Ukraine TB/HIV Concept Note Outcomes of TRP GAC and Grant Making PlaceDay Month Year 1

Overview of Allocation Request Technically sound and overall well balanced Concept Note. –Builds on achieved results and strong experience in a difficult programming environment. –The funding request aims to scale-up and ensure equitable access to prevention, care, treatment and support for key populations and vulnerable groups, and to strengthen health and community systems that enable integrated and sustainable interventions for key populations. –The CN builds on gains of previous investment in HIV and TB control, and is aligned with the National TB Program A number of strategic, technical and operational issues to be addressed. CONGRATULATIONS Hard work, tight deadlines, 3 consecutive proposals, limited funding!!! Very difficult country circumstances! In previous TRP window, 50% of proposals referred back to country.

Overview of Allocation Request Recommendation on allocation amount: Budget ceiling for NFM period ( ): USD 130,489,741, incl. USD 128,828,095 (est. budget ceiling prior to TRP review) + USD 1,661,646 (additional savings in signed grant identified after TRP review). Partially, “above-allocation” request can be covered from the allocated funds (based on savings identified), but no additional/above-allocation funding. Since TRP/GAC, Country Team has approved reallocation of some savings (ca. USD 1.2 m) to cover unfunded activities for Red Cross and emergency gap in MDR medicines. Amount (USD) CCM request within allocation amount (A)123,693,062 Savings achieved in 2014 within existing grants (B)*6,796,679 Total budget amount available for NFM ( ) (A+B) 130,489,741 Additional savings found in NFM proposal (C)7,419,400 Total amount available for reinvestment within the allocated funds (B+C)14,216,079 Total proposed reinvestment at the time of submission to TRP (D)(12,554,433) Additional savings available for reinvestment1,661,646 * $5,135,033 of savings identified before submission to TRP + $1,661,646 identified after finalizing all Annual Funding Decisions, after submission to TRP.

Budget analysis – Confirmed savings Geneva16 May Intervention/justificationAmount – US$ Savings achieved in 2014 within existing grants6,796,679 MDR-TB treatment Latest GDF prices were not used (US$ 2.5m) and Funds that will have been provided in 2014, that partially cover need for 2015, were not considered (US$ 4.6m). 7,105,927 OST and other drug dependence treatment Funds that will have been provided in 2014, that partially cover needs for , were not considered. 203,473 OST and other drug dependence treatment The Global Fund is not willing to invest in additional procurement of methadone dispensing machines (electronic and manual) at this stage. 110,000 TOTAL12,554,433

Budget analysis – Potential savings and proposed allocation PlaceDay Month Year 5

Budget analysis – Proposed reallocation PlaceDay Month Year 6 Intervention/justificationAmount proposed (USD)Amount confirmed (USD) Procurement of medicines to treat Opportunistic Infections in 2015 and ,231,6782,519,086 Increased unit cost for PWIDs1,203,546 Legal barriers50,000 Stigma Index Survey50,000 Introduction of OST in prisons47,000 Activities in Crimea (across all proposed interventions)1,884,954 Activities in Crimea (across all proposed interventions)1,395,046 Procurement of additional ARV stock3,251,9023,251,90 Procurement of BACTEC and Hain reagents in 20171,190,307 Lubricants as part of programs for sex workers and their clients 600,0000 STI testing as part of programs for sex workers and their clients 250,000 POC CD4 testing as part of programs for PWID and their partners 150,000 Strengthening TB and TB/HIV routine reporting systems 150,000 STI testing as part of programs for MSM and TGs100,000 12,554,43310,346,795

Use of additional savings ItemsAmount (USD) Care and support912,000 OST medical support1,085,000 Advocacy350,000 UCDC administration1,200,000 OST (drugs, logistic)715,000 Drugs for MDR-TB treatment side-effects500,000 MSM, SW unit cost increase450,000 PlaceDay Month Year 7

Concept Note Review - Recommendations Proposed strategic approaches remain unclear: –social contracting mechanism for the HIV prevention package, –scale-up of VCT in key populations to twice a year and ART in people who inject drugs, –regionalisation approach, –approach to integration of services, –sustainability plan. Technical issues to resolve: –Optimize to ensure value for money for packages for MARPs, CD4 and treatment monitoring and different forms of methadone. –ARV treatment – 3FDC vs 2FDC +EFV – to follow the country decision –Strengthen rapid diagnosis of rifampicin resistance and quinolone-resistant MDR-TB by the Xpert and LPA. –Strengthen patient-centered approach to improve treatment outcomes for TB. –How to address low access to medical and social services in prison. Geneva16 May

Concept Note Review - Recommendations Operational issues require negotiation: –Crimea – to invest and seek for the solutions. –How we work in conflict-affected regions and what can be done for IDPs. –Implementation arrangements, including central level functional unit, need to be clarified: efficiency, effectiveness, coordination, relevance/expertise, effect on quality of service for end users.

Next steps In cooperation with technical partners agree on reinvestment of savings and address the remaining challenges. Develop and agree on grant making work plan and its implementation modalities. One week before November 13, 2014 – ready-to-sign grant documents have to be submitted for GAC2. GAC2 on November 13 followed by the board approval. WE HAVE 7 WEEKS TO FINALISE GRANT MAKING! Geneva16 May

Grant Making Process of translating the funding request based on the TRP and GAC1 recommendations into disbursement-ready grants for Board approval and signature. Geneva16 May Disbursement-ready grant: all required grant making outputs are in final form and agreed with PR(s) adequate risk mitigation measures are agreed and in place all significant issues to be resolved prior to first disbursement are addressed

Grant Making Geneva16 May WorkstreamExpected outputsResponsibility Development and negotiation of grant documents Performance Framework M&E Plan Detailed Budget List of Health Products, Quantities and Related Costs CCM and PRs Negotiation of implementation arrangements, identification and mitigation of capacity gaps and risks Completed capacity assessment tool Completed implementer mapping CT – LFA, PRs CCM and PRs Finalisation of administrative documents to enable grant signing PR master data and bank account details Grant agreement PRs We need to develop a work plan for the deliverables of these workstreams.

Deadlines Grant documents: – 1 st draft: 26 September (with turn around by 3 October) – 2 nd draft: 10 October (with turn around by 17 October) – Final submission: 24 October Implementation mapping: – Grant signing requirement – Half day macro-level planning tomorrow – Regional mapping – understanding of regionalisation approach, but regional mapping should be started and finished by end of year. CAT: – CT will work with PRs and LFA. Final deadline is 31 October, but need support. Grant agreement documents: – PRs to begin populating information. – Government framework agreement needs to be worked on right away. PlaceDay Month Year 13 During review, please do not change the documents.

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