Programme Update Overcoming HIV/AIDS Epidemic in Ukraine

Programme Update Overcoming HIV/AIDS Epidemic in Ukraine National programme supported by GFATM Presentation by I. Borushek, L. Shurpach, L. Hyde and P. Smyrnov at the 2ndStakeholders’ Meeting on the GFATM Grant to Ukraine, Kyiv, June 3, 2004

Treatment, Care and Support

Procurement of health-products • ARVs • Non-ARV medications and baby formulas • Diagnostic equipment and reagents

ARV supplies • Emergency delivery (for 137 patients) expected to start arriving on the 1st week of June • Main delivery (for 2000 adult patients) is expected to arrive during the 3rd week of June • Main delivery of paediatric formulations (for 100 children) is expected in the first half of July

ARV supplies • Specifications for ARV drugs for prevention of mother-to-child HIV transmission (PMTCT) and post-exposure prophylaxis (PEP) are approved • Permission of the Global Fund to procure ARVs for PMTCT and PEP through IDA obtained

Procurement: what’s done • Local logistical companies recommended by MoH assessed by an independent expert • Agreements • concluded with Ukrainian Centre for AIDS Prevention on provision of humanitarian aid in the form of ARVs; • prepared with logistical company “Ukrmedpostach” on handling ARV shipments upon arrival • Documents submitted to the Humanitarian Aid Commission at the Cabinet of Ministers of Ukraine (hearings are expected on June 3)

Procurement: what’s in progress • Ongoing working contact with MoH, National AIDS Centre, IDA, and PATH is maintained • Agreement with IDA on procurement of ARVs for PMTCT and PEP is being prepared • Tender documentation for procurement of medications for management of opportunistic infections and equipment for CD4 testing (with reagents) is being prepared • Specifications for infant milk formula for children born to HIV+ mothers and equipment (with reagents) for viral load and CBC testing are in progress

Clinical subcomponent Grant Agreement with Ukrainian Centre for AIDS Prevention of the MoH of Ukraine for implementation of the project «Organization of medical care provision to people with HIV and AIDS» budgetUSD 246,000 First steps of the project: 1. Treatment preparedness of the 6 priority regional AIDS centres (by definition of the MoH) is assessed 2. Meeting of head physicians of the regional AIDS centers to be the 1st stage treatment sites (Odesa, Donetsk, Dnipropetrovsk, Mykolayiv, AR Crimea, Kyiv) held jointly with MoH and the Alliance 3. Multidisciplinary treatment model adopted 4. Specifications for pharmaceuticals and medical equipment to be procured under the project developed 5. Drugs distribution plan for the regions for the 1st stage of ART implementation is prepared

Clinical subcomponent Created Specification Review Committee for review and approval of specifications for health products to be procured representing: • International HIV/AIDS Alliance Secretariat (UK) • ICF „International HIV/AIDS Alliance in Ukraine” • Ministry of Health of Ukraine • Ukrainian Centre for AIDS Prevention • Clinic of the Institute of Epidemiology and Infectious Diseases of AMS of Ukraine • World Health Organization (WHO) • All-Ukrainian Coalition of HIV-service NGO • All-Ukrainian Network of People Living with HIV • Program for Appropriate Technologies in Health (PATH). Observers: Local Fund Agent (PWC), USAID,Delegation ofEuropean Commission to Ukraine (EU), DFID, MSF-Holland in Ukraine, Embassy of Japan in Ukraine.

Clinical subcomponent On May 26, 2004 the Specification Review Committee has approved the following specifications: • Drugs for management of opportunistic infections; • Drugs for prevention of mother-to-child transmission; • Drugs for post-exposure prophylaxis; • Diagnostic equipment and test-systems for CD4 testing; • Drugs for substitution therapy for HIV+ injecting drug users.

Clinical subcomponent • RFAs announced: • “Provision of technical assistance to the clinical component implementers in planning, implementation and monitoring of treatment programmes" , • “Provision of a comprehensive unified professional training programme under the project “Overcoming HIV/AIDS epidemic in Ukraine" • Applications Review Committee to assess the received applications is being formed.

