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Objective:
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Objective Description:
OBjective task:
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- Removing structural barriers to increase of HIV testing in EECA
- Removing structural barriers to ART in EECA
- Launching critical enabling interventions to improve HIV care cascade
- Implementation of COVID-19 response mechanism
- Select a objective task
- Monitoring situation with human rights of KPs, responding to viloations
- Revision of legisation and other regulations on KPs that pose barriers to accessing HIV services:
- Select a objective task
- IT solutions to improve the efficiency of service delivery within the HIV care cascade and ensure the sustainability of HIV services
- Developing necessary legal framework and technical solutuions for cost-effective care package for KPs in EECA
- Advocacy for domestic resource allocation for KP services in EECA
Solutions
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- Select an implementer
- APH
- APH
Period:
Supporting key group populations in a COVID setting
Provision of HIV prevention services with precautions against COVID-19
Progress to date
Work on shelters has expanded – in addition to 5 shelters for working with women who use drugs in conditions of violence (Ukraine, Serbia, North Macedonia, Kazakhstan), support for flexible shelters for representatives of the LGBT community in Kazakhstan, Uzbekistan, Kyrgyzstan and Tajikistan has been added. The program was distinguished by a special programmatic approach to working with clients – about 3,200 clients received material assistance in the form of food packages (Georgia, Kazakhstan). PPE support in Kaz for migrants and KGP (124,000 disposable masks, 1,000 antiseptics); CLM to provide quality services for clients of OST programs in 7 countries.
Supporting key group populations in a COVID setting
National Contingency Planning
Progress to date
Supporting key group populations in a COVID setting “General contingency planning guide developed in the frames of the C19RM is available here.
Guide by APH for Contingency Planning for Key Population HIV Services during COVID-19 and Other Emergencies for North Macedonia, Serbia, Bosnia and Herzegovina, Montenegro, Moldova, Georgia, Kazakhstan, Uzbekistan, Tajikistan and Kyrgyzstan in English is available at the link https://aph.org.ua/en/eeca/ in the folders with the names of each country.
Solutions
Implementer:
- Select an implementer
- ECOM
- EHRA
- ECOM
- EHRA
- EHRA
Period:
Prevention (Pre-exposure prophylaxis – PrEP)
Inclusion of PrEP into nationally approved service packages for MSM and/or other key populations
Progress to date
ECOM in partnership with WHO regional office for Europe analyzed five national PrEP protocols (Armenia, Kazakhstan, Kyrgyzstan, Georgia and Ukraine) and provided Report with recommendations on the steps needed to include PrEP into nationally approved standard package of servises. The report is under design and will be published by the end of February.
Much work was done in 2023 to present recommendations based on analyzes of PrEP Protocols in 5 countries. Online and offline meetings with stakeholders, monitoring visits (Kazakhstan, Kyrgyzstan) were held, the results were presented at various meetings, conferences, and technical consultations. Based on the analysis of PrEP Protocols and updated WHO recommendations, policy briefs were developed and sent to countries, the purpose of which was to show and not miss the importance of new interventions that can improve PrEP services in countries.
PrEP is available and integrated into the healthcare system as part of the standard service package funded by the government in 5 countries: Armenia, Georgia, Kazakhstan, Kyrgyzstan, and Ukraine.
1. Armenia
PrEP is available as part of the national HIV prevention program and partly funded by the governmentand. PrEP has been officially included in the national HIV prevention guidelines approved by the Ministry of Health of Armenia.
2. Georgia
PrEP is available as part of the national HIV prevention program and partly funded by the governmentand.
3. Kazakhstan
PrEP is available as part of the national HIV prevention program and fully funded by the governmentand.
4. Kyrgyzstan
PrEP is included in the healthcare system and fully funded by the governmentandand.
5. Ukraine
PrEP is available and included in national clinical protocols.
Continued state support is confirmed to ensure the availability of PrEP for key populations.
Measures have been taken to strengthen the position of PrEP within healthcare.
Integrated service delivery and HIV service quality improvement
Community groups conduct community-led assessment of national quality standards in accordance to IDUIT and organize dialogue with service providers and MOH/local authorities
Progress to date
Moldova
PULS Communitar conducted CLM study to evaluate OAT programs in the Republic of Moldova, identify the level of the availability and acceptability of programs, outline achievements, and identify and evaluate difficulties faced by the program participants. Report with findings and conclusions was prepared and presented on the meeting with service providers and decision makers. Next steps and recommendations for CCM were elaborated.
