progress in implementation of the gf-supported r1 & 6 grants by the icf “international...

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

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

1155thth General Meeting of General Meeting of StakeholdersStakeholders28 August 200828 August 2008

Andriy KlepikovAndriy KlepikovExecutive Director, International HIV/AIDS Alliance in Ukraine

Major achievements by 1 July 2008:

www.aidsalliance.org.ua

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: 4 573 in 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)

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

Open call for proposals: 2008-09 Programme year, interim results


12 prevention directions were announced 12 prevention directions were announced The CFP budget is $ The CFP budget is $ 8,3 8,3 mlnmln 93 NGOs out of 128 applied pre-approved 93 NGOs out of 128 applied pre-approved

Direction Budget, $# of NGOs with prior confirmation

1. HIV prevention among the IDUs, community centers for the IDUs

$4 127 709,00 672. HIV prevention among the IDUs-stimulants

3. HIV prevention among the FSW, community centers for the FSW $1 022 956,00 36

4. HIV prevention among the MSM, community centers for the MSM $467 919,00 14

5. HIV prevention in penitentiary establishments $309 600,00 19

7. National advocacy of interests of HIV vulnerable populations $10 000,00 0

8. HIV/AIDS Information Center $240 120,00 9

9. Development of regular information materials for the HIV vulnerable populations on the national level $452 400,00 9

10. Mobilization and capacity building of the HIV vulnerable communities $195 000,00 2

11. Medical and social and psychological support for the substitution maintenance therapy programmes $842 654,00 24

12. HIV prevention among the IDUs according to the “Peer Driven Intervention” model $700 000,00 17

STI area: cooperation progress


The MOH Working Group established and action plan, to give access The MOH Working Group established and action plan, to give access to the STI diagnostics and treatment for vulnerable groups, approved to the STI diagnostics and treatment for vulnerable groups, approved

4 regional trainings for the STI doctors (50 people) and All-Ukrainian 4 regional trainings for the STI doctors (50 people) and All-Ukrainian joint meeting of the regional AIDS Centers chief doctors and regional joint meeting of the regional AIDS Centers chief doctors and regional STI doctorsSTI doctors

66 agreements on diagnostics and treatment concluded between 66 agreements on diagnostics and treatment concluded between NGOs and STI clinics NGOs and STI clinics

Agreement with the Academic Institute of Dermato-Venerology signed Agreement with the Academic Institute of Dermato-Venerology signed to develop method guidelines on STI treatment among vulnerable to develop method guidelines on STI treatment among vulnerable populations populations

55 658 syphilis rapid tests procured and delivered to all regions 55 658 syphilis rapid tests procured and delivered to all regions (16 294 syphilis screening tests conducted )

Achievement of Rounds 1 and 6 main programme indicators


* - Round 1 only

** - Round 6 only

0

0

16 294

42 274

50 761

13 417

25 601

162 583

5 684

8 955 230

0% 20% 40% 60% 80% 100% 120% 140%

People taking ARV therapy*

IDU covered by HIV/AIDS prevention programmes

Commercial sex workers (CSW) covered byHIV/AIDS prevention programmes

Men having sex with men (MSM) covered byHIV/AIDS prevention programmes**

Inmates covered by prevention programmes

VCTs conducted (including provision of test results)for HIV with rapid tests among vulnerable groups**

STI screening tests provided to vulnerable groups**

STI counselling and treatment courses received bypeople from vulnerable groups**

Visits by people from vulnerable groups to mobileclinics**

Condoms distributed to vulnerable groups

Key targets on coverage: end of Year 2 of R6 Programme implementation


Indicator Achieved as of 01.07.08 Target at the end of the 2nd Year (01.07.2009)

Number and percentage of IDU covered by the HIV/AIDS prevention programmes

162,583 170,000(52% of estimated number)

Number and percentage of FSW covered by the HIV/AIDS prevention programmes


Number and percentage of MSM covered by the HIV/AIDS prevention programmes

13,417 13,800(7,8% of estimated number)

Number and percentage of inmates covered by the HIV/AIDS prevention programmes


VCT and HIV rapid testing among risk groups 42,274 158,600

STI screening tests among risk groups 16,294 153,830

STI counseling and treatment courses among vulnerable groups

0 38,206

Risk groups visits to mobile clinics 0 30,000

Condoms distributed among the risk groups 8, 955,230 23,980,000

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%

476 054 (84%*)