Care and support Grant Agreement with the national charitable organization «All-Ukrainian Network of PLHA» for implementation of the project “Ensuring care and support for people living with HIV/AIDS”, budgetUSD 801,000. Components of the project: • Non-medical home-based care • Self-help movement development • Psychosocial care and support (community cеntre) • Provision of comprehensive care to PLHA • Care and support for HIV+ children and women • Care and support in penitentiary institutions • Social entrepreneurship • Training andinternships programme

Care and support Grant Agreements with existing partners are being prepared for signing: А) Social and psychological ARV treatment support • NGO «Time for Life +» (Clinic of the Institute of Epidemiology and Infectious Diseases known as Lavra Clinic) • NGO «Self-help club «Life+» (Odesa AIDS Centre) Б) Rehabilitation of HIV+ injecting drug users • NGO «Rehabilitation Centre «Steps» В) National hot line on HIV/AIDS issues • CF «Substance Abuse and AIDS Prevention Foundation» (SAAPF)

Care and support • RFA announced:„Social and psychological ARV treatment support in Kyiv, Dnipropetrovsk, Donetsk, Mykolayiv oblasts and AR of Crimea” for partner NGOsto work with AIDS Centres • Applications Review Committee to assess the received applications is being formed

Care and support RFA announcements prepared for the following projects: • Care and support for HIV+ pregnant women, young mothers and infants (up to 6 mnths.) born to HIV+ mothers to prevent mother-to-child HIV transmission • Introduction of substitution therapy • Psychosocial rehabilitationof HIV+ drug users

Prevention in Vulnerable Communities

Achievements to date • Expert meetings held on the following issues: centralised/decentralised procurement of disposables, mutual coordination of the Global Fund and World Bank programmes, prevention in penitentiary institutions. • Grant agreement with IRF has been signed. • 9 grant agreements with local partners are signed. • Expert Committee and Proposal Review Committee are formed. • Training on Project Monitoring and Evaluation for local partners is developed. • Coordination mechanisms for all prevention programs at the oblast level are being developed.

Requests for Applications. Prevention • RFAs on HIV prevention in Kyiv, Mykolaiv and Odesa oblasts are about to be launched (geographical expansion of prevention activities – 5 new grants). • RFAs on HIV prevention in penitentiary institutions is being developed (2 new grants). • Tender on logistical support of the training programme is being finalised.

Expected Results. Prevention • 32000 people will receive HIV prevention services in 8 priority regions. • At least 2500 people will get access to HIV prevention services as a result of launching 5 new projects in Kyiv, Mykolaiv and Odesa oblasts. • At least 13500 people will receive HIV prevention services in 13 “second line” regions. • At least 2000 imprisoned people will receive access to information, means of hygiene and protection, and services of peer support groups. • More than 300 local project staff will participate in 17 trainings. • Inter-sectoral prevention programmes will be launched in penitentiary institutions.

Creating an Enabling Environment through Information, Education, and Advocacy

One-off grant to the Network of PLHA for Memorial Day events. • Participation in the 10th Kyiv International Media Fair. • Publications: 4th edition of HIV/AIDS and the Media, new Policy and Advocacy Update, programme update, PLHA booklet Recently Diagnosed (with MSF).

National communication strategy • A strategy coordinating all AIDS-related work in Ukraine. • Working group formed; collecting assessments and research carried out in Ukraine to serve as a basis of a strategy. • Advocating for the strategy. • UNAIDS ‘three ones’ principles of unified strategy, unified M&E system and unified country coordinating body.

HIV prevention through the education system • Series of RFAs for developing and piloting educational programmes and materials, running training courses for teachers and peer educators. • One grant to Ukrainian Scientific and Methodological Centre of practical psychology and social work of the MoES for advocating for subcomponent activities. • Seven regional resource centres (RFA for NGO/government coalitions).

Advocacy • Small grants to NGOs working on advocacy issues around vulnerable groups. • Grant to a national human rights organisation working with PLHA Network alternative information. • Trainings, round tables for militia and prisons administration on basis of regional resource centres (involvement of trainers supported by UNDP).