GENDERDOC-M conducted a CLM study to identify the barriers in access to PrEP among MSM/TG. The results were presented to the Key Affected Populations (KAP) committee. After the presentation, it was strongly recommended to showcase these results at the National Dialogue event. The aim is to leverage the platform to advocate for a comprehensive revision of the National Clinical Protocol on Pre-Exposure Prophylaxis (PrEP) in the first quarter of 2024. This strategic move aligns with the commitment to fostering meaningful changes in the national approach to PrEP in response to the insights gained through the CLM survey.
Kazakhstan
Forum of PWUD conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian is prepared. Meeting with CCM is planned to be organized in January 2024.
Georgia
Rubikoni conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Furthermore, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Kyrgyzstan
Equal to equal conducted a study on the client satisfaction with OAT. Report in Russian was prepared. Moreover, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Tajikistan
Intighob (Initiative group based on SPIN PLUS) conducted a study of the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian language was prepared. Moreover, the meetings with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Armenia
“New Generation” conducted Community Based Assessment of HIV Services Provided to MSM Living With HIV In Armenia through a focus group with broad number of experts and MSM community members (including representatives from CCM). The results were included to “Funding Priorities of Civil Society and Communities Most Affected by HIV, Tuberculosis and Malaria” by Global Fund under the number 9 (The funding priorities and minutes from CRG group meeting attached). These priorities are in active use to prepare an application for the Global Fund grant in Armenia. In addition, results are in active use in the National dialogue now.
Integrated service delivery and HIV service quality improvement
Integration of community-led monitoring (CLM) into the health care systems of countries in the EECA region to assure the quality of services for key populations (KPs)
Progress to date
Practical handbook on community-led monitoring tools was developed in English and Russian languages. The checklist with EHRA and other partners for CLM was discussed and agreed upon.
On 2-8 December 2022, specialists from the Eurasian Harm Reduction Association (EHRA) conducted regional online training “Community-Led Monitoring Methods” for the representatives of community organizations in the CEECA region. The training was attended by 38 representatives of organizations from different vulnerable communities in the CEECA region. The aim of the training consisting of three online sessions was to train leaders of self-organizations from different key communities in the CEECA region to understand, which role CLM can play in their advocacy work, how to formulate the proper problem and research question for CLM, and which of the different methodologies can most effectively provide the data needed for advocacy. Video recordings of the training, as well as presentations can be found at the link.
Following the CLM Handbook, developed in 2022, integration of CLM into the healthcare system can be ensured through productive and sustainable participation of community representatives in the decision-making process, mainly within CCM, and through national consultations with CCM and other health sector coordination bodies on key needs for CLM and its findings and recommendations on improving of health services.
CLM has been conducted in all planned countries. Results were presented in 5 countries and protocols were received (Moldova, Georgia, Tajikistan, Kazakhstan and Kyrgyzstan). In Armenia, the results of the CLM are in active use in the National dialogue now. The focus group with broad number of experts and MSM community members (including representatives from CCM) was conducted, and based on the results PrEP was identified as a key priority and included to “Funding Priorities of Civil Society and Communities Most Affected by HIV, Tuberculosis and Malaria” by Global Fund under the number 9 (The funding priorities and minutes from CRG group meeting attached). These priorities are in active use to prepare an application for the Global Fund grant in Armenia.
Following CLM Handbook, developed in 2022, integration of CLM into healthcare system can be ensured through productive and sustainable participation of community representatives in decision-making process, mainly within CCM, and through national consultations with CCM and other health sector coordination bodies on key needs for CLM and its findings and recommendations on improving of health services. Within EHRA activities, CLM results in all countries in Georgia, Moldova, Kyrgyzstan, Kazakhstan and Tajikistan were presented and reviewed in CCMs and/or in other healthcare managing bodies. Protocol/minutes of the CCM meeting or other health authority body, based on the conducted national consultations with CCM and other health sector coordination bodies on key needs for CLM and discussed how results of CLM will help to improve services and integration of them into the healthcare system. What is more, additionally to presentation of CLM results, this year consultants in Georgia, Moldova, Kyrgyzstan and Kazakhstan prepared requests to healthcare managing bodies by asking provide information on how CLM results were being implemented. EHRA prepared a final publication – report, which draws on the three-year SoS 2.0. project of the EHRA to support community-led monitoring (CLM) initiatives for opioid agonist therapy (OAT) and the findings and results of community groups in Georgia, Moldova, Kazakhstan, Kyrgyzstan, and Tajikistan, offering insights into best practices and lessons learnt.
