1. ARV Treatment Scale Up: Progress in Ukraine Andriy Klepikov Executive Director, International HIV/AIDS Alliance in Ukraine ARV Treatment Scale Up: Progress in Ukraine Andriy Klepikov Executive Director, International HIV/AIDS Alliance in Ukraine

2. Epidemic in Ukraine Highest estimated HIV prevalence rate in Eastern Europe and Central Asia (1.63% among 15-49 years old). Estimated number of HIV-infected is 440 000 people Since 1987 when the first cases of HIV were registered in Ukraine the number of officially registered HIV-positive cases has reached 131 730 (as of July 1, 2008) Concentrated epidemic among injecting drug users. Growing sexual transmission in many cases indirectly related to drug use

4. Global Fund Grants to Ukraine $ 100 M Round 1 Global Fund grant focusing on ARV treatment and $ 150 M Round 6 grant awarded in mid 2007 are two major interventions In early 2004 R1 grant suspended as result of non- transparent procurement of drugs for initiation of ARV therapy by the Ministry of Health of Ukraine Starting from March 2004 stewardship of the grant given to the civil society organization — International HIV/AIDS Alliance. All major grant targets have been met or exceeded Grant funding allowed major ARV scale-up in the region of Eastern Europe and Central Asia

5. 137

6. Starting point 137 patients were receiving ARV with governmental support as of early 2004

7. Implementation of ART in Ukraine August 2004 – July 2008 Number of patients

8. Partnership and approach Major Alliance partners: Ministry of Health of Ukraine, Ukrainian AIDS Center, All-Ukrainian PLWH Network All 27 regions enrolled into treatment programs during 5 years of the Global Fund funded program (based on the prevalence data) Assessment of all regions of Ukraine before ART initiation followed by further technical support National guidelines on treatment and diagnostics of ART for adults, opportunistic infections treatment, laboratory diagnostic, VCT, TB diagnostics, diagnostic of extra pulmonary TB, VCT at STI clinics, narcological and TB dispensaries developed

9. Service model Multidisciplinary approach: government organizations (AIDS Centers) cooperate with NGOs to ensure comprehensive medical, psychological and social support to PLWH Since 2004, 147 multidisciplinary teams on ART were trained (over 450 specialists) Training topics – ART for adults, ART for children, ART at the detention facilities, joint trainings for infectious disease specialists and TB specialists, as well as narcologists Clinical preceptorship program

10. Package of services Treatment and prevention of opportunistic infections Diagnostics: laboratory equipment, test-systems for CD4, viral load, PCR are procured, as well as rapid HIV tests and ELISA tests ARV drugs for PMTCT (clinical protocol providing for triple therapy was adopted in November 2007) Milk formula for children Drugs for post-exposure prophylaxis Substitution therapy with buprenorphine and methadone

11. HIV treatment coverage

12. Main Program targets and results - 2008 IndicatorBaseline2008 Number of people receiving anti- retroviral treatment 255 (2004) 5 684 Number of service deliverers receiving clinical qualification 8 (2004) 560 Percentage of people still alive 12 months after initiation of antiretroviral treatment 85% (2005) 89.9% Percentage of unsupervised discontinuations of antiretroviral treatment for 1 month or more during 12 months after initiation 12% (2005) 5.73%

13. Number of AIDS cases and AIDS-related deaths reported annually among the citizens of Ukraine, 1991-2007

14. We are proud of Setting implementation standards: meeting all major targets and effective managementSetting implementation standards: meeting all major targets and effective management  Influencing policy environment: civil society led advocacy campaign reached the President of Ukraine Introducing crucial innovations such as methadone based substitution maintenance treatment Ensuring sustainability by strengthening national capacities and systems, advocating for proper national strategy and funding level

15. Key lessons Civil society organizations proved ability to successfully manage national scale programs Country is benefiting from shared civil society and governmental ownership, the proper ground for sustainable response

16. Addressing challenges Continuation with the ARV treatment of 6000 patients and PMTCT patients with governmental funds starting from October 2008 Decentralization of treatment with a view of further treatment scale up Integrated treatment Centers for patients with HIV, TB and drug dependency Ensuring cost-effectiveness and quality of drugs procured from the state budget Policy barriers for scaling up methadone based substitution maintenance treatment

17. Further plans Meeting Universal Access ARV treatment target: 80 000 patients by the end of 2013

18. THANK YOU, and NO PASARAN!