USAID RESPECT Project

The Network has implemented the USAID RESPECT Project with the financial support of the United States Agency for International Development (USAID) in the framework of the US President’s Emergency Plan for AIDS Relief (PEPFAR) in 2013-2017.

The goal of the Project is to reduce HIV-related stigma and discrimination among healthcare workers against the most at-risk populations (MARPs), including people living with HIV (PLHIV) and people who inject drugs (PWID), and involve patients in HIV testing and treatment.

Project areas:

Involve patients in the cascade of testing and treatment services by means of reducing stigma and discrimination, as well as increasing healthcare provider initiated testing.
Strengthen the advocacy capacity of civil society in combating corruption in the healthcare sector.
Form adherence to medical services for HIV-infected prisoners, including people who inject drugs, preparing for release from penitentiary institutions, and provide continuous access to treatment and social support services outside penitentiary institutions.

Tasks and main results of the Project:

Reducing stigma and discrimination increase the number of patients receiving ART through the implementation of models Client’s Involvement to Testing and Treatment and Community-based HIV Testing in four pilot regions of the Project.

The project’s interventions covered 67 health care facilities (HCF) in Kyiv, Lviv, Kryvyi Rih, as well as Kyiv, Lviv, Mykolayiv, Cherkasy and Kirovohrad Oblasts.

A manual for the one-day training on issues of tolerant attitude towards PLHIV and MARPs was developed for health workers. The trainers’ teams conducted 330 training sessions for 7647 practicing doctors and nurses from the pilot regions.

According to the results of the final assessment of HIV-related stigma and discrimination against PLHIV and MARPs among the medical staff of the selected HCF, the Project has helped to reduce this indicator more than threefold, from 43% to 13%.

The algorithms of patient’s referral within the model Client’s Involvement to Testing and Treatment had the following results:

5513 people tested for HIV;
Among them, 939 HIV-positive people were identified;
797 of them started treatment.

The algorithms which were piloted in HCFs of Cherkasy, Kryvyi Rih, Mykolayiv and Kropyvnytskyi were analyzed, summarized, and described as best practices.

The report on the results of the survey “Evaluation of the Multilayer Stigma Faced by the Most Vulnerable Groups” was published to use while developing new approaches to VCT services for PLHIV and MARPs.

The Project provided NCFs of the pilot regions with the following materials, in total:

Medical gowns (4550 units);
Flash drives (4950 units);
Wall information stands (255 units);
Information floor stands (25 units).

Develop, pilot and implement training modules on gender-sensitive approaches to prevention and reduction of HIV-related stigma and discrimination against PLHIV and MARPs at the pre- and postgraduate medical education institutions in pilot regions.

The training programs of the following institutions of pre- and postgraduate training of doctors and nurses were supplemented with approved working programs consisting of the component Reducing Stigma and Discrimination:

National Medical University named after O.O.Bohomolets;
The higher educational institution “Kyiv City Medical College”;
The higher educational institution “Kyiv Medical College named after P.I.Gavrosya”;
Donetsk National Medical University named after M. Gorky;
Donetsk College of Advanced Training and Retraining of Medical and Pharmaceutical Personnel;
National Medical Academy of Postgraduate Education named after P.L.Shupyk.

National Medical University named after O.O.Bohomolets:

A typical curriculum program Epidemiology consisting of stigma and discrimination issues has been developed;
The program was approved at the meeting of the epidemiology department’s heads of higher medical educational institutions of Ukraine;
Training of trainers Formation of Tolerant Attitude of Medical Workers towards People Living with HIV was conducted for the departments of epidemiology/infectious diseases staff of higher medical educational institutions of Ukraine (18 participants);
The 4-hour interactive module HIV/AIDS Epidemiology. Ways to Overcome Stigma and Discrimination against People Living with HIV/AIDS in Healthcare Facilities was presented for 1094 students.

Kyiv City Medical College (pre-graduate education): 450 students were trained on Reducing HIV-related Stigma and Discrimination against PLHIV and MARPs.