Moldova
PULS Communitar conducted CLM study to evaluate OAT programs in the Republic of Moldova, identify the level of the availability and acceptability of programs, outline achievements, and identify and evaluate difficulties faced by the program participants. Report with findings and conclusions was prepared and presented on the meeting with service providers and decision makers.
GENDERDOC-M conducted a CLM study to identify the barriers in access to PrEP among MSM/TG. The results were presented to the Key Affected Populations (KAP) committee. After the presentation, it was strongly recommended to showcase these results at the National Dialogue event. Following dialogues and agreements with the Protocol revision experts, the recommendations were formally presented on August 23, 2024, during the Round Table on the National Clinical Protocol on PrEP. The updated draft protocol, which includes the proposed recommendations, is currently under review by government authorities. In addition, the approval of new service standards, which will also include CLM, is expected in June 2025.
Kazakhstan
Forum of PWUD conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian is prepared.
Georgia
Rubikoni conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Furthermore, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps. In addition, based on ECOM recommendations, the working group developed CLM mechanisms and a special chapter was included in the Standards for Management of Public Health Interventions (PrEP Protocol). The working group included representatives from the National Centre for Disease Control and Public Health (NCDC), the Research Centre for Infectious Diseases, AIDS and Clinical Immunology, NGOs and MSM representatives, including members of the András team. Letter received from NCDC in support of the modified protocol.
Kyrgyzstan
Equal to equal conducted a study on the client satisfaction with OAT. Report in Russian was prepared. Moreover, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Tajikistan
Intighob (Initiative group based on SPIN PLUS) conducted a study of the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian language was prepared. Moreover, the meetings with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Armenia
“New Generation” conducted Community Based Assessment of HIV Services Provided to MSM Living With HIV In Armenia through a focus group with broad number of experts and MSM community members (including representatives from CCM). The results were included to “Funding Priorities of Civil Society and Communities Most Affected by HIV, Tuberculosis and Malaria” by Global Fund under the number 9 (The funding priorities and minutes from CRG group meeting attached). The National Guidelines on PrEP for HIV infection have been officially approved under Order No. 6241-L by the Minister of Health, dated 13 November 2024. These guidelines are now available on the Ministry of Health’s official website.
Integrated service delivery and HIV service quality improvement
Assessment of OAT sustainability
Progress to date
Assessment of the sustainability of the opioid agonist therapy programme in the context of transition from donor support to domestic funding was conducted in Moldova and Tajikistan. The reports are being finalized and sent for design, they’ll be published by the end of Q1 2023. The assessments in Albania, Kyrgyzstan and Ukraine are ongoing and will be finalized in 2023.
PULS Communitar conducted CLM study to evaluate OAT programs in the Republic of Moldova, identify the level of the availability and acceptability of programs, outline achievements, and identify and evaluate difficulties faced by the program participants. Report with findings and conclusions was prepared and presented on the meeting with service providers and decision makers. Next steps and recommendations for CCM were elaborated.
GENDERDOC-M conducted a CLM study to identify the barriers in access to PrEP among MSM/TG. The results were presented to the Key Affected Populations (KAP) committee. After the presentation, it was strongly recommended to showcase these results at the National Dialogue event. The aim is to leverage the platform to advocate for a comprehensive revision of the National Clinical Protocol on Pre-Exposure Prophylaxis (PrEP) in the first quarter of 2024. This strategic move aligns with the commitment to fostering meaningful changes in the national approach to PrEP in response to the insights gained through the CLM survey.
Forum of PWUD conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian is prepared. Meeting with CCM is planned to be organized in January 2024.
