Слайд 1 - Alliance Ukraine

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Слайд 1 - Alliance Ukraine
ART, Prevention of Mother-To-Child
Transmission, Substitution therapy
Findings Resulting from the Quarterly Report for
October – December 2006
Submitted to the Global Fund:
Key Issues and Challenges Identified
Indicators by the End of 2006






Number of patients on ART – 3730 (3730)
Number of pregnant women who received
PMTCT – 4487 (4975)
Number of patients on ST combined with ART
– 93 (300)
Number of patients on ST (without ART) – 343
(200)
VCT for the patients of STI facilities – 0 (4250)
VCT for patients of TB facilities – 0 (7500)
Кількість пацієнтів
Scaling-up of ART in Ukraine
(August 2004 till January 2007)
5000
4000
3
509
3
703
1047
Global Fund
3000
2000
3082
3431
3730
1000
0
118
137
As of July 2004
Aug2004-Jun2006
Other
sources
State Budget
Jul-Sept 2006
Oct2006-Jan2007
Ensuring ART Provision

As of January 1, 2007, 55 patients were receiving
ART at the penitentiary institutions (plan - 100 patients
before September 2007)
 Difficulties in provision of ART at the penitentiary
institutions (coordination between penitentiary
institutions and AIDS Centers related to timely
reporting on ART prescription and utilization of drugs,
insufficient laboratory monitoring)
NB: while planning of budget for 2008 it should be
remembered that the 1st Round Programme is over on
September 30, 2008!!!
Laboratory Monitoring

In the frames of the Programme supported by
the Global Fund test-systems for CD4 and
viral load testing are procured only for the
patients receiving ART from the Global Fund
costs (10000 and 8000 correspondingly in
2007)
 It was envisaged that the test systems will be
procured in the frames of the World Bank loan
(CD4 -58000, VL – 11976)
 It is planned to procure 16450 test systems for
CD4 tests and 3000 test systems for viral load
tests from the state budget
Treatment of Opportunistic
Infections

As of January 1, 2007, 7912 patients got treatment
and prophylaxis of opportunistic infections with the
Global Fund support
 Up to 5% from the general needs (1515 treatment
courses) will be procured with the Global Fund support
 The biggest number (85%) of procurement of drugs for
treatment and prophylaxis of opportunistic infections is
envisaged in the World Bank loan (28435 treatment
courses)
 10% (3351 treatment course) – from the state budget
funds
VCT



Instructions on VCT and the TB and STI facilities are
approved by the MoH Order
During October – December 2006 the process of test
systems procurement and conclusion of agreements
was taking place
Test-systems (47 000 tests) are procured in February
and delivered to the regions in March 2007
PMTCT (1)
In the frames of the Programme supported by the Global
Fund:
 Procurement of ARV drugs for monotherapy
 PMTCT with three drugs is planned (after approval by
the MoH Ukraine of the Clinical protocol – expected in
2007)
 Milk formula (procurement in the Year 5 is not
planned)
 Work on social support of HIV-infected pregnant
women and mothers
According to the data of Ukrainian Center for AIDS
Prevention, 90,92% of HIV-infected pregnant women
were provided with PMTCT during 2006
PMTCT (2)
246 HIV-infected pregnant women have not received
PMTCT.
Of them:
- 110 pregnant women – were not registered at the
prenatal clinics
- 57 cases – tests were not available
- 37 cases – false-negative test results
- 18 cases – child-bearing out of hospital and premature
birth
- 16 cases – refusal of the pregnant women
- 8 cases – other reasons
Complementarity

Test systems for VCT of pregnant women from the
state budget funds
 Test systems for CD4 and viral load testing in the
frames of the World Bank loan as well as from the
state budget funds
 Procurement of drugs for treatment and prophylaxis of
opportunistic infections in the frames of the World
Bank loan as well as from the state budget and local
budget funds
 Procurement of the milk formula – in 2007 is still taking
place under the Global Fund support, in future – from
local budgets
Up-to-Date Information on SMT
Implementation





As of March 02, 2007, substitution maintenance
therapy in Ukraine was provided to 519 patients
with opioid dependency
330 of them are patients with HIV/AIDS
Treatment with buprenorphine is provided at 11
sites in 9 regions
SMT projects are implemented in the cities: Kyiv,
Donetsk, Dnipropetrovsk, Mykolaiv, Odesa,
Simferopol, Kherson, Vinnytsia, Poltava.
FarmCenter has registered methadone in tablets
(producers – PharmaScience, Canada, and
Sandoz, Germany)
Plans for the Current Programme
Year
According to MoH Order №846 dated December 20, 2006
on scaling-up SMT proposals are provided to the MoH
on initiation of treatment with:
 Meathadone – at 45 healthcare facilities (at 8 of them
SMT with buprenorphine is already provided)
 Buprenorphine – at 14 healthcare facilities in 12 regions
of Ukraine, where SMT was not provided yet
 It is planned that by the end of the 4th programmatic year
SMT will be provided to 3000 patients. SMT will be
initiated in majority of regions of Ukraine.
Difficulties in the Area of SMT
Implementation (1)
SMT scaling-up is significantly delayed:
 MoH Order with the list of the healthcare facilities and
regulating distribution of the buprenorphine and
methadone for scaling-up SMT is not issued yet
 Committee on Narcotic Drugs Control of Ukraine has
not submitted the data regarding the quotas for
methadone necessary for Ukraine in 2007 to the
International Narcotic Control Board (INCB)
 It’s impossible to provide technical support to
healthcare facilities before they are identified by the
MoH, to prepare them to SMT initiation, to start
projects on psycho-social support of SMT
Difficulties in the Area of SMT
Implementation (2)

The detailed operational SMT scaling-up plan is not
approved by the National Coordination Council
 Introduction of SMT with methadone still faces obstacles:
- from the representatives of political forces and certain nongovernmental institutions, which initiated the campaign in
the mass media aimed to revoke the MoH Order № 846 on
SMT scaling-up and usage of methadone for the purposes
of prevention of HIV spread through injecting drug use
- from the representatives of certain security agencies, who
straightforwardly express their rejection related to this
method’s application for the purposes of HIV transmission
prevention

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