In GFO 414 the Global Fund Observer (GFO) published an article on A Global Fund regional program amid the war in Eastern Europe. Based on feedback received by the GFO, the article presented incomplete information about the situation of the Global Fund Eastern Europe and Central Asia (EECA) multicounty program. The GFO accordingly invited Its Principal Recipient, the Ukraine-based International Charitable Foundation Alliance for Public Health (APH), to describe the program and its achievements in more detail.

Despite the prevailing circumstances of the Russian invasion of Ukraine, APH’s goal is to significantly contribute to the sustainability of HIV services for key populations (KPs) in EECA while mitigating the war’s impact. It has had to demonstrate flexibility in its working practices to ensure this result in EECA countries, affected in various ways by Russian military aggression. As we know from watching the news, Ukraine’s nearest neighbors as well as other countries in Europe have been opening their doors to displaced Ukrainians and refugees (who are members of large antiretroviral therapy (ART) and harm reduction programs) whose homes have been destroyed and are seeking asylum.

Amid the turmoil of the invasion, APH was not only able to maintain service delivery but, even more importantly, also developed new response measures.

About the program

The multicountry program is a three-year regional project entitled Sustainability of Services for Key Populations in the Eastern Europe and Central Asia (EECA) Region (#SoS_project 2.0). It covers 15 countries in the region with HIV and TB service sustainability, human rights and service digitalization. The full list of the EECA multicountry program consortium partners for 2022-2024 is publicly available on the APH website. The program is coordinated by APH in partnership with the largest patient organization in Ukraine CO ”100% Life”, in collaboration with the Central Asian Association of People Living with HIV and the South Eastern Europe Regional TB and HIV Community Network (SEE RCN), the World Health Organization (WHO) European Office, the PAS Center in Moldova, the Eurasian Harm Reduction Association (EHRA), the Eurasian Coalition on Health, Rights, Gender and Sexual Diversity (ECOM), the Eurasian Women’s Network on AIDS (EWNA), the Eurasian Network of People Who Use Drugs (ENPUD), the Eurasian Key Populations Coalition (EKPC), and the Regional Expert Group (REG) on Migration and Health in EECA. Also, national state and non-governmental organizations representing the interests of HIV-vulnerable population groups, as well as people living with HIV (PLHIV), are involved in implementing the program.

Activities since the Russian occupation of Ukraine

The regional program has only been up and running for six months but has already surpassed its envisaged workplan. Some highlights of its work are:

• The program curtailed its activities in Russia and started operations in Tajikistan (a country which initially was not included in the project). In Tajikistan its focus is coordinated with national stakeholders and has been established as a sustainable city HIV response in the cities of Dushanbe, Khorog and Kuliab.
• SoS 2.0, being uniquely positioned as a regional program, has established a component to support the world’s largest flow of refugees who are ART and/or opioid substitution treatment (OST) patients. On 1 March, in response to Russia’s large-scale military aggression in Ukraine, a regional emergency program to support refugees and internally displaced persons was launched with the #HelpNow coordination service; hubs were supported in three countries (Germany, Moldova, and Poland), the online platform of Ukrainian doctors providing telemedicine consultations was launched, and shelters were created. To date, over 6,000 requests for ART and OST have been addressed.
• Southern and Eastern Europe (SEE) countries held key discussions on ART price reduction and the roll out of pre-exposure prophylaxis (PrEP). In June a meeting in Skopje to discuss regional plans for activities and cross-country cooperation resulted in the partners developing common country-tailored strategies on antiretroviral drug (ARV) price reduction and scaling up access to PrEP in Balkan countries.
• To envisage and map the changed landscape due to the Russian invasion and its impact on EECA and plan the requisite changes to program implementation, partners met in Vilnius in July 2022 to discuss EECA-wide strategies for interventions on budget advocacy and human rights. As a result, implementing partners developed action plans to ensure the availability of funds for uninterrupted HIV-related KP service delivery in the EECA region in the time of the war and its aftermath, and to maximize the impact of the regional project to protect KP’s human rights.
• Many online meetings and webinars held by APH and its partner organizations have enabled cross-region cooperation in the response to COVID-19, scaling up access to PrEP and improving the HIV treatment cascade, as well as advocacy activities to obtain and increase funds for KP-targeted activities in EECA and the SEE countries.

To date, the project’s significant contributions means that it is well on the way to achieving its three objectives. In particular:

Improving the HIV care cascade and access to HIV testing and treatment services in EECA

• The first national meeting on ARV access was held in Kazakhstan and recommended the next steps of increasing generic competition for dolutegravir (DTG) procurement, as well as registering bictegravir (BIC).
• The project initiated an evaluation of the existing national PrEP protocols in SEE countries.
• An assessment of OST sustainability in the context of transition from donor support to domestic funding is ongoing in Albania, Belarus, Kyrgyzstan, Moldova, Tajikistan, and the Ukraine.
• The development of documents to enable research on decentralizing HIV testing and treatment in the EECA region has been finalized and the research has been started.
• The project launched an analysis of HIV diagnostic and treatment guidelines in seven EECA countries with the further development of recommendations to align the guidelines with the World Health Organization (WHO) clinical protocols.

Improving human rights and KP decriminalization, and gender-based activities

• In Kazakhstan during the first quarter of 2022 the Regional Expert Group on Migration and Health launched a forum for experts to discuss issues related to migrants’ access to HIV services including ART. It resulted in the formulation of various recommendations to both governments and civil society organizations in migrant origin countries and to international organizations.
• The program launched a regional version of an online course on the decriminalization of drug use for EECA activists (https://idpc.healthefoundation.eu).
• The program recorded and addressed approximately 1,500 cases of violations of KPs’ human rights in 10 countries (Albania, Bosnia and Herzegovina, Georgia, Kyrgyzstan, Montenegro, Moldova, North Macedonia, Serbia, Tajikistan, and Uzbekistan).
• The project started to collect data to feed into the most comprehensive gender assessment of barriers to accessing HIV services in 15 countries in EECA and has launched a call for applications for gender programs in selected countries.
• Stigma Index Surveys have been initiated in two EECA countries.
• Jointly with its partners, APH submitted a Shadow Report on violations of the rights of KPs in Uzbekistan to the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW). A “shadow report” is information submitted by non-governmental organizations (NGOs) to the treaty monitoring bodies that addresses omissions, deficiencies, or inaccuracies in the official government reports.

Budget advocacy for sustainable KP services in the EECA region

• Project partners in Moldova have revised the care and support standards and submitted them to the Ministry of Health (MOH) for approval.
• In Uzbekistan, the services list and tariffs for the “School of the Patient” were finalized and translated into Uzbek.
• In Kazakhstan, program partners have developed a tariff for KP service provision at the point of care and for HIV testing for the general population and submitted these for approval to the Vice Minister of Health.
• An analysis of the procurement of ARV medicines and price comparison with the Global Fund’s reference prices was carried out in Georgia.
• Partners in SEE advocated for the allocation of local budget funds for HIV activities through NGOs (Podgorica – 40,000 Euros; Novi Sad – $9,000); the MOH in Montenegro will allocate 130,000 Euros for these purposes.
• In 2022, in North Macedonia the project’s advocacy efforts have resulted in an increase of funds to national HIV programs of 42.5% compared to 2021.

The project continued implementation of its COVID-19 response Mechanism (C19RM) work across the countries.

These successes were only possible because APH and its partners, including the Global Fund, created an effective financing and implementation mechanism that was able to function regardless of war conditions.

For further information on the regional program, please contact Inna Gavrylova, APH’s Senior Communications Manager at gavrylova@aph.org.ua.