Collaboration among TB/HIV CSOs and HIV and

TB programs in Ukraine

Zahedul Islam

International HIV/AIDS Alliance in Ukraine

Wolfheze 2013

16th Wolfheze Workshop

28-31 May 2013, The Hague,

The Netherlands

www.aidsalliance.org.ua

Epidemiology: 2012

Number of officially registered HIV-positive new cases – 20 743

Number of officially registered new TB ca ses - 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

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TB and HIV incidence in Ukraine: 2000-2012

Center of Medical Statistics of the Ministry of Health of Ukraine, 2013 4

60,268,6

75,6

77,5

80,9

84,1

83,2

79,8

77,8

72,768,4

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

902000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

TB HIV

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TB-HIV dynamics: 2004-2012

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MoH TB/HIV Management Structure before 2012

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Ministry of Health

State Services

Regional Healthcare Department

National TB Center

Regional TB Dispensary and TB

Hospital

National AIDS Center

Regional AIDS Center

Infections

Disease

Laborator

y

District

hospitals

Polyclinic

s

Cabinets

of trust

TB

laboratory

1-3 levels

District

hospitals

Polyclinic

s

6

MoH TB/HIV Management Structure after 2012

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Ministry of Health

State Servises

Regional Healthcare Department

Regional TB Dispensary and TB

Hospital Regional AIDS Center

Infections

Disease

Laborator

y

District

hospitals

Polyclinic

s

Cabinets

of trust

TB

laboratory

1-3 levels

District

hospitals

Polyclinic

s

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Ukrainian Center for Disease Control (UCDC)

Alliance Ukraine in TB/HIV Management Structure

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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

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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

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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

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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

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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)

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Achievements

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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)

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- 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

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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

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Thank you!

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