Kyiv Medical College named after P.I.Gavrosya (post-graduate education): 612 students visited postgraduate courses on HIV-infection. Reduce HIV-related Stigma and Discrimination against MARPs in Healthcare Facilities.

Medical College of LNMU named after D.Halytskyi (pre-graduate education): 320 students were trained on Reduction of Stigma and Discrimination against PLHIV and MARPs in Healthcare Facilities of Ukraine (4 academic hours).

National Medical Academy of Postgraduate Education named after P.L.Shupyk:

The curriculum and program of the thematic advanced training Management of the Patient with HIV/AIDS by the Family Doctor were developed and approved; a methodical manual on this topic as issued with a circulation of 500 copies.
This topic was followed by:

Three training sessions for 43 lecturers from the departments of family medicine of the higher medical educational institutions of Ukraine;

Sixteen cycles of the thematic advanced training Management of the Patient with HIV/AIDS by the Family Doctor for 327 family doctors of the primary health care centers (Dnipropetrovsk, Zhytomyr, Kyiv,Mykolayiv, Lviv, Odesa, Poltava, Kherson, Cherkasy, and Chernihiv Oblasts and the cities of Kyiv, Kropyvnytskyi and Lviv.

The assessment of the impact of the thematic advanced training Management of the Patient with HIV/AIDS by the Family Doctor on the quality of family doctors work; in 2015 these doctors were trained on the involvement of PLHIV and MARPs in HIV testing and treatment. The report on the results of the survey was published in 200 copies in two languages.

Three medical universities of Dnipropetrovsk, Odesa and Poltava regions will conduct the cycle of training Management of the Patient with HIV/AIDS by the Family Doctor in 2018 -2019 at the expense of local budgets.

Strengthen the capacity of the Network and its executive partners to combat stigma and discrimination against representatives of MARPs and PLHIV, as well as increase the number of people who have access to HIV testing and treatment.

Seven non-governmental organizations received sub-grants to carry out project tasks related to the reduction of stigma and discrimination in medical institutions in Ukraine. These are the Kyiv and Kryvyi Rih city branches of the Network; Lviv, Cherkasy, Mykolayiv, Kirovohrad region branches of the Network and the Ukrainian Association of Family Medicine.

Information campaigns to respond stigma and discrimination against PLHIV in Ukraine, raising the level of tolerant attitude of the society and drawing attention to these issues were developed and implemented:

“I’m not a Zero!” 297 city-lights were located in 22 cities of Ukraine; 141 information posters were placed in the health care facilities of the six largest cities of Ukraine;
Contest of the best video on tolerance towards HIV-positive people was conducted for teenagers and young people.
“HIV is Invisible” was an appeal campaign to assess HIV risks and take HIV test.

Social workers and psychologists of partner organizations have also been trained to train the Project’s clients to reduce self-stigma and self-discrimination.

Strengthen the oversight and advocacy capacity of civil society in combating corruption in the health sector.

It was conducted an analysis of the Ministry of Health’s procurement according to specialized nosologies at all stages of the tender procedure, as well as monitoring compliance with the mandatory requirements of the Law of Ukraine “On Government Procurement.”

The specialists of the Network and the Transparency International Ukraine conducted the routine monitoring of procurement proceeded by the target HCTs through the ProZorro system. Each of the violations was accompanied by official letters asking them to remove shortcomings and/or providing recommendations for future procurements. In total, 147 tender procedures were analyzed.

Representatives of the Network and the Anti Corruption Action Center participated in the working groups of the Ministry of Health and the Institute of Epidemiology and Infectious Diseases named after L.Gromashevsky to adopt an international unpatentable name and dosing for procurement. The main results were:

The transparency and legality of the decision-making process regarding the approval of UNICEF procurement requirements for antiretroviral drugs are ensured. Potential corruption risks were eliminated;
Recommendations were prepared for the Ministry of Health to reform: 1) the decision-making process during the formation of the assortment and nomenclature; 2) the technical requirements for the procurement.

In 2017, the Network and the Transparency International Ukraine conducted three two-day training sessions for procurement specialists of the selected HCTs, as well as provided consulting support of NGO representatives regarding analytical modules and shortcomings and errors in procurement procedures.

