Transcript Слайд 1 - Alliance for Public Health

VII Stakeholders meeting
21st October, 2005
Results of phase I
Global Fund grant
Overcoming the HIV/AIDS epidemic in Ukraine
Results of phase I
Global Fund grant
Andriy Klepikov
Alliance Ukraine, International HIV/AIDS Alliance in Ukraine, Executive Director
Alla Scherbinska,
National AIDS Center, Director
Natalia Leonchuk
All-Ukrainian PLHA Network Coordinating Council, Deputy Head
VII Stakeholders meeting
21st October, 2005
Presentation structure
• Main programme characteristics
– Structure of Phase I investment
– Geographical distribution of efforts
• Main achievements
–
–
–
–
Increasing access to AIDS Treatment
Developing care and support for PLHA
Scaling up focused prevention
Building supportive environment
• Progress against the key targets
• Challenging areas of implementation
• Did the programme succeed?
Expenditure summary
Ukraine - Phase I expenditure
25 000 000
20 000 000
$
15 000 000
10 000 000
5 000 000
Q1
Q2
Q3
Q4
Q5
Quarter
Budgeted expenditure (cumulative)
Actual expenditure (cumulative)
Q6
Expenditure – Budget vs. Actual
Activity description
Budget
(USD)
Actual
inc commitments
(USD)
Variance
Under/(over) spend
(USD)
1
Establishment and maintenance of PR
Unit
2,681,000
2,520,539
160,461
2
Treatment, care and support (excl
procurement of ARV and other medical
supplies)
4,383,000
4,409,364
(26,364)
Procurement and delivery of ARV and
other medical supplies
8,874,116
8,689,004
185,112
3
Focused prevention
2,319,000
2,441,241
(122,241)
4
Information, education and advocacy
3,326,000
3,364,174
(38,174)
5
Surveillance and evaluation
1,021,000
958,804
62,196
6
Alliance management fee
750,000
750,000
-
23,354,116
23,133,126
220,990
2.3
TOTALS
Expenditure profile
Alliance's expenditure structure within Global Fund Project:
from March 14, 2004 to September 30,2005
7. International technical assistance, ($ 1 124 489)
5%
8. Alliance M anagement Fee, ($ 750 000)
3%
1. Establishment & maintenance of PR Unit, ($ 1 467
516)
6%
2. Treatment, Care & Support, ($ 4 412 898)
19%
3. Focused Prevention, ($ 2 441 241)
11%
6. Procurement & delivery of ARV and other medical
supplies, ($ 8 685 470)
38%
4. Information, Education & Advocacy, ($ 3 292 708)
14%
5. Surveillance & Evaluation, ($ 958 804)
4%
1. Establishment & maintenance of PR Unit, ($ 1 467 516)
2. Treatment, Care & Support, ($ 4 412 898)
3. Focused Prevention, ($ 2 441 241)
4. Information, Education & Advocacy, ($ 3 292 708)
5. Surveillance & Evaluation, ($ 958 804)
6. Procurement & delivery of ARV and other medical supplies, ($ 8 685 470)
7. International technical assistance, ($ 1 124 489)
8. Alliance Management Fee, ($ 750 000)
Total: $ 23 133 126
Partnership in numbers:
 303 health care facilities supplied with medicines and
other health products
 135 organisations have participated in the program
implementation during phase one
 256 grants/contracts/agreements were signed during
18 month period
Geographical distribution of efforts
Distribution of funding across the regions of Ukraine
(1 April 2004 to 30 Septemeber 2005)
4 500 000,00 грн.
4 000 000,00 грн.
3 500 000,00 грн.
3 000 000,00 грн.
2 500 000,00 грн.
2 000 000,00 грн.
1 500 000,00 грн.
1 000 000,00 грн.
500 000,00 грн.
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ART scale-up in Ukraine
August 2004 – April 2005
Regions which began ART during phase 1
Regions which began ART during phase 2
Other regions
ART scale-up in Ukraine
August 2004 – September 2005
3000
2500
2000
1500
1000
500
0
Total number
01.09.2004
Adults and teenagers
01.03.2005
Children
01.10.2005
ART implementation in Ukraine
from August 2004 to September 2005
Based on sources of financing
Number of patients
3000
159
106
2500
162
108
2000
1500
161
86
1000
500
0
165
100
118
137
for July 2004
148
42
551
Aug-Sept 2004
Global Fund
1813
1382
1052
Oct-Dec 2004
2601
Jan-Mar 2005
State Budget
Apr-June 2005 July-Sept 2005
Other sources
ART INFLUENCE ON THE AIDS MORTALITY RATES:
ANALYSIS OF DATA FROM DONETSKS OBLAST
Years
AIDS
incidence
AIDS mortality
Mortality rate (per
10,000 patients)
1987 – 2004
1807
1143
6325,4
2004 – 2005
497
33
664,0
One year of ART programme implementation
resulted in nearly 10 times decrease in AIDS
mortality rate
Scaling up ART in Ukraine training of specialists
in the Regional Knowledge Hub
• 18 trainings were conducted for 437 participants from 15
regions of Ukraine, where ART has been introduced
• 223 specialists were trained:
– 172 adult ART specialists
• 96 doctors,
• 47 nurses,
• 29 social workers
– 23 paediatric ART specialists
• 9 doctors,
• 8 nurses,
• 6 social workers
– 28 laboratory specialists
Strengthening laboratory base (I)
• 4 flow cytometers were purchased for immunological testing as well
as test-kits for them, for 8000 examinations.
