Findings Resulting from the Quarterly Report for October – December 2006 Submitted to the Global Fund: Key Issues and Challenges Identified ART, Prevention of Mother-To-Child Transmission, Substitution therapy

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)

Scaling-up of ART in Ukraine (August 2004 till January 2007)

Ensuring ART Provision As of January 1, 2007, 55 patients were receiving ART at the penitentiary institutions (plan 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 1 st 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 (CD , VL – 11976) It is planned to procure 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 ( 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: 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 4 th 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 non- governmental 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