academic sector) 3. Solid capacity to implement a comprehensive national training program 4. Ability and right to certify trainees

Non-medical care and support Continued work with NGOs that started their work at the first stage of the project implementation and demonstrated progress in the following directions: • development of self-help groups, psychosocial care and support, non-medical home-based care (All-Ukrainian Network of PLHA + 26 local partner organizations), • rehabilitation of HIV+ drug users (Rehabilitation center “Steps”), • national hotline (Substance Abuse and AIDS Prevention Foundation), • medical and social aspects of treatment provision, treatment adherence support (Time for Life + Kiev, Life + Odessa).

Treatment, care and support (continued) Development of new directions of work (tender based approach): • medical and social aspects of treatment provision, treatment adherence support (NGOs together with AIDS centers) in Donetsk, Dnipropetrovsk, Nickolayev, AR Crimea, and Kiev. • care, psychosocial support for pregnant and breast feeding women and their children and building their ARV treatment adherence skills; • development of drug rehabilitation and substitution therapy programs for HIV+ IDU receiving ARV treatment and developing their ARV treatment adherence (NGOs jointly with narcological dispensaries or AIDS centers); • development of the hospice care and creating specialized unit at the Institute of Pulmonary Disease in Kiev to be postponed until the next phase of the project implementation.

2. Focused prevention (What has been done) • Situation assessment in 23 cities and towns of 8 oblasts • 23 HIV prevention projects among vulnerable groups supported • Project activities extended to small and medium towns • 8 trainings for local implementing partners conducted • Regular monitoring and technical assistance

Focused prevention (Planned Activities) • 25 HIV prevention projects among vulnerable groups to be supported in 8 priority regions • Cherkassy oblast is determined as a new priority region • HIV prevention projects among vulnerable groups to be supported in 13 non-priority regions. Preparation for the “second wave” of expansion • 3 HIV prevention projects among prisoners to be supported • Technical assistance and monitoring • 15 trainings and seminars for local implementing partners

Focused prevention (Existing Partners) • International Renaissance Foundation – main partner in HIV prevention program among vulnerable group (project support in 4 priority and 13 non-priority regions; training program and monitoring — through the British Council) • State Penitentiary Department of Ukraine – prevention programs in penitentiary facilities • International HIV/AIDS Alliance

Focused prevention (Call for Partnership) • Expert group on procurement of prevention commodities • Stakeholders’ participation. Expansion of partnership • Development of quality standards for HIV prevention programs among vulnerable groups

3. Creating an Enabling Environment for HIV/AIDS work in Ukraine Harmonised IEA campaign on a national and regional level: through schools, regional resource centres, media, public events, specific activities with key organisations and institutions (e. g militia, local authorities), targeted publications.

IEA support for prevention and for care and support: • IEC materials, best practice, media support, experience exchange, series of advocacy activities. IEA support for research and evaluation: • National indicators on media monitoring, coverage in education establishments. Coordination and harmonisation: • A joint communication strategy for Ukraine.

Five sub-components: 1. Mainstreaming of HIV prevention in the education system 2. Working with and through media 3. IEC work with vulnerable communities 4. National and local level advocacy 5. Coordination, documentation, sharing

HIV prevention in the education system • New curricula (materials, teacher training). • Peer-education system (through eight regional resource centres). Collaboration and partners: • Ukrainian Scientific Methodical Centre of Practical Psychology and Social Work of Mo. ES (existing partner). • regional resource centres (open tender for NGO/government coalitions). • Partners for materials and training development.

Working with and through media • Support for journalists and editors. • National public awareness campaign. Collaboration and partners: • Training on basis of regional resource centres • Training programme developed by working group. • Bulletin for journalists, media monitoring. • Open tender for media agencies to develop National public awareness campaign. • Public events.

IEC work with vulnerable communities • Assessment, reprint of existing IEC materials. • Online database of Russian/Ukrainian language resources. • New materials produced centrally and locally. Collaboration and partners: • Working group for assessment (building on existing work with BC, IRF). • shared ownership of resource database. • Grants to NGOs for new materials.

Advocacy for an enabling environment • National level advocacy around PLHA rights • Local advocacy around vulnerable groups (uniformed services, prisons administration, local authorities) Collaboration and partners: • National advocacy grant for 2 national or international NGOs (to work on PLHA rights) • Training on basis of regional resource centres • Open tender for small grants to local NGOs

Coordination, documentation, sharing • • Best practice publications for all components Exchange visits. Keeping the ‘AIDS community’ informed. A joint national communication strategy? Collaboration and partners: • Bursaries for exchange visits. • Existing coordination structures (e. g UN theme groups). • Working group to develop a joint strategy?

4. Surveillance and Evaluation (goals and objectives) • Supporting necessary improvements of the national epidemiological surveillance system including introduction of regular and well-structured sentinel and behavioral surveillance • Supporting social research necessary to improve understanding of epidemiological trends and development of appropriate responses • Supporting the development of the financial and managerial efficiency assessment system • Supporting development of national response evaluation system • Monitoring and evaluation of the project performance

Existing situation • At the beginning of the 2003 there was an increasing need in monitoring and evaluation of country response to HIV/AIDS expressed as by National bodies as well as by international donors • Existing information on financial, administrative, behavior, and epidemiologic aspects of HIV/AIDS in the country appeared to be rather sporadic and fragmentary

Actions already taken To address this issue the following actions were taken by HIV/AIDS community: • National indicators were developed in series of workshops • Assessment of the current M&E system and practices on HIV/AIDS in Ukraine • The plan of the National M&E System was drafted with involvement of all key players

Next steps • GF project is called to support the National M&E system • To implement this goal the following steps will be taken: – To follow up on draft of the National ME plan – To create an expert group, coordinated and on the base of UNAIDS technical group on strategic planning, to formulate recommendations on sampling, methodology and tools for research on indicators

Next steps (cont. ) • To actively involve key Government bodies in the process in order to build their capacity for the future • Developed methodology will be discussed on UN technical group on strategic planning and made available to public • Open tenders will be conducted for each research and survey • After research will be performed, data will be analyzed and results will be distributed

Topics for research • The following research activities are included in the plan: - BSS on groups vulnerable to HIV (IDU and CSW) parallel with testing on biomarkers (second generation epidemiologic surveillance) - BSS on youth - Research project on stigma and discrimination among general population

Other areas of interest • Other potential research topics within the 1 st year: - Research or BSS on MSM issues - Research or BSS on persons in uniformed services - Research to provide information on composite policy index and amount of national funds spent on HIV/AIDS - Research on prison population

Expected results • Unified methodology for assessing country is developed and made available to public • Conducted research and activities provides information on about 18 indicators • Other indicators could be possibly covered by other donors (WB, EC, UN agencies, etc. ) or by data collection which is already in place (for PMTCT or blood transfusion indicators)

Other work within GF Research and Evaluation component • Technical support to AIDS centers for enhancing of routine epidemiologic surveillance • Assessment of financial and managerial efficiency • Monitoring of GF project activities