Presentation french red cross, Alliance Ukraine, march17 2010


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  • Introduction notes: - Your Excellencies, distinguished guests and partners, I am very pleased to share Alliance Ukraine experience with you in this meeting
  • These are new estimation recommended by WHO in 2009 and approved by NCC
  • GF R6 with 140$ USD for 5 years (2007-2012) $40M USD for the year 2010-2015
  • Prevention programs: Harm reduction, Syringe exchange program, condom distribution, counseling and testing, STI testing and treatment
  • Pic 1: Home made drug use (chornaya) Pic 2: Injecting drug Pic 3: information distribution Pic 4: Counseling and testing
  • Social worker distributing condoms and IEC materials Mobile clinics providing testing and counseling STI/HIV and referral to other HCI Counseling and testing distribution of leaflet with hotline information
  • ART medicines, Lavra clinics Patient and doctor in Lavra clinics
  • Before going to the main presentation I would like to share with a small story, During my visit to the clinic I met this incredible person, who strike me as a man with vision, his name is Pavel Kutsev 49 years old male (born in Turkmenistan but moved to Kiev for study) married with 1 child (21 year old boy) 30 years of injecting drug use (before this time he tried other drugs such as marijuana, hashish etc.. he has been in prison twice he was on and off from drugs when he was in Turkmenistan and after having a terrible road accident, no access to drugs during 2 years of hospitalization Had no real job but supported himself initially with some small business but later on producing and selling illegal home made drugs In 2000 Pavel and his wife felt severely ill, they could not move
  • In 2009, together with other CBO’s working for and with IDU’s formed an association to participate during the decision making Ukraine has huge success story of Network of PLHA becoming the main stakeholder in policy making ON HIV programs by representing the civil society Through out these turmoil, they are still together..
  • AU handed over 6000 ART patients to MoH after end of the program Scale up of SMT 800 on Bup in May 2008 to over 3800 by May 2009 with methadone High service coverage to vulnerable populations
  • GFATM 11300 UASAID 300
  • IDU’s report less risky behaviour: using sterile injecting equipment has increased in 2006 80% to 86% in 2008 New registered HIV cases among IDU has slightly decreased from 7127 in 2006 to 7009 in 2008 Decreasing HIV prevalence among newly initiated IDUs: Sentinel surveillance data indicates that the median indicator for HIV prevalence among IDUs injecting for a short period of time (less then 2 years) in sample groups from eight cities has substantially decreased in the past years: 29, 9% in 2004, 17, 7% in 2006 and 11, 2% in 2008 (Donetsk, Lutsk, Odessa, Poltava, Simpheropol, Sumy, Kharkiv, Kherson). Decrease in prevalence is more visible in large cities, where harm reduction programmes supported by the Global Fund have large coverage rates (for example, Donetsk, Odessa).
  • Current legislation does not allow confirmation of HIV result by 2 rapid test, every positive rapid test needs to be confirmed by and Eliza test in the regional lab which takes 2-4 weeks before a status can be confirmed. This creates a major problem of follow up with initial patients and their in time enrolment in the ART or other treatment programs almost 80% of IDU’s are hepatitis positive and out of those 80% average 33% of them are HIV+ there are no institutional structure for integrated services exist in the Ukraine however, number of pilot project has been initiated by Alliance, CHAI and PLHA network National program target for ART is 80000 people need on ART by 2013 but receives only 10000, 53000 need of SMT but receives only 3809
  • Stigma and discrimination is still widely exist (people do not like to access service in the vertical health care system fear of disclosure etc) the drug users are mostly harassed by police if found injecting and at the needle exchange sites In order to scale up access to service provision decentralization of health care system is must Though psychosocial services is recognized by the MoH as a necessary component of the programs there is no attempt of including this services within the health care system and fully provided by NGO’s with donor fundings
  • Presentation french red cross, Alliance Ukraine, march17 2010

    1. 1. Briefing meeting for French Red Cross, Kiev. March 2010Successful implementation of HIV programs in Ukraine Zahedul Islam International HIV/AIDS Alliance in Ukraine
    2. 2. Population size Estimation  • Recommended IDUs estimated  230 000- 360 000 range  63 000- 93 000• Recommended FSWs estimated  range• Recommended MSM aged  95 000- 213 000   15-49 estimated range 2
    3. 3. Alliance programs in Ukraine• • $79 million Round 6 HIV program for vulnerable population 2007 – 2012 • Recently approved R9 TB proposal Alliance as SR• USAID SUNRISE and other bilateral donor
    4. 4. Area of activities•  Working on prevention programs focused on MARP’s specially targeting IDU’s, FSW, MSM and prisoners•  SMT program for IDU’s• Integrated care for HIV+ IDU’s• Medical and psychosocial support to IDU’s• Street children program• STI testing and treatment• Trainings for NGO’s• Capacity building• Technical support• Drop in
    5. 5. Injecting drug users – key driving force of the epidemic in the region
    6. 6. Prevention programs for female sex
    7. 7. ART
    8. 8. Pavel Kutsev Past life…
    9. 9. Pavel Kutsev Life has changed ever
    10. 10. Substitution Maintenance
    11. 11. Milestone of these programs• Rapid scale up of Methadone based SMT program in  Ukraine (5252 as of March 2010, 843 with Bup and 4409  with Methadone)• Scaling up prevention: more than 266 000 injecting drug users, over 45 000 women involved in commercial  sex, 28 881 men having sex with men, and more than  80 000 prisoners have accessed prevention services
    12. 12. SMT scale up in 2009-2010
    13. 13. AU plans for SMT scale up in 2009-2013
    14. 14. MARP coverage % target implementation 0% 20% 40% 60% 80% 100% 120% 140% 160% IDU 266 666 CSW 45 729 MSM 28 881 Prisoners 80 404pogbVlnsaeru m g tio s a n p v e r D /A S H IV w ith d o e v c
    15. 15. Achievements• IDUs report less risky behaviour: IDUs who report use of sterile  injecting equipment during last injection:    2006:  80%  2007:  83%  2008:  86%• Fewer registered HIV cases amongst IDUs: after a decade of  constant rise the number of new registered HIV cases has  peaked (while numbers being tested continued to rise).      2006: 7,127 2007: 7,084 2008: 7,009 • Decreasing HIV prevalence among newly initiated IDUs (who  have been injecting drugs for less than 2 years):      2004:  30% 2006:  18% 2008:  11%
    16. 16. Service gaps    Simplified HIV testing and confirmation  Hepatitis treatment poorly available  Integrated service for PLHA (MARP’s)  Needs vs
    17. 17. Challenges • Stigma and discrimination  • Criminalization of the drug usage •  Wider introduction of HIV rapid testing • Decentralization of health care service provision • Integration of social services in to clinical care
    18. 18. Thank