Prevention materials are still getting through to the “uncontrolled areas” of Eastern Ukraine
Operating in difficult and deteriorating conditions, the Alliance for Public Health (formerly the International HIV/AIDS Alliance Ukraine), in cooperation with the Global Fund and the World Health Organization, have managed to deliver a one-year supply of the rapid test kits for HIV, STIs and hepatitis C to the uncontrolled regions of the Donbas area in Eastern Ukraine – i.e. Donetsk and Lugansk.
They have also managed to deliver eight months’ worth of medical supplies (single syringes, alcohol wipes, condoms and lubricants).
In 2014, the Global Fund and the Ukraine principal recipients established a health sub-cluster group, which is coordinated by the WHO. Regular meetings are held involving all international agencies operating in the country and the Ministry of Health. The sub-cluster is coordinating and supporting the health programs operating in the uncontrolled regions.
Since the occupation of parts of Eastern Ukraine, the Alliance had been able to provide HIV testing and prevention services for the people residing there. At the same time, the Alliance had been able to continue supplying TB drugs for the treatment program run by TB centers in Lugansk and Donetsk. All commodities were procured under existing programs financed by the Global Fund.
However, the situation became more complicated in 2015 because of restrictions imposed by the de-facto authorities in the uncontrolled regions. Governors of the occupied territories introduced accreditation, application, and other systems covering all types of cargo delivered to the region, including humanitarian aid. At the same time, the Ukrainian Government established strict regulations requiring documenting deliveries to the territories it no longer controls.
In these difficult conditions, the Alliance managed to deliver three shipments of prevention commodities in 2015. Each of them required precise planning, obtaining of all necessary permits from both sides, and intense co-ordination with the authorities and recipients of the commodities. The last shipment was done in mid-November. While delivering the test kits, it was very important to organize proper temperature conditions for their transportation. To do so, a refrigerator lorry was specially rented by the Alliance.
According to Pavel Skala, associate director of policy and partnership at the Alliance:
“In light of the current epidemiologic situation and existing high risks of spreading infections, it was extremely important to ensure that our beneficiaries have kept access to prevention materials. Since the last delivery in July 2015, the situation has significantly deteriorated, in terms of both administrative procedures and security. Therefore, it is a success to know that our local partners have sufficient supply to last until July 2016 and enough medical supplies of the test systems to last until the end of 2016.”
According to the Alliance, historically, the Eastern part of the country has had higher HIV prevalence than the rest of the country, but through the efforts of programs supported by the Global Fund, the epidemic in Eastern Ukraine had stabilized by 2013. However, as a result of the current conflict, the epidemiological situation has significantly deteriorated.
Increased sex work has contributed to increasing cases of HIV and hepatitis C. In 2014, 3,000 new cases of HIV were registered in Donetsk, representing 27% of all new cases across the country. In the first six months of 2015, 593 new cases of HIV were registered in Donetsk. HIV prevalence among persons who inject drugs has increased from 26.5% to 34% in Donetsk and from 3.2% to 7.3% in Lugansk. It has become difficult to get a handle on the situation because there is no official surveillance data and internal migration is not controlled. However, according to Alliance, the increase of HIV prevalence among soldiers and the female population (mostly due to increased sex work) is already noticeable.
New border regulations have affected the work of Médecins sans Frontières and U.N. agencies in Donbas. They do not have accreditation and, therefore, are not allowed to work in the Eastern territories at the moment. MSF was a partner of Alliance Ukraine in delivering TB medication. Now the Alliance is in the process of establishing new channels and negotiating with potential new partners.
“Delivery of the prevention consumables and TB medicines are two different things,” explained VitaliyVelikiy, head of the Alliance procurement and supply management team:
“We have our local partner NGOs which provide prevention services on the ground in occupied part of Donbas, and they at the same time act as legal recipients of cargoes with consumables from Alliance. But for TB medicines we need to have the legal recipient (consignee) which is a medical institution and which can accurately register distribution of the medicines to the patients. Previously we performed our deliveries directly to so-called TB dispensaries, located in occupied territories, which have been moved out of Ukrainian jurisdiction since December 2014. This is why after that the only solution for us was to deliver medicines via partnering international humanitarian organizations like MSF (delivery in July-August 2015 to Donetsk and Lugansk). Meanwhile, since MSF has now lost its accreditation at the de-facto authorities there, we are keen to find a new partner as soon as possible.”
At the moment, Alliance Ukraine is providing eight types of medicines for MDR-TB which support treatment of 507 patients in Donetsk and 260 in Lugansk. The stock of TB-medicines in these two areas is enough to last only to the end of 2015.