“STOP TB IN UKRAINE” PROGRAM

In 1995 the epidemic of tuberculosis (TB) was announced in Ukraine. In 2009, Rinat Akhmetov Foundation for Development of Ukraine, along with the Ministry of Health submitted the Proposal to the Global Fund to Fight AIDS, Tuberculosis and Malaria (hereinafter - GF) for Round 9 under “Tuberculosis” component. On March 2010, the GF has endorsed funds allocation to Ukraine in accordance with the Proposal. And on December 10, 2010 the Grant Agreement was concluded between Ukraine and GF. According to this document Rinat Akhmetov Foundation for Development of Ukraine is the Principal Recipient of the grant; and the allocated funds are invested in “Stop TB in Ukraine” program implementation for years 2011-2015. Rinat Akhmetov Foundation for Development of Ukraine also invests its own funds into the Program.    

Total budget for the Program: USD 94 862 399

 
Total for Phase 1 (2011 and 2012 years): USD 29 659 314 (UAH 237 million).  
 
“Stop TB in Ukraine” Program was created in order to overcome the TB epidemic in Ukraine.

Key program objectives:

• To improve TB diagnosis by optimizing laboratory network in public and prison settings.
• To improve access to high quality diagnosis and treatment services for the whole population.
• To increase the capacity of the health care system of Ukraine in TB combat through the improved management (leadership, monitoring and evaluation, human resource development), which is necessary for the successful implementation of the TB Program.
• To raise public awareness on TB prevention and treatment, to contribute to political support mobilization, fight against self-treatment, stigma and discrimination reduction regarding TB patients and those cured from TB.

The agreement with GF stipulates that within 5 years, Ukraine has to reach international standards in the TB diagnosis and treatment and reverse epidemic trends.
 
 
Program implementation results (as of the end of 2012)

Diagnosis improvement:

• To improve lab equipment, quality and time of TB diagnosis 25 types of lab equipment (with consumables) were procured in the amount of UAH 52.7 million. In particular:

 - analyzers BACTEC MGIT with consumables for over UAH 10 million; that contribute to quality and time improvement (from three month to two weeks) in TB diagnosis;
 - 12 systems GeneXpert with consumables for over UAH 8 million; that provide for decreased time (within 2 hours) of TB diagnosis and detection of resistance to Rifampicin (one of the basic TB drugs);
 - 2 systems HAIN with consumables in amount of UAH 1.4 million; that perform molecular genetic TB diagnosis providing identification of the complete resistance pattern to all first and second line TB drugs within one day.

• Guidelines for lab network optimization for microbiological TB diagnosis in Ukraine are developed and approved.
• The manual "Standards for bacteriological TB diagnosis" are developed.
• The terms and guidelines "Quality control systems for lab TB diagnosis in Ukraine" are to be approved by the end of May 2013.

Trainings:

Over 3500 specialist were trained in "Lab TB diagnosis by microscopy. Quality assurance of bacterioscopic lab investigations", "Microbiological and molecular genetic TB diagnosis (including resistance to drugs) and quality assurance of investigations", "Monitoring and Evaluation", "MDR-TB case management and infection control methods", "Education on TB and HIV prevention", etc.

Treatment improvement:

• as of April 1, 2013, second line TB drugs for the MDR-TB treatment (760 patients) are procured and delivered to regions;
• by August 2013, it is planned to procure TB drugs for additional 960 patients;
• as of the end of 2012, 14 regions were covered by controlled treatment and social support to TB patients;
• from February 1, 2013, 13 new regions of Ukraine have been enrolled in social support services. Thus, today, controlled treatment and social support for TB patients is carried out in all 27 regions.

Improvement of monitoring and evaluation system:

• to implement national electronic register of TB patients an open competition was conducted for the procurement of 324 computers for regional level and 43 for the prison system, as well as payment for Internet connection, Internet access and server support;
• the support and technical assistance was provided to regions via monitoring visits: the use of improved standard tools (checklists) in line with international guidelines during such visits and analysis of the results; 532 regional- and 18 national-level visits were financed;
• the current temporary recording and reporting forms on MDR-TB were revised and improved in accordance with international standards.