Rubikoni conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Furthermore, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Equal to equal conducted a study on the client satisfaction with OAT. Report in Russian was prepared. Moreover, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Intighob (Initiative group based on SPIN PLUS) conducted a study of the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian language was prepared. Moreover, the meetings with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
“New Generation” conducted Community Based Assessment of HIV Services Provided to MSM Living With HIV In Armenia through a focus group with broad number of experts and MSM community members (including representatives from CCM). The results were included to “Funding Priorities of Civil Society and Communities Most Affected by HIV, Tuberculosis and Malaria” by Global Fund under the number 9 (The funding priorities and minutes from CRG group meeting attached). These priorities are in active use to prepare an application for the Global Fund grant in Armenia. In addition, results are in active use in the National dialogue now.
Solutions
Implementer:
- Select an implementer
- SEH
- HAC
- HAC
- HAC
- 100% Life
Period:
HSS: Health products management systems
Decentralization of HIV treatment through integration to primary healthcare
Progress to date
Synthesis Report on assessment of health systems to decentralize HIV treatment services in 5 countries of the EECA is developed and can be found at the link.
The road maps were finalized in Armenia, Georgia, Moldova, Kazakhstan, and Kyrgyzstan.
HSS: Health products management systems
Technical support in implementation of long-term contracts for ARV procurement
Progress to date
Advocacy plans were developed for Kazakhstan, Kyrgyzstan and Moldova to further contribute to ARV price reduction. Official letters were sent to pharmaceutical companies and government authorities regarding further price reduction for ARVs, keeping the simplified procedures of registration of medicines and medical devices, etc.
The national experts in Kazakhstan, Kyrgyzstan, and Moldova implemented the activities envisaged by the developed advocacy plans.
Advocacy efforts were aimed at developing by-laws to implement all norms of the new draft law “On Circulation of Medicines”, revision of the program of state medical and social guarantees and the list of vital medicines after the adoption of laws and on training of PLHIV communities, and service organizations on HIV procurement monitoring, new legislation in the field of health care, and involvement in the development of normative legal acts. The list of subordinate legal acts on the new draft law “On Circulation of Medicines” was developed; the draft law “On Circulation of Medicines” was approved in third reading. The comparative analysis of national recommendations on diagnosis, treatment, and monitoring of HIV treatment was conducted with the recommendations of WHO, EACS, FDA, and EMA and is available at the link.
As part of the analysis, a comparative table of drugs included in the current list of essential medicines and those recommended for the new list was prepared; the roundtable “Ensuring accessibility of diagnostic tools and medicines in the Kyrgyz Republic” was held on December 13, 2023 . The results of the analysis and recommendations on the list of vital drugs and medical devices were presented to the attendees.
In Kyrgyzstan, an advocacy strategy was developed based on an analysis of the procurement of ARV tests, HIV diagnostic and treatment monitoring products procured with public funds and humanitarian supplies funded by the Global Fund (GF) and UNDP. Official letters were also sent to the State Enterprise “Kyrgyzpharmacy” and the GF, UNDP outlining potential measures to optimize procurement processes and reduce the cost of ARVs and diagnostic tests. In addition, a number of informal discussions were held with the Kyrgyzpharmacy SE, the Republican Center for HIV/AIDS Control and GF/UNDP on further optimization of procurement strategies, expansion of the range of ARVs and diagnostic tests procured with public funds, and the possibility of reducing the cost of certain ARVs and diagnostic tools. A meeting was also held with experts engaged by the GF and the GF/UNDP to prepare for the transfer of GF grant management to national agencies.
HSS: Health products management systems
Technical support in implementation of simplified registration for ARVs
Progress to date
Advocacy plans were developed for Kazakhstan, Kyrgyzstan and Moldova to further contribute to ARV price reduction. Official letters were sent to pharmaceutical companies and government authorities regarding further price reduction for ARVs, keeping the simplified procedures of registration of medicines and medical devices, etc.
The national experts in Kazakhstan, Kyrgyzstan, and Moldova implemented the activities envisaged by the developed advocacy plans.
Advocacy efforts were aimed at developing by-laws to implement all norms of the new draft law “On Circulation of Medicines”, revision of the program of state medical and social guarantees and the list of vital medicines after the adoption of laws and on training of PLHIV communities, and service organizations on HIV procurement monitoring, new legislation in the field of health care, and involvement in the development of normative legal acts. The list of subordinate legal acts on the new draft law “On Circulation of Medicines” was developed; the draft law “On Circulation of Medicines” was approved in third reading. The comparative analysis of national recommendations on diagnosis, treatment, and monitoring of HIV treatment was conducted with the recommendations of WHO, EACS, FDA, and EMA and is available at the link.
