Wolfheze 2013 16 th Wolfheze Workshop 28-31 May 2013, The Hague, The Netherlands Collaboration among TB/HIV CSOs and HIV and TB programs in Ukraine Zahedul Islam International HIV/AIDS Alliance in Ukraine
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 2
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 TB and HIV incidence in Ukraine: 2000-2012 90 80 70 60 50 40 30 20 10 0 75,6 80,9 83,2 84,1 60,2 68,6 77,5 79,8 38 29,1 21 34,5 14,5 26,4 18,2 12,7 77,8 72,7 68,4 68,1 67,2 43,2 46,2 40,9 44,7 45,5 TB HIV Center of Medical Statistics of the Ministry of Health of Ukraine, 2013 4
TB-HIV dynamics: 2004-2012 5
MoH TB/HIV Management Structure before 2012 Ministry of Health State Services National AIDS Center National TB Center Regional Healthcare Department Regional AIDS Center Regional TB Dispensary and TB Hospital 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 Ministry of Health State Servises Ukrainian Center for Disease Control (UCDC) Regional Healthcare Department Regional AIDS Center Regional TB Dispensary and TB Hospital Infections Disease Laborator y District hospitals Polyclinic s Cabinets of trust TB laboratory 1-3 levels District hospitals Polyclinic s 7
Alliance Ukraine in TB/HIV Management Structure 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
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
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
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
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
Achievements 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
- 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
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
Thank you! 16