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Due to the antiterrorist operation in Donetsk and Luhansk regions, NGOs working in those regions have encountered various problems in provision of socio-medical services for people living with HIV.

Due to the advocacy efforts of All-Ukrainian Network of PLWH on January 28, 2015 was provided the delivery of ARV-medicine for:

o 14 HIV-positive children in Kramators'k (delivery from Donetsk).

o 1200 HIV-positive patients in Luhansk (delivery from Kyiv).

BARRIERS TO PROVISION OF SOCIO-MEDICAL SERVICES FOR PLWH IN ATO ZONE

o Due to the movrment restrictions patients cannot visit AIDS centers and receive ART (to move between territories not controlled by Ukraine and Ukrainian territories a special permit needs to be obtained);

o Viral load, CD4 cell and PCR diagnostics blood samples transportation within region cannot be provided. Patients must visit clinics personally;

o Many members of medical staff and social workers have terminated their work contracts due to difficult working conditions and psychological pressure. In Luhansk region 90% of medical staff providing services in NGO projects quit their jobs;

o Curtailment of services by many companies in ATO zone led to problems with delivery of goods and procurement of humanitarian aid;

o Free baby formula for infants born to HIV positive mothers provided as part of PMTCT is currently unavailable. The procurement of baby formula for PMTCT is funded by local budgets but due to difficult political, economic and military situation in the region is currently impossible. Repeat appeals to UNICEF for donation of baby formula produced no result.

o The significant number of businesses within the ATO zone have stopped the supply of products to the area;

o Due to the price increase of food and other goods (hygiene kits, diapers, medicines, gynecological sets) the number of aid packages has significantly decreased;

o Due to decreased number of financial institutions within the ATO zone and complete closure of banking sector in the so-called “LPR” and “DPR” the majority of suppliers refuse to accept bank transfer payments. Therefore, procurement procedures have been difficult to follow. It was decided to select providers of services and goods in neighboring regions.

BARRIERS to DELIVERY into the ATO zone

o Military action in the ATO zone;

o The courier and postal services stopped their activities within the ATO zone that prevents the delivery of cargo;

o The impossibility to insure the cargo which should be delivered into the ATO zone;

o Long process of re-registration of institutions at new locations on territory controlled by the Ukrainian authorities;

o The institutions that changed the location are unprepared to receive and store the medical products that require the compliance with special storage conditions (cold chain, etc.);

o Reagents and consumables for CD4 count and viral load diagnostics, OI and STI drugs have limited shelf life;

o Lack of equipment for CD4 count and viral load diagnostics in the institutions in Slovyansk and Severodonetsk;

o The new rules (from January 2015) of entrance into the ATO zone through check-points: http://www.ssu.gov.ua/sbu/control/uk/publish/article?art_id=135955&cat_id=39574 , limited number of check-points. The procedure of issue of special permits takes about 10 days which delays the process of delivery of ART.

Procurement of ART (Program year 3). Not delivered as of January 23, 2015:

Luhansk

Efcure, (Efavirenz 600 mg, tab., # 30, # 60)

Viracomb (Zidovudine 300 мг/ Lamivudine 150 мг, tab., № 60)

1945 packs

27 packs

All other ART medications procured in program year 3 were delivered to Lugansk and Donetsk in March-July 2014.

Procurement of ART (Program year 4). Delivered as of January 23, 2015:

Donetsk region (Slavyansk)

Truvada (Tenofovir 300 mg / Emtricitabine 200 mg, tab., # 30 tablets in a bottle)

Viracomb (Zidovudine 300 mg/ Lamivudine 150 mg, tab., # 60)

Aluvia (Lopinavir 200 mg / Ritonavir 50 mg, tab., pack № 120)

Kaletra (solution for oral use, 60 mg in vial, 5 vials in a cardboard box)

709

5100

3049

180

Luhansk region (Severodonetsk)

Aluvia (Lopinavir 200 mg / Ritonavir 50 mg, tab., pack # 120)

Kaletra (solution for oral use, 60 mg in vial, 5 vials in a cardboard box)

Viracomb (Zidovudine 300 mg/ Lamivudine 150 mg, tab., # 60)

200

12

20

These ART medicdownload the documentations were delivered to the treatment institutions to avoid treatment interruptions to cover the needs of the patients who receive treatment at the expense of the State budget. All other ART medications will be delivered in January-February 2015.

ARV TREATMENT FOR PLWH

DONETSK REGION – there are 13 NGOs serving 24 sites (cities), among them:

15 on the territory controlled by Ukrainian authorities (Avdiyivka, Krasnogorivka, Slovyansk, Donetsk, Druzhkivka, Kramatorsk, Konstyantynivka, Chervonoarmijsk, Selidove, Dzerzhynsk, Krasnyj Lyman, Dobroppilya, Mariupol, Mykolaiivka, Volnovakha).

