EUROPE BUREAU PROGRAMS OVERVIEW

REGIONAL ADVISORY GROUP

KIEV, UKRAINE

17 JUNE 2014

Mass HIV screening of general population (not high-risk groups)

Centralized and Compartmentalized

HIV system

Bureaucracy, stigmatization,

paternalism

Lack of evidence-based approach

Workforce shortage, high staff turnover

Challenges to AIDS Control in the Region

1. Targeted to high-risk groups outreach rapid testing with linkage2. Decentralized ART, integrated care (HIV, TB) in one location close to client3. Simplified procedures, staff education on service provision and client-orientation4. Implementation of 12 Principles, regular data collection and quality review5. Task-shifting, payment to staff based on performance

AHF Europe Care Model As a Response to ChallengesAHF Europe Care Model As a Response to Challenges

Targeted advocacy to bring political priority and adopt the model

HIV is not a priority for the Governments

•7 European countries

•More than 100 testing sites

•More than 45 000 people tested since the beginning of year

•More than 1800 positive results since the beginning of year with targeted linkage

•More than 1 000 000 condoms distributed

RAPID TESTING PROGRAM

AHF SUPPORTED MODEL: DRAMATICALLY INCREASED IDENTIFICATION OF HIV+ CLIENTS

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* Leningrad Oblast, 8 months of 2013

Most of them would not be identified by state-run provider-initiated testing model

•37 PIT sites in the most affected by HIV areas + outreach/mobile testing

•Target groups: IDUs, SW, MSM, general population, young people, migrants

•More than 17 000 people tested*

•Seropositivity rate 3.4%

•More than 180 000 condoms distributed** Since the beginning of year

UKRAINE

•21 testing sites across country + outreach/mobile testing

•Target groups: IDU, SW, MSM, General Population, Young People

•Almost 5 000 people tested*

•1.5% seropositivity

•More than 75 000 condoms distributed** Since the beginning of year

LITHUANIA

•33 testing sites throughout the country + outreach/mobile testing

•Target groups: IDUs, SW, MSM, general population, young people, migrants

•More than 4 500 people tested*

•4.2% seropositivity

•More than 65 000 condoms distributed** Since the beginning of year

ESTONIA

•40 testing sites in Krasnoyarsk, Tatarstan, Yekaterinburg and the region, St Petersburg, Leningrad region + outreach/ mobile testing

•Target groups: IDUs, SW, MSM, general population, young people, migrants

•More than 15 000 people tested*

•Up to 14% seropositivity

•112 000 condoms distributed*

* Since the beginning of year

RUSSIAN FEDERATION

•Currently 12 ART sites in Russia: Leningrad oblast, StPetersburg, Krasnoyarsk region

•21 decentralized ART sites in Ukraine: Kiev and oblast, Odessa and Oblast, Mykolayv and Lughansk oblasts (Crimea: 2009/2014)

•Linda HIV Foundation clinic in Narva, Estonia (EU)

CLINICAL PROGRAM

MODELS OF SUPPORTING CLINICAL OPERATIONS (AT GOVERNMENT-OWN SITES)

Model 1 (Public healthcare in Russia and Ukraine) Model 2 (NGOs in Russia and Ukraine)

Model 3 AHF Europe Bureau result-based management system:

top ups tied to team performance on clinical indicators (revised quarterly)

Doctor 1 Doctor 2 Nurse Social worker Peer Doctor 1 Doctor 2 Nurse Social worker Peer

Doctor 1 Doctor 2 Nurse Social worker Peer

Other financial sourseAHF salary

AHF SUPPORTED MODEL: – MORE THAN DOUBLED COVERAGE OF ART

AHF SUPPORTED MODEL: – INCREASED ART COVERAGE AMONG PATIENTS

AHF SUPPORTED MODEL:– REDUCTION IN MORTALITY

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*including Kiev Boyarka site (TB/HIV Clinic with MRD TB) !!!

KIEV BOYARKA – UNIQUE AHF PROJECT• Situated in Kiev Regional TB Hospital• 20% of patients – pulmonary TB • 80% - extrapulmonary TB, including nearly 50% with TB meningoencephalitis• 25% of patients – with confirmed MDR-TB

Before AHF support:0% of patients tested for HIV0% of patients tested for CD40% of patients on ARTNo OI testing and treatment

With AHF support100% of patients tested for HIV95% of patient tested for CD4+85% of patients on ARTOI testing and treatment availableDocumented 25% mortality decrease in 2013 vs 2012

LINDA CLINIC – FIRST COMMUNITY OWN AND OPERATED HIV CLINIC IN EUROPE

• Situated in most affected by HIV town in EU – Narva (Estonia)

• 3000 HIV positive people

• 80% are current or former IDUs

• Low ART coverage

LINDA CLINIC

• Currently patients get ARVs at the city or regional hospital• Linda Clinic currently provides all required medical care and psychosocial support, including lab tests as required

by EACS guidelines• Court decision on providing the clinic with ARV was in favor of the clinic

DATA MANAGEMENT SYSTEM• Own database with all key information (GlobalTrack)

• Bi-weekly quality inquiries to sites concerning:- Missed appointments,- Eligible but not on ART patients- Causes of death- CD4 and VL testing- Lost-to-follow-up patients

• AHF global benchmarks - Percentage of eligible patients not on ART- Percentage of lost-to-follow-up patients- Percentage of patients who have had CD4 test doen in the last 12 months- Percentage of patients who initiated ART within 14 days after being eligible- Mortality rate

Country

Mortality rate for 2013

Percentage of eligible clients on

ART (Q4 2013)

Percentage of clients who are

LTFU during 2013

Percentage of clients who have had a CD4 count

test in 2013

Percentage of clients who are linked into care within 1 month

Percentage of clients initiated on ART within

14 days

Benchmarks target < 50/1000 > 80% < 20% 100% > 80% >80%Europe Bureau Ukraine 26.5 78.2% 11.2% 88.4% no data no dataRussia 14.6 85.9% 7.4% 92.1% no data no dataEstonia 0 66.7% 4.2% 95.9% 100% no data