As part of the analysis, a comparative table of drugs included in the current list of essential medicines and those recommended for the new list was prepared; the roundtable “Ensuring accessibility of diagnostic tools and medicines in the Kyrgyz Republic” was held on December 13, 2023 . The results of the analysis and recommendations on the list of vital drugs and medical devices were presented to the attendees.
ECAT meeting was held on December 4–6 in Tbilisi, Georgia.
Reports on procurement monitoring of CD4 and VL tests as well as the rapid tests for HIV implemented in 2023 are published.
HSS: Health products management systems
Advocacy for engagement of patient community experts into national working groups to develop and adopt medicine procurement lists and technical procurement documentation
Progress to date
Advocacy plans were developed for Kazakhstan, Kyrgyzstan and Moldova to further contribute to ARV price reduction. Official letters were sent to pharmaceutical companies and government authorities regarding further price reduction for ARVs, keeping the simplified procedures of registration of medicines and medical devices, etc.
The national experts in Kazakhstan, Kyrgyzstan, and Moldova implemented the activities envisaged by the developed advocacy plans.
The training was conducted to train PLHIV communities and service organizations on advocacy mechanisms for HIV procurement monitoring, new legislation in the health sector, community involvement in the development of normative legal acts, and procurement monitoring on November 16-17, 2023.
In Kazakhstan, comprehensive justification documents were prepared to demonstrate the benefits and necessity of transferring procurement responsibilities to the Sole Distributor. The legal rationale was presented to a wide range of stakeholders at the working meeting “On expanding access to essential medicines for people living with HIV by amending the legal acts regulating the procurement of medicines” held in Q4 2024.
In Kyrgyzstan, an advocacy strategy was developed based on an analysis of the procurement of ARV tests, HIV diagnostic and treatment monitoring products procured with public funds and humanitarian supplies funded by the Global Fund (GF) and UNDP. Official letters were also sent to the State Enterprise “Kyrgyzpharmacy” and the GF, UNDP outlining potential measures to optimize procurement processes and reduce the cost of ARVs and diagnostic tests. In addition, a number of informal discussions were held with the Kyrgyzpharmacy SE, the Republican Center for HIV/AIDS Control and GF/UNDP on further optimization of procurement strategies, expansion of the range of ARVs and diagnostic tests procured with public funds, and the possibility of reducing the cost of certain ARVs and diagnostic tools. A meeting was also held with experts engaged by the GF and the GF/UNDP to prepare for the transfer of GF grant management to national agencies.
In Moldova, to identify potential obstacles and opportunities for the introduction of a procurement mechanism through international procurement agencies, a comprehensive review of the current legislation on procurement of medical devices and medicines was conducted. An assessment of the current clinical protocol was conducted to develop recommendations for the inclusion of ART drug resistance monitoring. These recommendations were presented to the CCM HIV Working Group, and efforts are ongoing to advocate for their inclusion in the 2025 revision of the National HIV Protocol.
ECAT meeting was held on December 4–6 in Tbilisi, Georgia.
Reports on procurement monitoring of CD4 and VL tests as well as the rapid tests for HIV implemented in 2023 are published.
HSS: Health products management systems
Community-led advocacy of elimination of identified critical discrepancies with the WHO prevention, testing and treatment guidelines
Progress to date
Current testing and treatment protocols analysis is finished in 7 countries (Armenia, Moldova, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan, and Ukraine) and recommendations to align the national protocols with the WHO guidelines are provided. The report is available at the link.
WHO has held the analysis of HIV testing guidelines in 6 countries of EECA – Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Uzbekistan. The report is available at the link.
National HIV testing and ART-optimized strategies based on and aligned with the WHO recommendations were developed for 4 EECA countries – Armenia, Kazakhstan, Kyrgyzstan, Moldova.
