Collaboration among TB/HIV CSOs and HIV and TB programs in Ukraine
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This document summarizes collaboration between tuberculosis (TB) and HIV civil society organizations (CSOs) and HIV/TB programs in Ukraine. It notes that in 2012 there were over 20,000 new HIV cases and nearly 31,000 new TB cases reported in Ukraine. Only 44% of HIV-positive TB patients started antiretroviral therapy. Key challenges to integration include the vertical nature of Ukraine's health system, lack of cooperation between AIDS and TB services, and limited collaboration with CSOs. The document outlines efforts by the International HIV/AIDS Alliance in Ukraine to strengthen collaboration through a memorandum of understanding and expanding TB services among organizations working with most-at-risk populations.
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Collaboration among TB/HIV CSOs and HIV and TB programs in Ukraine
- 1. Collaboration among TB/HIV CSOs and HIV and TB programs in UkraineUkraine Zahedul IslamZahedul Islam International HIV/AIDS Alliance in UkraineInternational HIV/AIDS Alliance in Ukraine Wolfheze 2013 16th Wolfheze Workshop 28-31 May 2013, The Hague, The Netherlands
- 2. www.aidsalliance.org.ua Epidemiology: 2012 Number of officially registered HIV-positive new cases – 20 743 Number of officially registered new TB cases - 30 958 • TB patients with known HIV status – 29 410 (95%) • TB patients that are HIV-positive – 4 726 (15,3%) • HIV-positive TB patients started on ART - 44 % Cases tested for MDR-TB – 17 110 Confirmed cases of MDR-TB – 6 934 MDR-TB patients started treatment - 6 257 Ukrainian HIV/AIDS epidemics further fueled by injecting drug use Tuberculosis is the key reason of death in people living with HIV/AIDS 2
- 3. www.aidsalliance.org.ua TB and HIV incidence in Ukraine: 2000-2012 Center of Medical Statistics of the Ministry of Health of Ukraine, 2013 4 60,2 68,6 75,6 77,5 80,9 84,1 83,2 79,8 77,8 72,7 68,4 67,2 68,1 12,7 14,5 18,2 21 26,4 29,1 34,5 38 40,9 43,2 44,7 46,2 45,5 0 10 20 30 40 50 60 70 80 90 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 TB HIV
- 4. www.aidsalliance.org.ua TB-HIV dynamics: 2004-2012TB-HIV dynamics: 2004-2012 5
- 5. MoH TB/HIV Management Structure before 2012 www.aidsalliance.org.ua Ministry of Health State Services Regional Healthcare Department National TB CenterNational TB Center Regional TB Dispensary and TB Hospital Regional TB Dispensary and TB Hospital National AIDS CenterNational AIDS Center Regional AIDS CenterRegional AIDS Center Infections Disease Laborator y Infections Disease Laborator y District hospitals District hospitals Polyclinic s Polyclinic s Cabinets of trust Cabinets of trust TB laboratory 1-3 levels TB laboratory 1-3 levels District hospitals District hospitals Polyclinic s Polyclinic s 6
- 6. MoH TB/HIV Management Structure after 2012 www.aidsalliance.org.ua Ministry of Health State Servises Regional Healthcare Department Regional TB Dispensary and TB Hospital Regional TB Dispensary and TB Hospital Regional AIDS CenterRegional AIDS Center Infections Disease Laborator y Infections Disease Laborator y District hospitals District hospitals Polyclinic s Polyclinic s Cabinets of trust Cabinets of trust TB laboratory 1-3 levels TB laboratory 1-3 levels District hospitals District hospitals Polyclinic s Polyclinic s 7 Ukrainian Center for Disease Control (UCDC)
- 7. Alliance Ukraine in TB/HIV Management Structure www.aidsalliance.org.ua 8 CSOs- co-chairs of National CCM HP procurement (PSM) Good Practices development Cross-sectoral HIV/TB working groups (WG) Trilateral memorandum among Ukrainian AIDS Center, All-Ukrainian TB Control Center and Alliance; Biannual reporting meetings for TB and HIV program managers Technical support Grants Trainings Advocacy
- 8. www.aidsalliance.org.ua Alliance Ukraine activities - Principal Recipient (PR) for GFATM Round 1 HIV (2004-2008) and Co-PR for Round 6 HIV (2008-2012) - Key Sub Recipient (SR) for GFATM Round 9 TB program - Co-Principal Recipient (PR) for GFATM Round 10 HIV (2012-2016) - Strengthen the collaboration Mechanism at National, Regional and Local Levels - Decrease the burden of TB in PLWHA - Decrease the burden of HIV in TB patients - Scaling up NGO activities aimed at HIV prevention to the area of TB treatment - Access to quality treatment (advocacy) - Access to high quality integrated care (HIV, TB, HCV,OST,STI-diagnostics and treatment) services to MARPS specially focusing on HIV + IDU’s 9
- 9. www.aidsalliance.org.ua o CSOs- co-chairs of National CCM o Capacity building of Ukrainian CDC o Participation at MOH Working Groups on TB and TB/HIV issues o CSO’s are integral part of regional coordination council meeting on HIV and TB o R10 GF HIV grant is launching new initiative on TB/HIV integrated activities 10
- 10. www.aidsalliance.org.ua Key challenges – health system • Highly vertical heath care system of Ukraine is a major obstacle for integration of services. • Frequent changes of management in the government leadership • Lack of cooperation between AIDS and TB services: information sharing, joint planning, M&E performance measures and indicators. • Lack of adequate financing • Poor infection control • Rudimentary collaboration with CSO’s and HCF 11
- 11. www.aidsalliance.org.ua Key challenges – CSO’s Stigma and discrimination Lack of recourses at NGOs to initiate implementation of TB activities without additional support Lack of CS representatives to address TB issues to the government No mechanisms and initiative to regulate affairs between NGOs and TB HCF Collaboration with CSO’s and MoH are rudimentary Lack of technical capacity (technical knowledge about disease and treatment) 12