Sixty-nine representatives of regional partner organizations have been trained to use the ProZorro system for public monitoring in the field of medicine.

During 2016-2017, the final stage of the National List of Essential Medicines preparation took place. The project team, as one of the participants in this process, took an active part in the workshops and discussions initiated by the Ministry of Health and contributed to the inclusion in the List of drugs that will enhance access to effective treatment for thousands of HIV patients.

Raising public awareness about procurement and public expenditure in the healthcare sector.

A series of media events aimed at attracting public attention to the problems of public procurement of ARV medicines were held.

The website of the Ukrainian Price Monitoring Observatory (UMPO) was created in the framework of the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) project.

The Network’s and the Anti Corruption Action Center’s specialists have developed the drugjobbery.org website, which, along with the antac.org.ua, has become a platform for disseminating information on the situation with target procurements.

Due to the launch of the electronic procurement system, a series of training events for stakeholders was conducted within the Project:

Three-day training Anti-Corruption Monitoring of State Procurement of HIV and TB Medicines for 44 journalists, representatives of the public and patients’ organizations, as well as civil servants.
Two-day training for regional partner organizations on the peculiarities of the ProZorro system of electronic public procurement for public monitoring in the field of medicine.
All-Ukrainian forum Dozorro-Fest which has improved the cooperation among all the participants in the procurement process.
Three two-day training sessions for procurement specialists of HCTs.
Advisory support of NGO representatives on the use of analytical modules and clients regarding shortcomings and errors in the procurement procedures.

During the Project, the team carried out media support for the monitoring of dozorro.org portal. News on the most high profile healthcare procurements, the progress and the success of monitoring activities were also described in six media articles in the Dozzoro blog.

Improvement of procedures and processes of public administration

The Network advocated the adoption of the Cabinet of Ministers’ order No. 1396-r of January 12, 2016, “On the procurement of medicines, medical products and related services involving specialized procurement institutions,” so that the Ministry of Health can delegate the centralized process of medical products procurement to international organizations.

An analytical report on the main problems in public procurement of HIV/TB drugs has been drawn and published.

Videos on the methodology of the ProZorro system usage were produced.

In March 2016, within the Zakupki.Forum, series of presentations on the Prozorro system and its benefits were conducted for more than 400 representatives of large and medium-sized businesses in order to increase the number of potential purchasers. In February 2016, the Prozorro system was presented for the American Chamber of Commerce.

The Transparency International Ukraine supported anti-corruption activities of 18 public organizations in the framework of the procurement control direction of the ProZorro system.

Taking into account the priority of medical reform, the Network supported the work of the e-Health Project Office by contracting consultants in HR, GR, PR and coordination of stakeholders.

Development and implementation of the Algorithm of interaction between the probation authorized bodies, health care facilities of the State Criminal-Executive Service of Ukraine (SCES of Ukraine) and case managers of NGOs for effective preparation of prisoners for release and their acceptance for outpatient treatments at the Centers for AIDS Prevention and Control/ART sites after release

The interaction algorithm to provide HIV-positive prisoners with social support while serving sentences and after their release from prison settings was developed and approved by a separate instruction of the Deputy Minister of Justice of Ukraine No. 106/25/32-17 of April 13, 2017.

Ten handbooks with contacts of medical and social service providers (including the AIDS Centers, ART and SMT sites, local NGOs and local authorities) were developed. The handbooks were distributed among releasing prisoners.

Strengthening the capacity of representatives of authorized agencies on probation, health care institutions of the SCES of Ukraine and case managers of NGOs in order to effectively implement the developed interaction Algorithm and case management models.

A training program for regional multidisciplinary teams (RMTs), consisting of representatives from the departments of the social psychological service, the medical units of penitentiary institutions and social workers of NGOs, has been developed. Five training sessions on the implementation of the Algorithm were conducted for 38 RMTs (140 participants) from the pilot regions.

Thirty-eight institutions of the SCES of Ukraine received computer equipment.

The booklet “What do you need to know about probation?” was created and printed in 10 thousand copies on request of the Probation Department, the Ministry of Justice of Ukraine.

