Ukraine has the second largest HIV epidemic in the WHO European region. The country also has a high prevalence of multidrug-resistant tuberculosis. The region of the armed conflict in the Eastern part of Ukraine (UA) lacks provision of health services. 240.000 people live with HIV (PLHIV) in UA, with an HIV prevalence of 0,9% (ages 15-49). The number of people who know their HIV status increased by approximately 60,000 between 2014 and 2017.
Our Ukrainian member of the AAE Steering Committee (SC), Yaroslav Bliakharskyi, hosted AAE’s latest SC meeting at his charitable and patient-based organisation “All-Ukrainian Network of People Living with HIV/AIDS” (hereafter 100% LIFE) in Kyiv. The organisation was recently renamed to 100% LIFE, to point out that they work to provide 100% access to treatment to all patients living in Ukraine. After the meeting, AIDS Action Europe’s staff and Steering Committee visited the newly opened medical centre of 100% LIFE. Because HIV testing services in Ukraine are usually performed in a less comprehensive method, this medical centre aims to provide all needed services to all patients with all-needed tests, quick results and PLHIV-friendly doctors and treatment on the same spot with no stigma or discrimination towards patients.
TRANSITION OF FUNDING
HIV prevention programmes performed by NGOs and charitable organisations such as 100% LIFE, are mostly funded by Global Fund to Fight AIDS, Tuberculosis and Malaria (GF) programmes. From 2018 on, the GF has been cutting down its funding in UA and the aim is that the country transitions to domestic funding. “Key challenge in the transition process from GF to domestic funding is to ensure established well-working HIV prevention programmes and to make the government sources available for NGO’s”, said Valeria Rachynska, the head of the regional policy team at 100% LIFE. In her presentation, Valeria introduced the negotiations on the transition plan carried out by a strategic group for implementation. It is crucial to patients-based organisations to build up a system, which makes the government accountable to sustain life-saving programmes for people living with HIV (PLHIV). Besides her organisation other relevant stakeholders such as the government representatives came together to develop a reasonable plan of the transition period. The strategic planning group included participants from CO"100% Life", International Renaissance Foundation, CO "Hope of Light" and NGO "Institute of Analytics and Advocacy".
INCLUDING KEY POPULATION
To prepare the government to take over funding the strategic group developed a three-year implementation plan, according to which in 2018, the government took over 20% funding of prevention, care and support programmes, and in 2019, the percentage should be raised up to 50%. In addition, in 2020, the government funds are expected to cover 80% of the expenses.
The strategic group set up two phases, containing the analysis of pilot projects development of new models, technical assistance in the implementation of models, development of technical assistance to NGOs, internal and external communication and ensuring accountability and transparency of the implementation project. To ensure that the needs of diverse groups in HIV and TB services are met in this plan, representatives of all key populations were welcome to contribute and participate in the meetings. Almost every key population were considered and could make their recommendations.
ACCESSIBILITY OF SERVICES
By implementing this plan, the group wants to create a market of social services for all. Every Medical Centre should be able to apply for governmental funding. “We want to destroy the monopoly and establish a good care system for everyone”, said Valeria, “it is the greater aim of this work to eliminate corruption and fill out the gaps in support for key populations and PLHIV.”
IMPROVE QUALITY OF LIFE OF PLHIV
The Country Coordination Mechanism contributed to the plan by initiating a working group on the transition issue years ago. The GIPA principles worked hand in hand with the planning to realize the rights of PLHIV, including their right to participation in decision-making processes that affect their lives. Untrained general practitioners with no knowledge about HIV, stigma and discrimination towards PLHIV in the health sector, unreachable services for prisoners and corruption in health sector were just the tip of the iceberg during the implementation process.
The Ukrainian transition plan from Global Fund to domestic funding strives to keep good proven HIV, TB and HCV service programmes, while eliminating gaps in health care and improving the quality of life of PLHIV.
 In 2019 - Prevention: 72 million UAH ($ 2.6 million) and care and support: 27 million UAH ($ 1 million); in 2020 - Prevention: 133.6 million UAH ($ 4.9 million) and care and support: 51.4 million UAH ($ 1.9 million); in 2021 - Prevention: 174.2 million UAH ($ 6.5 million) and care and support: 52.3 million UAH ($ 1.9 million). Government procurement process: https://prozorro.gov.ua/tender/search/?edrpou=40524109