1 693 720 (94%*) 3 481 736 (89%*)

6 048 115 (78%*)

1 699 931 (76%*)

Treatment, Care & Support

Focused Prevention

Information, Education & Advocacy

Surveillance & Evaluation

Management / PR Implementation Unit

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%

3 202 027 (72%*)

34 679 (112%*)

210 516 (74%*)

73 030 (15%*)

Ensuring adequate access to comprehensive services on prevention, treatment,care and support for vulnerable communities

Creating favourable environment for sustainable and effective response to HIV andAIDS in Ukraine

Monitoring and evaluation of grant imple-mentation and strengthening of nationalmonitoring and evaluation system

Programme management and implem-entation by Principal Recipient

Summary budget by component of the Year 2 Rd 6 Grant: July 2008 – June 2009


Total 10 455 250 USD

31 827,00

1 139 899,05 589 407,78

8 694 116,23

To ensure sufficient access to integrated prevention, treatment, care and supportfor marginalized populations

To create a supportive environment for a sustainable and sufficient response toHIV/AIDS in Ukraine (in the part administered by Alliance, Ukraine as a PR)

To monitor and evaluate grant implementation and strengthen the national M&Esystem

Management / PR Implementation Unit

v

AU Organisation development plans


Strategy for transition from the Country Office of Alliance to an Strategy for transition from the Country Office of Alliance to an independent Linking Organisation independent Linking Organisation with a membership at the Global with a membership at the Global Alliance Partnership (statute reviewed and new governance bodies to Alliance Partnership (statute reviewed and new governance bodies to be set up by the end of 2009 1be set up by the end of 2009 1stst quarter) quarter)

Strengthen internal compliance and programme oversightStrengthen internal compliance and programme oversight. . New New position of Senior Advisor on compliance and internal procedures (by position of Senior Advisor on compliance and internal procedures (by the PR and sub-grantees) the PR and sub-grantees)

Develop an action plan to respond to evaluation Develop an action plan to respond to evaluation recommendationsrecommendations – – after finalizing External Evaluation Report of the after finalizing External Evaluation Report of the National 2004-2008 HIV/AIDS Response, incl. GF grants National 2004-2008 HIV/AIDS Response, incl. GF grants implementation. implementation.

Improve quality of work with sub-grantees Improve quality of work with sub-grantees ((develop and implement develop and implement a technical assistance provision plan, introduce and support a technical assistance provision plan, introduce and support development of new EFR reporting; better oversight and quality development of new EFR reporting; better oversight and quality assurance of services provided by the Alliance-Ukraine sub-grantees assurance of services provided by the Alliance-Ukraine sub-grantees within the GF and other donors’ programmes).within the GF and other donors’ programmes).

Major challenges: SMT


Slow enrollment of patients for the methadone-based SMTSlow enrollment of patients for the methadone-based SMT ( (the the MoH Order MoH Order № 295№ 295 of of 04.06.2007 04.06.2007 not implemented in the AR of not implemented in the AR of Crimea, Zaporizhzhya, Mykolayiv and Kherson oblastsCrimea, Zaporizhzhya, Mykolayiv and Kherson oblasts))

Lack of state health system structure to take responsibility for Lack of state health system structure to take responsibility for the SMT programmesthe SMT programmes. . The health care settings lack staff to work The health care settings lack staff to work with SMT patients; there is no state centralized monitoring system for with SMT patients; there is no state centralized monitoring system for the SMT projects including patients’ records and drugs for SMT. No the SMT projects including patients’ records and drugs for SMT. No unified system for SMT patients registrationunified system for SMT patients registration..

2007 state budget for buprenorphine-based SMT was not spent, 2007 state budget for buprenorphine-based SMT was not spent, while there is no money for SMTwhile there is no money for SMT in 2008 state budget at allin 2008 state budget at all

Current legal regulations on narcotic drugs do not allow a Current legal regulations on narcotic drugs do not allow a comprehensive SMT implementation; comprehensive SMT implementation; they require urgent review. they require urgent review. The SMT patients are “chained” to points of drugs provision; it is not The SMT patients are “chained” to points of drugs provision; it is not possible to administer liquid methadone.possible to administer liquid methadone.