The remaining stocks of ARV medications as of January 26, 2015:

o ART site in Slovyans’k (344 patients) –till February-March 2015

o ART site in Krasnyj Lyman (65 clients) – till February-March 2015

o ART site in Mykolaiivka (45 clients) – till February-March 2015

o ART site in Konstyantynivka (213 clients) – till the end of February 2015

9 on the territory not controlled by Ukrainian authorities (Donetsk, Makiivka, Snizhne, Yasynuvata, Torez, Khartsyzk, Shakhtarsk, Enakieve, Horlivka).

Currently there are 1310 patients receiving ARV treatment who reside on the territory not controlled by Ukraine. 20-30% of clients were forced to change place of residence. About 50% of them come from time to time to get their ART. Contact is lost with 15% of clients who resettled.

The remaining stock of ARV medications would be sufficient only till March 2015.

*1.1. Coverage of HIV-positive clients within "All-Ukrainian Network of PLWH" projects, Donetsk region

LUHANSK REGION – there is 1 NGO serving 10 sites (cities):

4 on the territory controlled by Ukrainian authorities (Rubizhne, Severodonetsk, Lysychans'k, Svatove).

The remaining stocks of ARV medications as of January 26, 2015:

o ART site in Lysychansk – till February 2, 2015

o ART site in Severodonetsk – till January 30, 2015

o ART site in Rubizhne – till February 5, 2015

o ART site in Svatove – till January 1, 2015

6 on the territory not controlled by Ukrainian authorities (Luhansk, Stakhanov, Krasnodon, Perevalsk, Alchevsk, Lutugino).

Luhansk AIDS Center will run out of ART stocks by March 2015.

*1.2. Coverage of HIV-positive clients within "All-Ukrainian Network of PLWH" projects, Luhansk region

SITUATION IN PENITENTIONARY SYSTEM:

Of 36 prisons in Donetsk and Luhansk regions only 8 prisons are under the control of the Ukrainian authorities. It is important to underline that under the Global Fund project Network provides drugs to all prisons of these regions as the State Penitentiary Service of Ukraine does not deliver drugs to those institutions.

As of January 19, 2015 the number of HIV-positive prisoners in Donetsk prisons is 1252 (404 on ART), in Luhansk prisons – 241 (134 on ART).

In August - October, 2014 Network delivered antiretroviral drugs procured under the Global Fund project to these prisons to avoid treatment interruption.

The stock of ARV medications would be sufficient only till March 2015.Starting from January 2015 prisons in Donetsk and Luhansk regions will have no medications for provision of emergency medical care for prisoners.

Barriers for activities in prisons:

o CD4 and VL blood samples cannot be delivered to and tested by the laboratories;

o Lack of medical staff due to the antiterrorist operation;

o Lack of food, toiletries, warm clothes, medicines due to lack of centralized supply by the State Penitentiary Service of Ukraine to institutions that are not under the control of Ukrainian authorities.

National preventive mechanism with support from the Network conducted monitoring visits to 3 SIZO on the territory of ATO.

It should be noted that the issues of health care, including the issues of HIV-positive people, are neglected. For example, in Starobelskiy SIZO there is de facto no medical ward, because there is no head physician and only one doctor on staff who is not able to provide adequate medical care for more than 400 prisoners. All visited SIZO had low stocks of drugs and uncertainty in their supply in the near future.

Due to the problems with the transportation of patients to healthcare facilities the issue of providing quality medical care (surgery, complex diagnostics) has not been solved. It is important to emphasize the critical situation with prisoners’, including HIV-positive prisoners, evacuation from facilities in the combat territory. For example, the issue of evacuation of HIV-positive women prisoners with their babies from Donetsk SIZO is still not resolved.

THE FOLLOW-UP ACTIONS

For improvement of medical services in ATO zone it is proposed:

1. To accelerate the adoption of Decree of the Cabinet of Ministers of Ukraine “On introduction of temporary procedure for provision of support to the population in temporary uncontrolled territories of Donetsk and Luhansk oblasts”;

2. To start cooperation with International Committee of the Red Cross before the adoption of the aforementioned Decree;

3. To leave part of ART medications procured by the Network at the central warehouse to ensure prompt response to the changes in the ATO zone;

4. To organize redistribution of ARV medications for Donetsk region both to Slovyansk and Mariupol AIDS centers to improve access of patients to ART and avoid unnecessary travel;

5. To organize delivery of ARV medications procured under the Global Fund project for penitentiary system to Slovyansk (Donetsk region) and Severodonetsk (Luhansk region). After that delivery of ARVs to HIV-positive prisoners located in other institutions will be provided by social workers of NGO’s. The negotiations to implement the mechanism are currently held.

6. To install laboratory equipment for CD4 count (PIMA) in AIDS Centre in Slovyansk and Severodonetsk.

To change the logistic routs of the deliveries in the ATO zone to fully meet the needs of the patients in medications and healthcare goods and to ensure prompt response Network sent a number of letters, particularly to the Ministry of Health of Ukraine (# 1617 of November 27, 2014, # 32 of January 21, 2015) and to the Ukrainian Center for Disease Control (# 48 of January 26, 2015, # 15 of January 16, 2015).

For more detailed information, please contact Oleksandr Gatiyatullin, 098 377 23 26, All Ukrainian Network of PLWH, advocacy officer