Advocacy, communication (ACSM):

• activities on representation of TB patients’ rights and interests were launched;
• all regions of Ukraine are working to improve the legal framework, in particular regional ACSM strategies are already developed and approved;
• a survey on knowledge, attitudes, practices and behavior regarding TB was conducted among the general population, certain groups and the media;
• an information portal on TB issues www.stoptb.in.ua was created;
• two waves of info campaign for the general public were comprehensively implemented, including the video and audio production, as well as relevant outdoor social advertising. The purpose of the first wave was raising concerns within population about TB as a real threat to the health of the nation. The second wave implied combat against stigma and discrimination of cured TB patient who can lead a fulfilling life;
• the hotline on TB issues 0-800-50-30-80 is functioning from December 1, 2011. The calls from all phones are free of charge. Info campaign resulted in gradual increase of calls to the hotline: during January 2013, 1866 people referred for public consultation, which is twice higher compared to January 2012.

 
Main Sub-Recipients of the Program:
 

• The State Penitentiary Service of Ukraine(http://www.kvs.gov.ua/peniten/control/main/en/index;jsessionid=89B35CD42...)

1. Maintenance of the TB patients register;
2. Optimization of the laboratory network and improvement of diagnostics;
3. Introduction of international standards in TB case management.
 

• ICF “International HIV/AIDS Alliance in Ukraine”(http://www.aidsalliance.org.ua/cgi-bin/index.cgi?url=/en/news/index.htm)

1. Procurement of equipment and second line TB drugs;
2. Improved access to quality services for HIV/TB patients through:

• Participation in the development of regulations regarding HIV/TB co-infection
• HIV prevention among TB patients
• TB prevention among PLWH
• Introduction of infection control in settings for HIV+.

 

 PATH Ukraine (www.path.org)

1. Education (arrangement of trainings);
2. Participation in the development of regulations;
3. Procurement of equipment for the TB register.
 

• Ukrainian Red Cross Society (http://www.redcross.org.ua/eng/)

Patient support among risk groups who have a tendency to treatment interruption

• AUCF “Coalition of HIV Service NGOs” (http://en.hiv.org.ua/home)

ACSM component: Social Mobilization

• CF “Foundation for Prevention of Chemical Addictions and AIDS”(www.helpme.com.ua)

The All-Ukrainian TB hotline (0 800 503 0 80)

Partners of the Program:

• The Ministry of Health of Ukraine;
• The State Service of Ukraine for combating HIV/AIDS and other socially dangerous diseases;
• The National Institute of Tuberculosis and Pulmonology named after F.G. Yanovsky;
• All-Ukrainian Charitable Organization “All-Ukrainian Network of PLWH”.

 
Implementation of the Program in the regions:

2011 - Dnipropetrovsk, Donetsk, Kharkiv, Lviv, Mykolaiv, Kirovohrad, Kyiv regions and Kyiv city
2012 – AR Crimea, Zaporizhzhya, Luhansk, Odesa, Kherson regions and Sevastopol city
2013 – Volyn, Zhytomyr, Poltava, Rivne, Sumy, Khmelnytsky, Chernihiv, Cherkasy regions
2014 – Vinnytsa, Zakarpattya, Ivano-Frankivsk, Ternopil, Chernivtsi regions.
 

Within 5 years the Program will provide assistance and support to all regions of Ukraine.

Reference:
The Global Fund to Fight AIDS, Tuberculosis and Malaria is one of the major international institutions providing funding for projects aimed at combating the three dangerous diseases. The decision to establish the Fund was made at the UN General Assembly Special Session on HIV/AIDS in 2001. The Fund was established in early 2002 and since then it annually awards grants to countries that most need support in the fight against the given epidemics.
The distribution of grants is carried out in the format of “rounds” - the so-called stages of funds allocation. In 2002 all countries were able to apply for participation in the first round of the Global Fund. In 2010, the winners of the 9th round were announced, and Ukraine was among them. In general, during its existence the Global Fund has allocated USD 22.4 billion to 150 countries to support programs to control the above three diseases.