Progress in implementation of the GF-supported R1 & 6 Grants by the ICF “International HIV/AIDS Alliance in Ukraine

1. 15th General Meeting of Stakeholders 28 August 2008 Progress in implementation of the GF-supported R1 & 6 Grants by the ICF “International HIV/AIDS Alliance in Ukraine : Andriy Klepikov Executive Director, International HIV/AIDS Alliance in Ukraine

2. Major achievements by 1 July 2008: • Start up of the methadone-based substitution therapy 273 patients (first patients from the end of May 2008) Total patients on ST: 1100 persons • AIDS mortality rate continues decreasing in 2008 New AIDS cases: 4 573in 2007 vs. 4 723 in 2006 2295 over ½ 2008 (2372 over ½ 2007) • 5 684 patients taking ART(63% of total number of 9005 GF+state budget) • 9112 pregnant women received PMTCT (planned: 8575) • 4 major indicators of the R6 Programme: IDU, FSW, MSM, inmates prevention coverage - exceeded • Start up of the STI screening and treatment among IDU, FSW, MSM (16 294 syphilis tests, joint action plan with the MoH) www.aidsalliance.org.ua

3. 1 Year R6: key achievements • 94 grantees received funding 202 grant agreements with total budget of UAH 12 252 971 +58 organizations got condoms for prevention programmes (total number of sub-grantees: 152 organisations) • «Peer Driven Interventions»:intervention piloted by 5 NGOs till October 2007. 15 implementers in regions starting from May 2008. • Community centers for IDU and FSW: 27 in 22 cities of Ukraine • Pharmacy interventions: 30 pharmacies in 8 cities, 2000 clients, 15 000 visits • VCT with rapid tests: 42 274 rapid tests in prevention projects • 14 mobile clinics (VCT+HIV rapid tests, syphilis, chlamydia and gonorrhea): start up from 1 October 2008 • HIV prevention among injecting stimulants users: start up from 1 October 2008 www.aidsalliance.org.ua

4. Open call for proposals:2008-09 Programme year, interim results • 12 prevention directions were announced • The CFP budget is $ 8,3 mln • 93 NGOs out of 128 applied pre-approved www.aidsalliance.org.ua

5. STI area: cooperation progress • The MOH Working Group established and action plan, to give access to the STI diagnostics and treatment for vulnerable groups, approved • 4 regional trainings for the STI doctors (50 people) and All-Ukrainian joint meeting of the regional AIDS Centers chief doctors and regional STI doctors • 66 agreements on diagnostics and treatment concluded between NGOs and STI clinics • Agreement with the Academic Institute of Dermato-Venerology signed to develop method guidelines on STI treatment among vulnerable populations • 55 658 syphilis rapid tests procured and delivered to all regions (16 294 syphilis screening tests conducted ) www.aidsalliance.org.ua

6. Achievement of Rounds 1 and 6 main programme indicators * - Round 1 only ** - Round 6 only www.aidsalliance.org.ua

7. Key targets on coverage: end of Year 2 of R6 Programme implementation www.aidsalliance.org.ua

8. Alliance Ukraine’s Expenses vs Budget of the Rd 1 Year5: October 2007 – June 2008 (USD) • *Budget performance percentages • Total: $13,399,566 or 82% www.aidsalliance.org.ua

9. Expenses of the 1st Year Rd 6 vs budget for August 2007 – June 2008 (USD) • *Budget performance percentages • Total: $3,520,253 USD or 68% www.aidsalliance.org.ua

10. Summary budget by component of the Year 2 Rd 6 Grant: July 2008 – June 2009 www.aidsalliance.org.ua

11. AU Organisation development plans • Strategy for transition from the Country Office of Alliance to an independent Linking Organisation with a membership at the Global Alliance Partnership (statute reviewed and new governance bodies to be set up by the end of 2009 1st quarter) • Strengthen internal compliance and programme oversight. New position of Senior Advisor on compliance and internal procedures (by the PR and sub-grantees) • Develop an action plan to respond to evaluation recommendations– after finalizing External Evaluation Report of the National 2004-2008 HIV/AIDS Response, incl. GF grants implementation. • Improve quality of work with sub-grantees (develop and implement a technical assistance provision plan, introduce and support development of new EFR reporting; better oversight and quality assurance of services provided by the Alliance-Ukraine sub-grantees within the GF and other donors’ programmes). www.aidsalliance.org.ua