At the request of the United Nations Office on Drugs and Crime and in the framework of the project “Penitentiary, Law Enforcement and Drugs Sectors Government Efficiency in HIV response” (HIV-PLEDGE), the following informational materials were translated into English and printed:

Analytical report on the results of the bio-behavioral survey “Monitoring of HIV awareness, behavior and prevalence among prisoners as a component of second generation surveillance for HIV,” 200 copies;
An analytical review of the bio-behavioral surveys in 2009, 2011, 2013, 2017 “Trends in the HIV prevalence and risky behavior among prisoners,” 200 copies.

At the request of the Ministry of Health of Ukraine, the Network involved a consultant to assess expenditures to ensure the availability and quality of medical services for prisoners and detainees, including the budget for salaries of doctors and medical staff.

The possibilities of further use of the Algorithm for all penitentiary institutions was discussed during the final conference on the results of the project implementation “RESPECT: reducing HIV stigma and discrimination against representatives of the most-at-risk groups in healthcare facilities of Ukraine.”

Development and implementation of case management model by non-governmental organizations to link HIV-positive prisoners, including injecting drug users, who are released from penitentiary institutions to ART on the basis of the regional AIDS Centers/ART and SMT sites.

As the result of the open competition, ten NGOs were selected for the implementation of regional sub-grants to realize the case management model.

Thirty-eight RMTs were created in pilot regions to effectively implement the Algorithm of cooperation.

Altogether 1568 people who were preparing for release have participated in voluntary HIV counseling and testing, and they know their HIV status. HIV was detected in 24 prisoners. Twenty-three prisoners firstly started ART. Seventy-eight ex-prisoners remained on treatment within 3 months after their release. Seventy persons with HIV received services in SMT, detoxification, rehabilitation, and harm reduction programs after release. In total, 488 prisoners received medical and social services in the framework of the Project.

The manual “The best implementing practices of the Algorithm for providing HIV-positive prisoners with social support during the sentence and after release from penitentiary institutions” was published in 300 copies.

The Network‘s experts presented the results of the Project at the 2017 International Working Meeting on Health in Prisons, Lisbon, Portugal.

Publications in the framework of the Project:

Formation of a tolerant attitude among health care workers towards people living with HIV, and representatives of the most at-risk populations. The training manual.

Management of the patient with HIV/AIDS by the family doctor. Educational and methodical manual.

Gender-sensitive policy that is friendly to people living with HIV and representatives of the most at-risk populations for HIV infection

The policy of countering discrimination and stigmatization of people living with HIV and representatives of the most at-risk populations in health care facilities. Ways to resolve the issue including the referral system.

Memos for health care workers about:

HIV prevention at work;
HIV post-exposure prophylaxis;
Disposal of medical waste.

The patient’s memos of how to counteract stigma and discrimination.

The best implementing practices of the Algorithm for providing HIV-positive prisoners with social support during the sentence and after release from penitentiary institutions

Impact assessment of knowledge that family doctors gained during the training cycle “Management of the patient with HIV/AIDS by the family doctor” to involve PLHIV and MARPs in VCT and HIV treatment programs. The report on the results of the survey.

Monitoring of HIV awareness, behavior and prevalence among prisoners as a component of second generation surveillance for HIV. Analytical report on the results of the bio-behavioral survey.

Trends in the HIV prevalence and risky behavior among prisoners. Analytical report on the results of bio-behavioral survey 2009, 2011, 2013 and 2017.

The assessment of the multiple stigmas faced by representatives of the most at-risk groups for HIV infection. Report on the results of the survey.

The indicator of stigma among people living with HIV/AIDS. HIV Stigma Index 2016. Report on the results of the survey.

What do you need to know about probation? The booklet.

Directory of medical and social institutions for persons preparing for release from the places of detention.

Restoration of the violated rights of people who suffered from stigma and discrimination in connection with HIV-positive status in health care facilities in Ukraine: Case descriptions.

Posters of an information campaign to draw attention to the rights of patients and the problem of HIV-related stigma and discrimination.

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