- 12. Achievements www.aidsalliance.org.ua Signed a trilateral MoU among Ukrainian AIDS Center, Ukrainian TB Control Center and Alliance Ukraine on partnership and collaboration Involvement of the CSOs into the TB/HIV activities Expansion of TB services among NGOs working with MARPs (Projects on early TB diagnostics among MARPs) •Creation and coordination of TB/HIV reference group •Representing CSOs needs at national level •TB/HIV protocols and orders review •Training on TB awareness among NGOs •Integrated care services provision in TB clinics (HIV/TB/SMT) 13
- 13. www.aidsalliance.org.ua - CSO’s participation in TB and TB/HIV activities is crucial to successful implementation of TB programs - Patient-oriented approach is needed for TB/HIV implementation (DOTs, Stop TB strategy) - CSO’s staff should be trained on TB issues to avoid new TB cases among MARPs -With the leadership from the Government a functional coordination mechanism between all these services must be in place - State financing is a cornerstone of sustainability - Further develop and mobilize civil society to demand accountability and to address stigma and discrimination 14
- 14. www.aidsalliance.org.ua Good practice guide on Community based TB/HIV integration by Alliance in partnership with PATH at http://www.aidsalliance.org/Publication sdetails.aspx?Id=90632 15
Editor's Notes
- Introduction notes: I am very pleased to share Ukraine experience with you in this conference and would like to give an overview of civil society engagement in HIV/AIDS implementation in Ukraine.
- - Ukraine is estimated at 350.000 people living with HIV. - However, officially registered numbers still far below than estimation Ukrainian epidemic is fueled by unsafe injecting drug use made of locally cultivated poppy seeds - WHO estimates, that 325 000 to 425 000 injecting drug users in Ukraine, and according to the data from the Ukrainian Centre of Disease Control, HIV prevalence in this group may vary from 17% to 70%. In the year 2012, there were a total of 29410 TB patients with known HIV status in Ukraine, which represents 95% of all TB cases. Of these TB patients, 4726 were reported to be HIV positive. - 17 110 patients were tested for MDR TB and out of which 6934 were confirmed. 6257 of them started treatment, which makes 90%.
- The data are provided by the Center of Medical Statistics of the Ministry of Health of Ukraine. This slide demonstrates the growth and stabilizing ( 2010- 2012) of new HIV cases and overall decrease in TB cases; as you may see there was a peek of TB incident in 2006 with 84 per 100 000 and that has decreased to 68 in 2012. At the same time HIV has a steady increase until 2011 and started to fall slightly in 2011due to targeted intervention in most at risk groups specially people who inject drugs
- If to compare Incidence and Mortality of TB/HIV co-infection, both incidents are growing in Ukraine in general. Growth in incidence because of the intensifyed case finding.
- As you may see this is vertical healthcare system where decision, implementation and information are circulated in hierarchical order: Ministry of Health orders and requests go down to the Regional Healthcare Departments, which, in their turn, send relevant questions to all of the below-mentioned healthcare institutions, get answers and send them back to the Ministry of Health. There’s no single person or unit within regional healthcare departments responsible for “uniting” HIV and TB statistics; thus, the information on HIV/TB flows in parallel. At the end of 2012 an structural changes was initiated by the Minister of health by merging National TB and HIV centers under one management thus created a new institution named “Ukrainian Centre for Disease Control” (UCDC).
- As you can see this health care reform will allowed the UCDC to manage and coordinate all activities related to HIV and TB including, development of protocol or methodological support, implementation, data collection and evaluation. This reform is still in transition however under the new operational policy UCDC aimed to organize the uniform HIV/TB policy in Ukraine and perform coordination between TB and AIDs health hare facilities.
- National Level: Cross-sectoral HIV/TB working group (WG) Trilateral memorandum among Ukrainian AIDS Center, All-Ukrainian TB Control Center and Alliance; Biannual reporting meetings for TB and HIV program managers to share experience and plan joint activities. Technical support in creating proper terms and conditions for PITC (group and individual) in TB control institutions Development of the guidelines: - on conducting VCT among the patients of TB control facilities; - on preventive cotrimoxazol treatment for HIV/TB patients; - of the mechanisms for passing ART and SMT medications to the patients who are treated in in-patient units of TB control facilities. - Advocacy Regional Level: -Technical support – health system strengthening, grant support – integrated care, trainings on method guidance, integrated care etc..and advocacy
- Vertical health care system State funding Lack of collaboration between services Rudimentary collaboration with health care facilities
- Patients still face stigma and discrimination Lack of resources No partnership framework between health care facilities and CSO’s Very little collaboration exist at the moment
- Thank you for attention!
- Thank you for attention!