• Flow cytometers were installed at:
• National AIDS Center
• Crimean republican AIDS Center
• Odesa oblast AIDS Center
• Dnipropetrovs'k oblast AIDS Center
• Immunological testing was initiated in April 2005
• 2 hematological analyzers with reagents were purchased
for 10000 tests
• Analyzers were installed at:
• Donetsk oblast AIDS Center
• Dnipropetrovs'k oblast AIDS Center
• Put into function in February 2005
Strengthening laboratory base (II)
• 3 set of equipment for HIV viral load level evaluation were purchased as
well as kits for them for 5000 tests
• The equipment was intended for the National, Crimean republican and
Odesa oblast AIDS centers. Equipment and test-kits have not yet arrived
into Ukraine due to registration of the new format of equipment and testkits
• Equipment for early HIV diagnostics for children of HIV-infected mothers
was received.
• This equipment was installed at:
• National AIDS Center
• Crimean republican AIDS Center
• Odesa oblast AIDS Center
Providing care and support for PLHA
Supported:
 52 projects
 37 organisations
 17 regions
Based on the following directions of activities:
Community center for PLHA – 8 projects
Non-medical home based care – 8 projects
Self-help groups for PLHA – 18 projects
Therapeutic camps – 4 projects
Children centers – 5 projects
Comprehensive support rendering to PLHA– 4 projects
PLHA support in prisons – 5 projects
Number of regular clients of the projects
(through September 2005)
4507
Phase 1 results
3500
As planned by the
end of Phase 1
0
1000
2000
3000
4000
5000
Comparative number of regular clients of the projects
(April 2004 – September 2005)
4507
Phase 1
completion
228
Beginning of the
project
0
1000
2000
3000
4000
5000
Referring to ART
(January – September 2005)
1000
PLHA referred to medical
institutions for diagnostics,
consultations, therapy, etc.
900
800
925
700
600
500
400
300
200
100
0
212
PLHA who began ARV therapy
as a result of such referral
PLHA advocacy at the regional level
In 11 regions PLHA-community representatives are members of regional
(city) HIV/AIDS Coordination Councils and participate in decision-making:
Kyiv, Odesa, Poltava, Kharkiv, Donetsk, Chernihiv, Kherson, AR of Crimea,
Mykolaiv, Kirovograd, Cherkasy.
15 regions regularly cooperate with mass media in order to develop
tolerance toward PLHA.
Cooperation with regional human rights organizations was established
(particularly, with regional partners of the Vinnitsa Human Rights Group) in
order to react to facts of PLHA rights violation.
Integrated HIV prevention programming
• Over 70,000 IDUs, 8,000 SWs, 1,700 MSM, and 8,000
prisoners accessed prevention and information services
throughout Ukraine
• Supporting integrated programmes providing legal,
social and medical support and counselling, IEC
materials, community mobilisation activities (self-help
groups etc), provision of prevention commodities
• Supporting introduction of additional services: care for
HIV positive IDUs, drug treatment and rehabilitation etc.
• Utilising the links of community mobilisation,
rehabilitation and re-socialisation services to safer
behaviour
Integrated HIV prevention programming (cont.)
• Achievements
– Well established and stable NGO-based provision of
core services and information
– Increasing rapport with the vulnerable communities
– Growing coverage of the programmes
– Ongoing expansion into new regions and rural areas
• Challenges
– Persisting repressive policies dominating law
enforcement system
– Unavailability of effective drug treatment services
(primarily substitution maintenance treatment)
Prevention, advocacy and awareness raising
activities among the general population
• 180 000 of 5th grade pupils from 8 000
schools all over Ukraine provided with
study books and covered by life-skills
based HIV/AIDS education.
• 669 teachers are trained to deliver
programs for primary and secondary
schools
• Aproximatelly 20 million people reported
being covered by two media campaigns
(‘Let’s be together! Let’s be humans!’
aimed to promote solidarity with people
living with HIV/AIDS and ‘Your Health – In
Your Hands!’, to educate people about
available ARV therapy in Ukraine.
Building Supportive Environment
• M&E capacity of key partners significantly
strengthened (Ministries, NGOs, AIDS Centres)
• Outcome and impact oriented planning, setting
challenging targets, target driven projects
• Strong partnership and collaboration of the key
stakeholders:
– Stakeholders consultations
– Participatory planning of the phase II
– Memoranda of Understanding
– Extensive partners’ involvement in program
implementation and evaluation
Treatment and C&S for PLHA: Targets vs. Actuals
General Prevention: Targets vs. Actuals
Focused Prevention: Targets vs. Actuals
Obstacles met in the course of initiating
Substitution Maintenance Therapy (SMT)

Political (lack of political will and support from the state authorities toward program
implementation)
 Regulatory (no MoH regulatory documents which would regulate the SMT
process. At the same time, effective regulations which relate to drug control
considerably limit SMT implementation)
 Organizational (lack of necessary experience in procurement and implementation
of SMT in Ukraine):
- It took almost 2 months for the “Sociotherapy” clinic to obtain the
status
of humanitarian aid recipient.
- It took nearly half a year to conclude a quadripartite agreement
between the state company “Liky Ukrainy”, PATH, “Sociotherapy”
clinic
and the company-supplier “Rusan-Pharma” as it was practically
impossible to finalize the budget for the “Liky Ukrainy” services.
- Obtaining a humanitarian aid status for buprenorphine supply (there was
no procedure for granting humanitarian aid status to narcotic
drugs)
- Receiving a permit from the Drug Control Committee to import
Addnok (import of buprenorphine in ready-to-use form was not
provided for in respective “Quotas” for 2005)
Constituents of Success
(as set at the 1st stakeholders meeting on April 8th 2004)
• Renewal of the grant for years 3 to 5
• Considerably improved access to treatment
• Significant coverage of focused prevention efforts in
selected areas
• State public health system ready to take over the
clinical care work
• Fully operational CCM resume programme oversight
and strategic guidance