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HIV Infection in Ukraine State Institution “Ukrainian Center for Socially Dangerous Disease Control of the Ministry of Health of Ukraine” State Institution “L.V. Gromashevsky Institute of Epidemiology and Infectious Diseases of the Academy of Medical Sciences of Ukraine” HIV Infection in Ukraine Information Bulletin No. 45 (Issued Since 1991) Kyiv–2016 1 UDC 616.98.578.828 (477) Authors: State Institution «Ukrainian Center for Socially Dangerous Disease Control of the Ministry of Health of Ukraine”: Prof. Nizova, N.M., D. Med. Sci., Director; Prof. Shcherbinska, А.М., D. Med. Sci., Assistant Director for Prevention, Research and Resource Development; Hetman, L.I., Assistant Director for Medical Assistance for HIV-Infected Patients. The Ukrainian Centre for Monitoring and Evaluation of Program Activities to Counter HIV/AIDS and Tuberculosis (M&E Centre) Kuzin, I.V., Director of the Center; Martsynovska, V.A., Physician-Epidemiologist, Cand. Med. Sci., Senior Researcher of SI “L.V. Gromashevsky Institute of Epidemiology and Infectious Diseases of the Academy of Medical Sciences of Ukraine”; Alekseieva, A.I., Physician-Epidemiologist, Specialist in Routine Epidemiological Surveillance; Nguen, I.V., Medical Statistician, Researcher of SI “L.V. Gromashevsky Institute of Epidemiology and Infectious Diseases of the Academy of Medical Sciences of Ukraine”; Yatsyk, V.B., Regional HIV/AIDS M&E System Development Specialist; Tsybulska, L.O., Programming Engineer, Database Management Specialist. Planning and Organizing Division for Medical Assistance for HIV-Infected People Soboleva, Ya.V., Head of the Division; Riabokon, S.V., Physician-Infectious Disease Specialist; Mishchenko, O.L., Capacity Building Coordinator; Starychenko, T.M., Coordinator for Treatment Programs within the State Penitentiary Service. Division for Prevention Service Development Ivanchuk, I.O., Coordinator for Substitution Maintenance Therapy Programs, Cand. Psych. Sci. Reference Laboratory for HIV/AIDS Diagnostics with Specialist Divisions Focusing on Immunology, Virology, and Serology Andrianova, I.V., Head of the Laboratory; Liulchuk, M.G., Laboratory Physician, Cand. Med. Sci., Senior Researcher of SI “L.V. Gromashevsky Institute of Epidemiology and Infectious Diseases of the Academy of Medical Sciences of Ukraine”; Babii, N.O., Microbiologist, Cand. Bio. Sci., Senior Researcher of SI “L.V. Gromashevsky Institute of Epidemiology and Infectious Diseases of the Academy of Medical Sciences of Ukraine”; Naichuk, L.O., Laboratory Physician. State Institution “L.V. Gromashevsky Institute of Epidemiology and Infectious Diseases of the Academy of Medical Sciences of Ukraine”: Sergeieva, T.A., D. Med. Sci., Assistant Director for Academic Affairs; Kruglov, Yu.V., Cand. Med. Sci., Lead Researcher; Maksimenok, O.V., Cand. Bio. Sci., Senior Researcher; Kyslykh, O.M., Researcher. According to the provisions set forth in Ukraine’s Copyright and Related Rights Act (No. 3792-XII dd. Dec. 23, 1993), the contents contained herein may not be used, copied, or cited in any form without explicit reference to the source of the material and State Institution “Ukrainian Center for Socially Dangerous Disease Control of the Ministry of Health of Ukraine” as the owner of the publication. Contents List of Abbreviations and Acronyms ......................................................................4 Section 1. Ukraine’s Global Strategies and Government Policies on HIV/AIDS ...............6 Section 2. HIV Epidemic in the World and the WHO European Region ........................ 13 Section 3. Evaluation of Epidemiological Surveillance Systems for HIV/AIDS in Ukraine ...18 Section 4. Current Trends in the Development of the HIV Epidemic in Ukraine ............ 22 Section 5. Cascade of Services for People Living with HIV, As of January 1, 2016 ......... 42 Section 6. Early 2016 HIV/AIDS Estimates ........................................................... 44 Section 7. HIV Testing and Linkage to HIV Services ............................................... 45 Section 8. Provision of Health Care to People Living with HIV and AIDS ..................... 50 Section 9. The Situation with Opioid Substitution Treatment Implementation ............ 56 Section 10. Prevention of Mother-to-Child Transmission of HIV in Ukraine ................. 63 Section 11. Analysis of the activities of regional AIDS centers’ laboratory service ....... 69 Section 12. Recommendations on Strengthening the AIDS Service Based on the Annual Reports Results ........................................................................... 75 Section 13. Using the Clinical Assessment for Systems Strengthening (ClASS) Methodology for Monitoring the Performance of Health Care Facilities ...................... 