IEC work with vulnerable communities • Grants for local NGOs to produce materials tailored to local situations. • Grants for national level publications. • Working group assessing existing materials for inclusion in a database.

Monitoring & Evaluation

Component activities • Program monitoring and evaluation of the Global Fund project (all four components) • Monitoring and Evaluation Plan • Supporting development of the National M&E system

Program update Routine and sentinel surveillance Ukrainian AIDS Center was identified as a key partner organization for conducting sentinel surveillance. Grant agreement between the Alliance Ukraine and AIDS Center on improving system of routine epidemiological surveillance and on conducting sentinel surveillance was signed.

Program update Working group on protocols and instructions development As a start-up activity of work within the component, previous PR work plan has been reviewed and discussed. On its basis, a working plan for the M&E component was developed. Consultations with international organizations such as UNAIDS, UNDP, WB, AFEW, WHO etc., international consultants, research institutions and Ministries as to the activities suggested in the working plan were held in the beginning of April. As a result of this process, several principal decisions have been made: • to establish a working model of the M&E system by supporting its crucial components, such as epidemiological and sentinel surveillance • to conduct surveys and research in order to obtain information on National indicators and report to UNGASS • to establish an expert working group for development of standard methodology and analysis of the results of social research • to establish a working group which would facilitate official recognition of methodology on National indicators

Program update Special studies Under the UNAIDS coordination 2 expert groups where established for operationalizing and standardising M&E data collection protocols The developing of the standardized protocols and methodical recommendations is working on such process: Expert sociological group Main research organisation representatives Working group on protocols and instructions developing Representatives from core ministries Approving by Technical Working Group on the Strategic Planning Process/UNGASS) Officializing Publishing

Program update Special studies on national indicators • Currently, the social research expert group is effectively working on development of standard methodical recommendations for behavioral research. • As a result, standardized methodical recommendations and questionnaires for sentinel surveillance among IDU and FSW have been developed, approved by TWG SPP/UNGASS and prepared for tender. Work on methodical recommendations and questionnaires for BSS among youth and MSM is in progress. • Work of the expert group on surveys in structure of Second Generation Surveillance is done in close cooperation with AIDS Center.

Program update Working group on protocols and instructions developing The Alliance M&E team was actively participating in preparation of the Cabinet of Ministries of Ukraine Decree aimed to recognize national indicators and designate responsible Ministries. In order to begin a process of data collection and to be able to report to UNGASS session on national indicators, a plan of survey activities and actions on indicators, which will be not covered by the research, was developed.

Monitoring and Evaluation of the GF program Monitoring and Evaluation Plan • enable the collection of baseline data and the subsequent monitoring of changes in the course of the program/project • develop common standards and guidelines regarding the scope and quality of monitoring and evaluating programs • to establish causal relationships between the activities of a particular program and results

Monitoring and Evaluation of the GF program Monitoring and Evaluation Plan Structure • Introduction • Key Indicators • Collecting, Reporting and Managing • Using • Quality and Accuracy • M&E plan table

Key indicators • Groups of indicators • Process, coverage, impact • National, international indicators, program specific indicators • Treatment, care and support, prevention, IEA, capacity building

Collecting and Reporting • Systematic data collection is the first and vital element of well functioning M&E system. • Software monitoring tool for programmatic activities and reporting • Reporting forms • Reporting requirements – quarterly basis, step approach • Frequency – will depend on the indicator • Responsibilities for data monitoring • Regional focus

Global Fund Alliance R&R Alliance workplan Collecting information Alliance report Stakeholders NGO/IO review NGO/IO workplan NGO/IO report Process of the reporting and sharing information

Quality, accuracy • Assessment to assure minimum capacities to successfully conduct monitoring and evaluation activities within the project • Monitoring visits to assure proper monitoring and reporting practices • M&E Technical Assistance

M&E plan • Structure of the plan • expected results • Indicators • timeframes for monitoring of each indicator • data source for verification of monitoring data • frequency of data collection for each indicators • person responsible for the data collection • Connection with master work plan • Main function of the plan • to be a useful management tool • To be a tool for evaluating results of the particular program

Programme Update Overcoming HIV/AIDS Epidemic in Ukraine