In Armenia, Kazakhstan, Kyrgyzstan, and Moldova, all key actions related to the development and implementation of HIV testing and ART optimization strategies, in line with WHO recommendations, have been completed. According to the results of the assessment in 2022, there was a need to replace Georgia with another country to implement activities for 2023 and 2024 since the Georgian testing and treatment protocol is generally in line with the 2021 WHO recommendations for the use of ARV drugs for the prevention and treatment of HIV, and as well as other aspects of the clinical management of HIV. During project meetings different optios were discussed, and the desicion was taken to continue the activities in Armenia instead of Georgia.
Kyrgyzstan
- Approved – HIV testing guidelines.
- Approved – The Resolution of the Cabinet of Ministers of the Kyrgyz Republic “On Amendments to Certain Decisions of the Government of the Kyrgyz Republic” dated on December 25, 2024, Resolution No. 795, which, in particular, approves:
- The list of persons subject to free examination and testing for HIV and hemocontact viral hepatitis in state healthcare organizations;
- List of specialties and positions subject to mandatory medical examination for HIV and blood-borne viral hepatitis;
- Procedure for compulsory HIV testing;
- The procedure for HIV testing of foreign citizens and stateless persons;
- Special list of specialties and positions regulating the employment of people living with HIV;
- Procedure for providing information about HIV to a third party without the prior written consent of the person being tested;
- Regulations on the provision of social assistance to people living with HIV and their families.
- Drafted – Resolution of the Cabinet of Ministers of the Kyrgyz Republic “On Approval of the List of Socially Significant Diseases”.
Solutions
Implementer:
- Select an implementer
- SEH
- 100% Life
Period:
HSS: Health products management systems
Decentralization of HIV testing services through integration to primary healthcare
Progress to date
Synthesis Report on assessment of readiness of health systems to decentralize HIV testing services in 5 countries of the EECA region is developed and can be found at the link.
The road maps were finalized in Armenia, Georgia, Moldova, Kazakhstan, and Kyrgyzstan.
Amendments related to HIV testing in Kazakhstan and Georgia were approved at the end of 2023. This, with close collaboration with local and international consultants, enabled in 2024 to focus on implementing normative acts through various measures, such as training sessions, advocacy campaigns, and strengthening cooperation among local CSOs and stakeholders into practice.
Local CSOs/community-based organizations, already involved in HIV testing, will play a key role in the decentralization of HIV treatment, further strengthening access to care at the community level.
1. Georgia
Georgia has completed the process of developing and approving regulations for decentralizing HIV testing and treatment. The HIV strategy for 2023–2025 was approved, and amendments to the national HIV/AIDS program have been made, including the creation of new testing and outpatient treatment points in new regions (Telavi, Akhaltsikhe, Poti, Khashuri). Measures for centralized supply of HIV tests have also been introduced. These changes came into force in January 2024.
Amendments approved by the Government of Georgia, on December 30, 2024. Annex 7 of the program regulates HIV services and indicates that decentralized testing with 2 different test kits will be implemented as a pilot together with sub contractor organizations and NGOs working with high risk groups in 8 cities of country – Tbilisi, Telavi, Khashuri, Akhsltsike, Kutaisi, Zugdidi, Poti and Batumi.
2. Kazakhstan
In Kazakhstan, in 3 cities: Almaty, Pavlodar and Ustkamenogorsk HIV testing is available through CSO, community based organizations: “You are not alone”, “Answer” and “Kemel Arma Foundation”. The document was registered in the Ministry of Justice of the Republic of Kazakhstan on December 4, 2023 № 33715. The adopted and entered into force document approving tariffs for HIV servies. In addition, the Roadmap to prevent HIV infection in the Republic of Kazakhstan for 2023-2026 was approved by Order of the Ministry of Health No. 155 dated March 16, 2023.
HSS: Health products management systems
Community-led advocacy of elimination of identified critical discrepancies with the WHO prevention, testing and treatment guidelines
Progress to date
Current testing and treatment protocols analysis is finished in 7 countries (Armenia, Moldova, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan, and Ukraine) and recommendations to align the national protocols with the WHO guidelines are provided. The report is available at the link.
WHO has held the analysis of HIV testing guidelines in 6 countries of EECA – Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Uzbekistan. The report is available at the link.
National HIV testing and ART-optimized strategies based on and aligned with the WHO recommendations were developed for 4 EECA countries – Armenia, Kazakhstan, Kyrgyzstan, Moldova.
