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
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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
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TB-HIV dynamics: 2004-2012TB-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 CenterNational TB Center
Regional TB Dispensary and TB Hospital
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
TB laboratory 1-3 levels
District hospitalsDistrict
hospitalsPolyclinic
sPolyclinic
s
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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 TB Dispensary and TB Hospital
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
TB laboratory 1-3 levels
District hospitalsDistrict
hospitalsPolyclinic
sPolyclinic
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) 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
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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 PATHat
http://www.aidsalliance.org/Publicationsdetails.aspx?Id=90632
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Thank you!
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