Results of phase I Global Fund grant

1. VII Stakeholders meeting 21st October, 2005 Results of phase I Global Fund grant

2. Overcoming the HIV/AIDS epidemic in Ukraine Results of phase I Global Fund grant Andriy Klepikov Alliance Ukraine, International HIV/AIDS Alliance in Ukraine, Executive Director Alla Scherbinska, National AIDS Center, Director Natalia Leonchuk All-Ukrainian PLHA Network Coordinating Council, Deputy Head VII Stakeholders meeting 21st October, 2005

3. Presentation structure • Main programme characteristics • Structure of Phase I investment • Geographical distribution of efforts • Main achievements • Increasing access to AIDS Treatment • Developing care and support for PLHA • Scaling up focused prevention • Building supportive environment • Progress against the key targets • Challenging areas of implementation • Did the programme succeed?

4. Expenditure summary Ukraine - Phase I expenditure

5. Expenditure – Budget vs. Actual

6. Expenditure profile

7. Partnership in numbers: • 303 health carefacilities supplied with medicines and other health products • 135 organisations have participated in the program implementation during phase one • 256 grants/contracts/agreements were signed during 18 month period

8. Geographical distribution of efforts Distribution of funding across the regions of Ukraine (1 April 2004 to 30 Septemeber 2005)

9. ART scale-up in UkraineAugust 2004 – April 2005 Regions which began ART during phase 1 Regions which began ART during phase 2 Other regions

10. ART scale-up in UkraineAugust 2004 – September 2005

11. ART implementation in Ukrainefrom August 2004 to September 2005 Based on sources of financing

12. ART INFLUENCE ON THE AIDS MORTALITY RATES: ANALYSIS OF DATA FROM DONETSKS OBLAST

13. Scaling up ART in Ukraine training of specialists in the Regional Knowledge Hub • 18 trainings were conducted for 437participants from 15 regions of Ukraine, where ART has been introduced • 223 specialists were trained: • 172 adult ART specialists • 96 doctors, • 47 nurses, • 29 socialworkers • 23 paediatric ART specialists • 9 doctors, • 8 nurses, • 6 socialworkers • 28 laboratory specialists

14. Strengthening laboratory base (I) • 4 flow cytometers were purchased for immunological testing as well as test-kits for them, for 8000 examinations. • Flow cytometerswere installed at: • National AIDS Center • Crimean republican AIDS Center • Odesa oblast AIDS Center • Dnipropetrovs'k oblast AIDS Center • Immunological testing was initiated in April 2005 • 2hematological analyzers withreagentswere purchased for 10000 tests • Analyzers were installed at: • Donetsk oblast AIDS Center • Dnipropetrovs'k oblast AIDS Center • Put into function in February 2005

15. Strengthening laboratory base (II) • 3 set of equipment for HIV viral loadlevel evaluation were purchased as well as kits for themfor 5000 tests • The equipment was intended for the National, Crimean republican and Odesa oblast AIDS centers.Equipment and test-kits have not yet arrived into Ukraine due to registration of the new format of equipment and test-kits • Equipment for early HIV diagnostics for children of HIV-infected mothers was received. • This equipment was installed at: • National AIDS Center • Crimean republican AIDS Center • Odesa oblast AIDS Center

16. Providing care and support for PLHA Supported: • 52 projects • 37organisations • 17regions Based on the following directions of activities: Community center for PLHA –8 projects Non-medical home based care –8 projects Self-help groups for PLHA –18 projects Therapeutic camps –4 projects Childrencenters –5 projects Comprehensive support rendering to PLHA–4 projects PLHA support in prisons –5 projects

17. Number of regular clients of the projects(through September 2005)

18. Comparative number of regular clients of the projects(April 2004 – September 2005)

19. Referring to ART(January – September 2005)

20. PLHA advocacy at the regional level In 11 regionsPLHA-communityrepresentatives are members of regional (city) HIV/AIDS Coordination Councils andparticipate in decision-making:Kyiv,Odesa, Poltava, Kharkiv, Donetsk, Chernihiv, Kherson, AR of Crimea, Mykolaiv, Kirovograd, Cherkasy. 15 regions regularly cooperate with mass media in order to develop tolerance toward PLHA. Cooperation with regional human rights organizations was established (particularly, with regional partners of the Vinnitsa Human Rights Group) in order to react to facts of PLHA rights violation.

21. Integrated HIV prevention programming • Over 70,000 IDUs, 8,000 SWs, 1,700 MSM, and 8,000 prisoners accessed prevention and information services throughout Ukraine • Supporting integrated programmes providinglegal, social and medical support and counselling, IEC materials, community mobilisation activities (self-help groups etc), provision of prevention commodities • Supportingintroduction of additional services: care for HIV positive IDUs, drug treatment and rehabilitation etc. • Utilisingthe links of community mobilisation, rehabilitation and re-socialisation services to safer behaviour

22. Integrated HIV prevention programming (cont.) • Achievements • Well established and stable NGO-based provision of core services and information • Increasing rapport with the vulnerable communities • Growing coverage of the programmes • Ongoing expansion into new regions and rural areas • Challenges • Persisting repressive policies dominating law enforcement system • Unavailability of effective drug treatment services (primarily substitution maintenance treatment)

23. Prevention, advocacy and awareness raising activities among the general population • 180 000 of 5th grade pupils from 8 000 schoolsall over Ukraine provided with study books and covered by life-skills based HIV/AIDS education. • 669 teachers are trained to deliver programs for primary and secondary schools • Aproximatelly 20 million people reported being covered by two media campaigns (‘Let’s be together! Let’s be humans!’ aimed to promote solidarity with people living with HIV/AIDS and ‘Your Health – In Your Hands!’, to educate people about available ARV therapy in Ukraine.

24. Building Supportive Environment • M&E capacity of key partners significantly strengthened (Ministries, NGOs, AIDS Centres) • Outcome and impact oriented planning, setting challenging targets, target driven projects • Strong partnership and collaboration of the key stakeholders: • Stakeholders consultations • Participatory planning of the phase II • Memoranda of Understanding • Extensive partners’ involvement in program implementation and evaluation

25. Treatment and C&S for PLHA: Targets vs. Actuals

26. General Prevention: Targets vs. Actuals

27. Focused Prevention: Targets vs. Actuals

28. Obstacles met in the course of initiating Substitution Maintenance Therapy(SMT) • Political(lack of political will and support from the state authorities toward program implementation) • Regulatory (no MoH regulatory documentswhich would regulate the SMT process. At the same time, effective regulations which relate to drug control considerably limit SMT implementation) • Organizational(lack of necessary experience in procurement and implementation of SMT in Ukraine): • - It took almost 2 monthsfor the “Sociotherapy” clinic to obtain the status of humanitarian aid recipient. • - It took nearly half a year to conclude a quadripartite agreement between the state company “Liky Ukrainy”, PATH, “Sociotherapy” clinic and the company-supplier “Rusan-Pharma” as it was practically impossible to finalize the budget for the “Liky Ukrainy” services. • - Obtaining a humanitarian aid status for buprenorphine supply (there was no procedure for granting humanitarian aid status to narcotic drugs) • - Receiving a permit from the Drug Control Committee to import Addnok (import of buprenorphine in ready-to-use form was not provided for in respective “Quotas” for 2005)

29. Constituents of Success(as set at the 1st stakeholders meeting on April 8th 2004) • Renewal of the grant for years 3 to 5 • Considerably improved access to treatment • Significant coverage of focused prevention efforts in selected areas • State public health system ready to take over the clinical care work • Fully operational CCM resume programme oversight and strategic guidance