In Armenia, Kazakhstan, Kyrgyzstan, and Moldova, all key actions related to the development and implementation of HIV testing and ART optimization strategies, in line with WHO recommendations, have been completed. According to the results of the assessment in 2022, there was a need to replace Georgia with another country to implement activities for 2023 and 2024 since the Georgian testing and treatment protocol is generally in line with the 2021 WHO recommendations for the use of ARV drugs for the prevention and treatment of HIV, and as well as other aspects of the clinical management of HIV. During project meetings different optios were discussed, and the desicion was taken to continue the activities in Armenia instead of Georgia.
Kyrgyzstan
- Approved – HIV testing guidelines.
- Approved – The Resolution of the Cabinet of Ministers of the Kyrgyz Republic “On Amendments to Certain Decisions of the Government of the Kyrgyz Republic” dated on December 25, 2024, Resolution No. 795, which, in particular, approves:
- The list of persons subject to free examination and testing for HIV and hemocontact viral hepatitis in state healthcare organizations;
- List of specialties and positions subject to mandatory medical examination for HIV and blood-borne viral hepatitis;
- Procedure for compulsory HIV testing;
- The procedure for HIV testing of foreign citizens and stateless persons;
- Special list of specialties and positions regulating the employment of people living with HIV;
- Procedure for providing information about HIV to a third party without the prior written consent of the person being tested;
- Regulations on the provision of social assistance to people living with HIV and their families.
- Drafted – Resolution of the Cabinet of Ministers of the Kyrgyz Republic “On Approval of the List of Socially Significant Diseases”.
Solutions
Implementer:
- Select an implementer
- ECOM
- REGMH
- FreeZone
- EWNA
- EKPC
- APH
- ECOM
- ENPUD
Period:
Reducing human rights-related barriers to HIV/TB services
Legal environment assessment on MSM and trans people in 4 countries
Progress to date
Legal environment assessments for Kyrgyzstan and for Uzbekistan were published.
In 2024, ECOM conducted a legal Environment Assessment in 4 countries of EECA. This comparative country analysis aimed to identify legal barriers and issues in areas where the necessary legislation already exists, but does not fully ensure the implementation of rights and freedoms for gay men, other MSM and trans people.
All reports consist of these chapters:
- International obligations of the country and their implementation;
- Table: Compliance of Domestic legislation with international standards;
- Analysis of legal regulations related to SOGI and HIV and their application;
- Recommendations.
All reports were published on ECOM’s website.
- Legal Environment Assessment in Armenia;
- Legal Environment Assessment in Georgia;
- Legal Environment Assessment in Kazakhstan;
- Legal Environment Assessment in Moldova.
Reducing human rights-related barriers to HIV/TB services
Legal environment and situation analysis as well as mapping of civil society partners in the area of access by migrants to HIV and TB services
Progress to date
On December 9, the REGMH with the assistance of the NCC Secretariat held in Dushanbe a Roundtable “Protection of health of migrants from Tajikistan”. The event was timed to presentation of a new study conducted by the REGMH: “Situation and Economic analysis of HIV-related health services in the field of migration in Tajikistan”.
On December 13, 2022, the Regional Expert Group on Migration and Health together with Central Asian Association of People Living with HIV held a Roundtable in Almaty “Health of HIV positive migrants in Kazakhstan”. The aim of the Round Table was to promote effective and timely treatment of international migrants living with HIV. During the meeting, the Situational and Economic analysis on the provision of HIV-related health services for international migrants in Kazakhstan was presented and discussed.
On December 19, REG together with local NGO “Real World. Real People” held a Roundtable in Armenia, Yerevan aimed to buster a discussion and exchange of experience on the provision of services for international HIV-positive migrants between heads of health authorities of the Republic of Armenia, government departments responsible for migration and civil society organizations. At the meeting, a study “Analysis of legal and institutional barriers to accessing HIV services among migrants in the Republic of Armenia” (developed by REG in 2021) was presented.
Also, in Q4 REG has launched a study is Kyrgyzstan.