12. Major challenges: SMT • Slow enrollment of patients for the methadone-based SMT (the MoH Order № 295 of 04.06.2007 not implemented in the AR of Crimea, Zaporizhzhya, Mykolayiv and Kherson oblasts) • Lack of state health system structure to take responsibility for the SMT programmes. The health care settings lack staff to work with SMT patients; there is no state centralized monitoring system for the SMT projects including patients’ records and drugs for SMT. No unified system for SMT patients registration. • 2007 state budget for buprenorphine-based SMT was not spent, while there is no money for SMTin 2008 state budget at all • Current legal regulations on narcotic drugs do not allow a comprehensive SMT implementation; they require urgent review. The SMT patients are “chained” to points of drugs provision; it is not possible to administer liquid methadone. www.aidsalliance.org.ua

13. STI: challenges and responses • Late treatment start up: the MoH issued the Order № 325 „On distribution of STI treatment drugs among the risk groups procured with support of the GF grant” only on 18 June 2008 • The current official STI management system of diagnostics fails to account for peculiarities of diagnostics and treatment of HIV vulnerable groups as well as for complexity of epidemiology; System requires urgent review. Plans: • Establish a national coordination centre of STI diagnostics and treatment among vulnerable groups • Develop Instruction on conducting STI screening tests among vulnerable groups • Procure and deliver the gonorrhea and chlamydia rapid tests for mobile clinics • Develop postgraduate training module for doctorson the STI among the risk groups www.aidsalliance.org.ua

14. Prevention: challenges and responses • Risk of delays in procurement and supply of syringes and other medical goods by the MoH with the World Bank HIV loan to the projects supported by the GF; • Lack of national mechanism of coordination, analysis and adaptation of prevention programmes among the vulnerable groups as well as care and support. Plans: • Establish an external expert working group on HIV/AIDS prevention among the vulnerable groups (in coordination with current WGs on M&E, treatment and ST, STI, and prevention among MSM). • Initiate re-establishment of subcommittees of the National HIV/AIDS and TB Coordination Council www.aidsalliance.org.ua

15. ART and PMTCT: problem areas • ART is offered to appr. 35% of those who need it; • Continuation of treatment and PMTCT after the GF funding is over (from 1 October 2008), incl.: • ARV drugs for 6000 patients as well as HIV-positive pregnant women and newborns • Laboratory follow up for treatment and PMTCT • Multi-disciplinary approach and psycho-social support for the ART patients • Training of medical staff in ART issues and other aspects of medical care of HIV-infected and AIDS patients, incl. palliative care • Introducing the ART clinical monitoring system • Provision of milk formulas for the PMTCT from local budgets www.aidsalliance.org.ua

16. Education component handover to the GoU Achievements: in close cooperation with the Ministry of Education regular Health Promotion curricula introduced; course books developed and experts trained. Problem • The Ministry of Education has limited state support for continuation of prevention programmes from September 2008 • Low priority for HIV prevention via education system at the operational level and in budget provision on the level of CabMin • Low institutional and financial capacity of the Ministry of Education Next steps • Special analytical report with practical recommendations on capacity building and budgeting of further prevention activities via education system • National round table on prevention via education system to develop practical steps on the component handover • Advocacy of the state responsibility for continuation and scaling up the prevention programmes via education system with the mass media involvement www.aidsalliance.org.ua

17. Humanitarian aid status Problem • The Government refuses to grant a humanitarian aid status to the medical drugs and goods procured with the GF grant (Round 6) • Estimated amount of customs and tax duties - 50 mln. UAH by 2012. Progress: 0! • The CabMin Commission on Humanitarian Aid refused repeatedly the Alliance Ukraine in granting a humanitarian aid donor status with reagrd to medical goods procured with GF grant • Alliance Ukraine received no answer to the letters addressed to the Vice Prime Minister, the Minister of Health and the President during last months Possible steps: • Start a new advocacy campaign to attract media and public attention • Arrange meetings with the Prime Minister of Ukraine and Verkhovna Rada of Ukraine. • Initiate amendments to the relevant legislation of Ukraine www.aidsalliance.org.ua