As of 31 March 2008, a recently completed Round 1 Global Fund grant in Ukraine had provided prevention services to 214,103 people who inject drugs. By the end of September 2008, 6,070 people, including 911 children, had received antiretroviral therapy (ART). And, in 2008, 80% of pregnant women living with HIV had received treatment to prevent mother-to-child transmission, up from 35% in 2003. The grant exceeded the vast majority of its targets.
This information was contained in a report released in September 2009 by the International HIV/AIDS Alliance. The grant, which cost $98 million over five years, supported programmes that involved the rapid scale-up of ART, a comprehensive package of care, support and prevention services for most-at-risk populations, and the roll-out of substitution maintenance therapy.
The Global Fund grant formed the major part of the national response to HIV and AIDS in the Ukraine. During the period of the grant, the number of new HIV cases per 100,000 tests decreased from 632.8 in 2006 to 590.2 in 2008; and the AIDS mortality growth rate dropped from 38% to 8% (between 2004 and 2008).
The report, "Civil Society Leads National Response - Final Report: Overcoming the HIV/AIDS Epidemic in Ukraine, Funded by the Global Fund (2004-2009)," also describes the experiences of the International HIV/AIDS Alliance as principal recipient (PR) of the grant, and outlines the lessons learned from the experience.
In 2002, the Global Fund approved a proposal for CCM Ukraine for a programme called "Overcoming HIV/AIDS Epidemics in Ukraine." In January 2003, the Fund awarded grants to three PRs, the Ukrainian Ministry of Health, a charitable organisation called the Ukrainian Fund to Fight HIV Infection and AIDS, and the United Nations Development Programme (UNDP). The International HIV/AIDS Alliance, through its country office, Alliance Ukraine, served as a sub-recipient (SR) under two of the PRs.
A year later, the Global Fund suspended the grants amid concerns about how they were being managed. Alliance Ukraine was selected as the new PR for all three grants (see GFO 18, available at www.aidspan.org/gfo). (The three grants were eventually rolled into one.) The Alliance thus became one of the first civil-society organisations to become a sole PR for a grant. During the course of implementing the grant, Alliance Ukraine went from a country office of the Alliance to being an independent organisation, but part of the Alliance family.
According to the report, one of the Alliance's major contributions to the grant was to strengthen civil society. The Alliance supported the development of the All-Ukrainian Network of People Living with HIV/AIDS (PLHA Network) and 150 new and existing NGOs.
Over the course of the grant, the Alliance conducted regular stakeholder meetings, involved vulnerable communities, and implemented transparent programmes to develop workplans and budgets. According to the report, this has led to a fundamental shift in the national response to the HIV and AIDS epidemic and in wider society, "creating a culture of increased openness, accountability and confidence."
Ukraine subsequently secured a Round 6 HIV grant from the Global Fund to finance another programme for 2007-2012. For this grant, the CCM selected Alliance Ukraine and the PLHA Network as co-PRs.
The report contains several case studies describing innovative approaches used to implement key activities of the Round 1 grant. The topics covered include the rapid scale-up of ART; getting services to vulnerable communities; using advocacy to remove barriers to substitution maintenance therapy; and providing life skills-based education in Ukrainian schools. The report also describes how the grant helped establish a national monitoring and evaluation system for Ukraine; and how procurement systems were set up to deliver better drugs more cheaply.
The report is available on the website of the International HIV/AIDS Alliance at www.aidsalliance.org/publication-search.aspx (select "Global Fund" under the heading "Subject Matter").