STI: challenges and responses


Late treatment start upLate treatment start up: : the MoH issued the Orderthe MoH issued the Order № 325 „ № 325 „On On distribution of STI treatment drugs among the risk groups procured distribution of STI treatment drugs among the risk groups procured with support of the GF grant” only on 18 June 2008 with support of the GF grant” only on 18 June 2008

The current official STI management system of diagnostics fails to The current official STI management system of diagnostics fails to account for peculiarities of diagnostics and treatment of HIV account for peculiarities of diagnostics and treatment of HIV vulnerable groups as well as for complexity of epidemiology; System vulnerable groups as well as for complexity of epidemiology; System requires urgent review. requires urgent review.

Plans: Establish a national coordination centre of STI diagnostics and Establish a national coordination centre of STI diagnostics and

treatment among vulnerable groupstreatment among vulnerable groups Develop Instruction on conducting STI screening tests among Develop Instruction on conducting STI screening tests among

vulnerable groups vulnerable groups Procure and deliver the gonorrhea and chlamydia rapid tests for Procure and deliver the gonorrhea and chlamydia rapid tests for

mobile clinicsmobile clinics Develop postgraduate training module for doctors on the STI among

the risk groups

Prevention: challenges and responses


Risk of delays in procurement and supply of syringes and other Risk of delays in procurement and supply of syringes and other medical goods by the MoH with the World Bank HIV loan to the medical goods by the MoH with the World Bank HIV loan to the projects supported by the GFprojects supported by the GF;;

Lack of national mechanism of coordination, analysis and adaptation Lack of national mechanism of coordination, analysis and adaptation of prevention programmes among the vulnerable groups as well as of prevention programmes among the vulnerable groups as well as care and support.care and support.

Plans: Establish an external expert working group on HIV/AIDS prevention Establish an external expert working group on HIV/AIDS prevention

among the vulnerable groups (in coordination with current WGs on among the vulnerable groups (in coordination with current WGs on M&E, treatment and ST, STI, and prevention among MSM). M&E, treatment and ST, STI, and prevention among MSM).

Initiate re-establishment of subcommittees of the National HIV/AIDS Initiate re-establishment of subcommittees of the National HIV/AIDS and TB Coordination Counciland TB Coordination Council

ART and PMTCT: problem areas


ART is offered to appr. 35% of those who need itART is offered to appr. 35% of those who need it; ; Continuation of treatment and PMTCT after the GF funding is over Continuation of treatment and PMTCT after the GF funding is over

(from 1 October 2008), incl.(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

Education component handover to the GoU


AchievementsAchievements: : in close cooperation with the Ministry of Education regular in close cooperation with the Ministry of Education regular Health Promotion curricula introduced; course books developed and experts Health Promotion curricula introduced; course books developed and experts trained. trained.

Problem Problem The Ministry of Education has limited state support for continuation of The Ministry of Education has limited state support for continuation of

prevention programmes from September 2008 prevention programmes from September 2008 Low priority for HIV prevention via education system at the operational level Low priority for HIV prevention via education system at the operational level

and in budget provision on the level of CabMin and in budget provision on the level of CabMin Low institutional and financial capacity of the Ministry of EducationLow institutional and financial capacity of the Ministry of Education

Next steps Special analytical report with practical recommendations on capacity building Special analytical report with practical recommendations on capacity building

and budgeting of further prevention activities via education systemand budgeting of further prevention activities via education system National round table on prevention via education system to develop practical National round table on prevention via education system to develop practical

steps on the component handover steps on the component handover Advocacy of the state responsibility for continuation and scaling up the Advocacy of the state responsibility for continuation and scaling up the

prevention programmes via education system with the mass media prevention programmes via education system with the mass media involvementinvolvement

Humanitarian aid status


Problem 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

progress in implementation of the gf-supported r1 & 6 grants by the icf “international...

Documents

hiv prevention

prevention projects

hiv vulnerable populations

hiv vulnerable communities

community centers

ua12 prevention directions

inmates prevention coverage

sti diagnostics