84 Annex 1. Tables no. 1–36 .................................................................................. 87 Annex 2. Territorial Ratings Based on 2015 Statistical Indicators ........................... 152 List of References .......................................................................................... 166 3 List of Abbreviations and Acronyms AIDS Acquired Immunodeficiency Syndrome ART Antiretroviral Therapy ARVs Antiretroviral Drugs ATO Anti-Terrorist Operation СD4 CD4 T-lymphocytes (CD4 cells) СDH Central District Hospital ClASS Clinical Assessment for Systems Strengthening ECDC European Centre for Disease Prevention and Control ELISA Enzyme-Linked Immunosorbent Assay ES Epidemiological Surveillance EU European Union GB Government Budget GF Global Fund to Fight AIDS, Tuberculosis and Malaria HCI Healthcare Institution HIV Human Immunodeficiency Virus HTS HIV Testing Services IEID State Institution “L.V. Gromashevsky Institute of Epidemiology and Infectious Diseases of the Academy of Medical Sciences of Ukraine” M&E Monitoring and Evaluation MARPs Most-At-Risk Populations for HIV MC/MOS Mobile Clinic/Mobile Outreach Site MCPC (AIDS) Municipal Center for Prevention and Control of AIDS (or ‘City AIDS Center’) MDGs Millennium Development Goals MH Municipal Hospital MMFU Medical Monitoring and Follow-Up MoH Ministry of Health MSM Men Having Sex with Men 4 MTCT (Rate of) Mother-To-Child Transmission NDTB Newly Diagnosed Tuberculosis NGO Non-Governmental Organization OCPC (AIDS) Oblast Center for Prevention and Control of AIDS (or ‘Oblast AIDS Center’) OI Opportunistic Infection OST Opioid Substitution Therapy PCR Polymerase Chain Reaction PLHIV People Living With HIV PMTCT Prevention of Mother-to-Child Transmission of HIV PWIDs People Who Inject Drugs RCPC (AIDS) Regional Center for Prevention and Control of AIDS (or ‘Regional AIDS Center’) RDT Rapid Diagnostic Test RES Routine Epidemiological Surveillance SDGs Sustainable Development Goals SEM Sero-Epidemiological Monitoring of HIV Prevalence SHCF Specialist Health Care Facility SPSU State Penitentiary Service of Ukraine STI Sexually Transmitted Infection SWs Sex Workers TB Tuberculosis TBCS TB Control Service TMA Territorial Medical Association UCDC State Institution “Ukrainian Center for Socially Dangerous Disease Control of the Ministry of Health of Ukraine” UCPMC Unified Clinical Protocol for Medical Care UN United Nations UNAIDS Joint United Nations Program on HIV/AIDS VH Viral Hepatitis VL Viral Load WHO World Health Organization 5 Section 1. Ukraine’s Global Strategies and Government Policies on HIV/AIDS Ukraine’s government policies on HIV/AIDS are closely aligned with appropriate international commitments and recommendations. The key role in shaping global strategies in response to the HIV pandemic is played by the United Nations General Assembly. Established in 1945 in line with the United Nations Charter, the General Assembly acts as the UN’s principal advisory and representative body responsible for policy making and development. Ukraine is one of the countries that founded the UN in 1945. After the country's declaration of independence in 1991, Ukraine’s participation in UN activities has figured among the top priorities of its foreign policy. In June 2001, the United Nations General Assembly called a special session on HIV/AIDS to explore ways to relieve world-wide human suffering and address global negative effects caused by the epidemic already well under way at that point in time. In the course of that meeting, government heads and representatives signed a Declaration of Commitment on HIV/AIDS (2001), which defined the global objectives and action steps to halt the spread of HIV. In 2005, in collaboration with WHO, UNAIDS, and other international organizations, the leaders of the G8 countries agreed to develop and implement global-scale efforts for a scaled-up response to the HIV epidemic worldwide. This strategy was subsequently approved by all member countries of the UN at the 2005 Millennium Summit. Ukraine also took part in that event, being represented at the highest level possible by the President of the country. In the 2006 Political Declaration on HIV/ AIDS, the participating countries committed to ensuring universal access to HIV prevention, treatment, care and support for all those who need it by 2010. After adopting the 2006 Declaration, the UN member countries proceeded to define the key goals and targets at national levels. A majority of the countries integrated their designated goals into their strategic plans through appropriate national strategies and regulatory frameworks, as well as incorporated them into their resource mobilization plans. In 2009, for the first time ever, the Verkhovna Rada of Ukraine adopted a nationwide program on HIV/AIDS as
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