1. EUROPE BUREAU PROGRAMS OVERVIEW REGIONAL ADVISORY GROUP KIEV, UKRAINE 17 JUNE 2014

2. Mass HIV screening of general population (not high-risk groups) Centralized and Compartmentalized HIV system Bureaucracy, stigmatization, paternalism Lack of evidence- based approach Workforce shortage, high staff turnover Challenges to AIDS Control in the Region 1.Targeted to high-risk groups outreach rapid testing with linkage 2.Decentralized ART, integrated care (HIV, TB) in one location close to client 3.Simplified procedures, staff education on service provision and client-orientation 4.Implementation of 12 Principles, regular data collection and quality review 5.Task-shifting, payment to staff based on performance AHF Europe Care Model As a Response to Challenges Targeted advocacy to bring political priority and adopt the model HIV is not a priority for the Governments

3. 7 European countries More than 100 testing sites More than 45 000 people tested since the beginning of year More than 1800 positive results since the beginning of year with targeted linkage More than 1 000 000 condoms distributed RAPID TESTING PROGRAM

4. AHF SUPPORTED MODEL: DRAMATICALLY INCREASED IDENTIFICATION OF HIV+ CLIENTS 4 * Leningrad Oblast, 8 months of 2013 Most of them would not be identified by state-run provider-initiated testing model

5. 37 PIT sites in the most affected by HIV areas + outreach/mobile testing Target groups: IDUs, SW, MSM, general population, young people, migrants More than 17 000 people tested* Seropositivity rate 3.4% More than 180 000 condoms distributed* * Since the beginning of year UKRAINE

6. 21 testing sites across country + outreach/mobile testing Target groups: IDU, SW, MSM, General Population, Young People Almost 5 000 people tested* 1.5% seropositivity More than 75 000 condoms distributed* * Since the beginning of year LITHUANIA

7. 33 testing sites throughout the country + outreach/mobile testing Target groups: IDUs, SW, MSM, general population, young people, migrants More than 4 500 people tested* 4.2% seropositivity More than 65 000 condoms distributed* * Since the beginning of year ESTONIA

8. 40 testing sites in Krasnoyarsk, Tatarstan, Yekaterinburg and the region, St Petersburg, Leningrad region + outreach/ mobile testing Target groups: IDUs, SW, MSM, general population, young people, migrants More than 15 000 people tested* Up to 14% seropositivity 112 000 condoms distributed* * Since the beginning of year RUSSIAN FEDERATION

9. Currently 12 ART sites in Russia: Leningrad oblast, StPetersburg, Krasnoyarsk region 21 decentralized ART sites in Ukraine: Kiev and oblast, Odessa and Oblast, Mykolayv and Lughansk oblasts (Crimea: 2009/2014) Linda HIV Foundation clinic in Narva, Estonia (EU) CLINICAL PROGRAM

10. MODELS OF SUPPORTING CLINICAL OPERATIONS (AT GOVERNMENT-OWN SITES) Model 1 (Public healthcare in Russia and Ukraine) Model 2 (NGOs in Russia and Ukraine) Model 3 AHF Europe Bureau result-based management system: top ups tied to team performance on clinical indicators (revised quarterly)

11. AHF SUPPORTED MODEL: – MORE THAN DOUBLED COVERAGE OF ART

12. AHF SUPPORTED MODEL: – INCREASED ART COVERAGE AMONG PATIENTS

13. AHF SUPPORTED MODEL: – REDUCTION IN MORTALITY 13 * including Kiev Boyarka site (TB/HIV Clinic with MRD TB) !!!

14. KIEV BOYARKA – UNIQUE AHF PROJECT Situated in Kiev Regional TB Hospital 20% of patients – pulmonary TB 80% - extrapulmonary TB, including nearly 50% with TB meningoencephalitis 25% of patients – with confirmed MDR-TB Before AHF support:  0% of patients tested for HIV  0% of patients tested for CD4  0% of patients on ART  No OI testing and treatment With AHF support  100% of patients tested for HIV  95% of patient tested for CD4+  85% of patients on ART  OI testing and treatment available  Documented 25% mortality decrease in 2013 vs 2012

15. LINDA CLINIC – FIRST COMMUNITY OWN AND OPERATED HIV CLINIC IN EUROPE Situated in most affected by HIV town in EU – Narva (Estonia) 3000 HIV positive people 80% are current or former IDUs Low ART coverage

16. LINDA CLINIC Currently patients get ARVs at the city or regional hospital Linda Clinic currently provides all required medical care and psychosocial support, including lab tests as required by EACS guidelines Court decision on providing the clinic with ARV was in favor of the clinic

17. DATA MANAGEMENT SYSTEM Own database with all key information (GlobalTrack) Bi-weekly quality inquiries to sites concerning: -Missed appointments, -Eligible but not on ART patients -Causes of death -CD4 and VL testing -Lost-to-follow-up patients AHF global benchmarks -Percentage of eligible patients not on ART -Percentage of lost-to-follow-up patients -Percentage of patients who have had CD4 test doen in the last 12 months -Percentage of patients who initiated ART within 14 days after being eligible -Mortality rate Country Mortality rate for 2013 Percentage of eligible clients on ART (Q4 2013) Percentage of clients who are LTFU during 2013 Percentage of clients who have had a CD4 count test in 2013 Percentage of clients who are linked into care within 1 month Percentage of clients initiated on ART within 14 days Benchmarks target< 50/1000> 80%< 20%100%> 80% Europe Bureau Ukraine 26.578.2%11.2%88.4%no data Russia 14.685.9%7.4%92.1%no data Estonia 066.7%4.2%95.9%100%no data