1. Harm reduction in Ukraine sustainability and transition to governmental funding 2018-2020

2. Current harm reduction program at outreach
Counseling and distribution of syringes/needles
Assisted testing for HIV and HCV
HIV case finding, peer driven interventions and case management for treatment initiation
TB screening
Supported by Global Fund and PEPFAR
Reach to 230,000 PWID annually (~60% of estimated)
All regions > more than 60 NGOs

3. Creating enabling environment
HIV prevention, care and treatment cascade
Creating enabling environment
Human rights Gender equality No stigma, discrimination and violence
90%
90%
Advocacy
Tested for HIV
HIV+
Data sources: *estimated size of KPs, 2014; **Alliance program monitoring data, 2015,
*** IBBS – 2015, calculated among HIV+ based on the results of rapid tests and respondents who agreed to answer questions about HIV status, experience of treatment at the AIDS center and ART
Continuous engagement with HIV negative and positive KPs on combination prevention, reach to new groups of KPs, ST
Earliest access and adherence to ART for
HIV-positive KPs upon HIV diagnosis.
Outreach workers navigation, CITI
case management
Lowest threshold HIV testing and diagnosis. Assisted self-testing, Optimized case finding
Community mobilization and capacity building

4. Country process for harm reduction transfer
Working group on development of GF concept note for
One of the tasks: to define interventions and how they will be transferred to government funding during

5. Interventions discussed at working group
Basic (outreach)
Counseling and distribution of syringes/needles
Self-testing for HIV
Assisted testing for HIV and HCV
Case management for positive cases
TB screening
Overdose prevention
Additional (outreach)
Special support (legal, medical, etc.)
Medical (in-reach)
OST, ART, PREP, PEP, HCV treatment, basic medical services

6. Harm reduction outreach role in provision of services for HIV prevention, finding and linkage
ART delivery
ART initiation
Self-testing
Assisted testing at outreach
Facility and home based testing
HIV testing
Social Media, hotlines, etc.
Pharmacy
Peer to peer
Peer outreach
Mobile outreach
DIC
Community
NGO sites
Family doctors
Mobile
Clinics
Stationary
Clinics
Labs
Referrals
PDI
OCF
CITI
Peer outreach navigation
Indirect
Outreach
In-reach
Hardest to reach
Easier to reach
Outreach bypass criminalization, stigma barriers
Reach people with no jobs, housing, education, income
Counterbalance lack of support (informal and formal groups)

7. Basic package of harm reduction for transfer
Definition of “basic” – basic outreach package should improve test and treat cascade for PWID
All tasks (counseling, distribution, testing, case management) in basic package are performed by trained (peer) outreach worker (non medical staff)

8. Proposed changes to assure transfer
Define “public health services”, licensing, financial models for purchasing “public health services”
Government funding should be used to pay salaries of peer-outreach workers, need to change government “jobs classification”
Include services for PWID into “bonus” package for family doctors and creating network of “KP friendly family doctors”
Coordinate involvement of medical staff in outreach programs (should be payed as medical services), particularly on TB and basic medical support
Ensure community involvement into budget planning at national and local level, implementation and evaluation of programs (expert TA and ME)

9. Principles of transfer
Harm reduction basic package should be defined as public health service
All components should be fully presented at outreach to assure continuum of services for a client – i.e. funded as a package
Transparent process of funding allocation to regional level and to implementers
Quality of services should be at high level
NGOs involvement should be granted without restrictions
Community involvement should be assured
Procurement should account for harm redaction needs

10. Coverage of harm reduction outreach program between GF and Government

11. Transition for OST
Due to advocacy efforts of Network of PLHA, Global Fund, Center for Public Health, Alliance for Public Health and many other partners funding for OST was finally allocated from Government budget in 2017
The plan: increase number of patients to 20,850 till 2020
Results based funding > increase number of OST providers (private, primary, pharmacies)
Scale up of government funding =
9 600
Government GF
2018
2019
2020
December 2020

12. Possible models for transition
National funding of “public health service” through Center for Public Health (MOH) > Regional Centers for Public Health > local NGOs and implementing partners
“Impact Bond” to allow for results based models (based on defined set of results indicators not a description of service package or functions)
Regional funding (“social contracting”, “subsidia”)