collaboration among tb/hiv csos and hiv and tb programs in ukraine

Collaboration among TB/HIV CSOs and HIV and TB programs in UkraineUkraine

Collaboration among TB/HIV CSOs and HIV and TB programs in UkraineUkraine

Zahedul IslamZahedul IslamInternational HIV/AIDS Alliance in UkraineInternational HIV/AIDS Alliance in Ukraine

Wolfheze 201316th 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 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

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TB and HIV incidence in Ukraine: 2000-2012

Center of Medical Statistics of the Ministry of Health of Ukraine, 20134

60,268,6

75,6

77,5

80,984,1

83,2

79,877,8

72,768,4

67,2

68,1

12,7

14,5

18,2

2126,4

29,134,5

38

40,9

43,2

44,7

46,2

45,5

0

10

20

30

40

50

60

70

80

9020

00

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

TB HIV


TB-HIV dynamics: 2004-2012TB-HIV dynamics: 2004-2012

5

MoH TB/HIV Management Structure before 2012


Ministry of Health

State Services

Regional Healthcare Department

National TB CenterNational TB Center

Regional TB Dispensary and TB Hospital


National AIDS CenterNational AIDS Center

Regional AIDS CenterRegional AIDS Center

Infections Disease

Laboratory

Infections Disease

Laboratory

District hospitalsDistrict

hospitalsPolyclinic

sPolyclinic

sCabinets of trust

Cabinets of trust

TB laboratory 1-3 levels



hospitalsPolyclinic

sPolyclinic

s

6

MoH TB/HIV Management Structure after 2012


Ministry of Health

State Servises

Regional Healthcare Department



Regional AIDS CenterRegional AIDS Center

Infections Disease

Laboratory

Infections Disease

Laboratory


hospitalsPolyclinic

sPolyclinic

sCabinets of trust

Cabinets of trust




hospitalsPolyclinic

sPolyclinic

s

7

Ukrainian Center for Disease Control (UCDC)

Alliance Ukraine in TB/HIV Management Structure


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


Alliance Ukraine activities

- Principal Recipient (PR) for GFATM Round 1 HIV (2004-2008) andCo-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


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 PATHat

http://www.aidsalliance.org/Publicationsdetails.aspx?Id=90632

15


Thank you!

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collaboration among tb/hiv csos and hiv and tb programs in ukraine

Health & Medicine