On October 11, REG held an online meeting “Migrants’ access to HIV services in Central Asia and Caucasus” that gathered representatives of UNAIDS, Central Asian Association of PLHIV (Kazakhstan), TB People (Georgia), NGO “Real World, Real People” (Armenia), IFRC Central Asia, WHO Europe, Elton John AIDS Foundation, NGO Equality Movement (Georgia), AFEW (Kyrgyzstan), IFRC South Caucasus, Global Fund, WHO, and MSF. The goal of the meeting was to initiate a discussion and work out possible solutions to provide access to HIV services for those who urgently left the countries following the political situation.
Situation and Economic analysis of HIV-related health services in the field of migration in Tajikistan and Kyrgyzstan were held and are available at the links: Tajikistan, Kyrgyzstan.
In addition, the report “Ukrainian Refugees in European Countries: Barriers, Solutions and Best Practices. Access to HIV and Tuberculosis Care” was developed and is available at the link.
Reducing human rights-related barriers to HIV/TB services
Ensure a monitoring system for the implementation of the human right to health in prisons through national preventive mechanisms
Progress to date
An analysis of the current situation regarding the development and implementation of tools to ensure access to harm reduction services with a focus on OST was conducted by FreeZone in Georgia and in Kyrgyzstan.
An analysis of the current functioning of NPMs was carried out by FreeZone in Moldova and Kazakhstan.
For Moldova and Kazakhstan, Information on key indicators of the incidence of socially dangerous diseases in penitentiary institutions was collected, namely data on the total number of convicts held in penitentiary institutions; detailed information on the number of people living with HIV infection; the number of detected cases of tuberculosis; the number of convicts who were provided with treatment for viral hepatitis. The results can be found at the links: Moldova, Kazakhstan.
In Georgia, the Overdose prevention training module was developed for prison staff. The Module is aimed at training the prison employees involved in the release preparation programs. The training module contains both theoretical material, as well as practical exercises. The Module details overdose prevention mechanisms and interventions that are necessary in case to prevent death.
In Kyrgyzstan, meetings were held with the Ministry of Justice, the Ministry of Finance, etc. on the expanding health services, including HIV services in the penitentiary institutions; extended discussions were initiated at the Country Coordination Committee meetings and round tables on issues related to expanding government funding for penitentiary institutions.
In Moldova, temporary accreditation of the training program for the profession of “peer-to-peer consultant” in penal institutions of Moldova was obtained, and activities related to advocating for the inclusion of the position of “peer-to-peer consultant” in the list of positions in penitentiary institutions were provided.
In Kazakhstan, on November 30, 2023, a meeting was organized to discuss the current issues of compulsory social health insurance, the guaranteed volume of free medical care services for representatives of the PWUD community, drug provision, and diagnosis of diseases among prisoners. To intensify community participation in the mechanisms to ensure the implementation of state policy on combating TB and HIV/AIDS, the prisoners and ex-prisoners community member was included in the CLM Working Group during the Country Coordination Committee meeting on November 3rd, 2023.
In Ukraine, communication was ensured with the relevant government bodies (Center for Health Protection of the Ministry of Health of Ukraine, the Health Center of the State Criminal-Executive Service of Ukraine, and others) to advocate for the updated SOP standard. Discussions were initiated for the preliminary approval of the SOP “Diagnostics, treatment and support of PLHIV (and suspected HIV) in medical points of the Health Center of the State Criminal-Executive Service of Ukraine”. An updated SOP was presented and discussed within the Working Group on ensuring the continuity of services in the penitentiary institutions. An order of the Health Center of the State Criminal-Executive Service of Ukraine on the approval of SOP has been prepared, signed, and published.
Moldova
10 training sessions for selected peer-to-peer consultants were held on the basis of the Peer Counselor’s Manual to train consultants among prisoners. Each session lasted 6 hours and included theoretical and practical components of counselor training. As a result of this training, two prisoners from Penitentiary Institution #4 and, Penitentiary Institution #7 were prepared as peer counselors (1 Male, 1 Female) and started provision of services to inmates on a voluntary basis.
Kazakhstan
Cooperation between NGO “Kazakhstan Union of People Living with HIV” and Department of organization of medical care of the Ministry of Health of the Republic of Kazakhstan and Committee of Criminal Executive System of the Ministry of Internal Affairs of the Republic of Kazakhstan was established, that led to improved service provision for prisoners. Increase in the state order for work with people released from prison was advocated.
Kyrgyzstan
In order to increase state funding for health care services in the penitentiary system, negotiations were held with representatives of the State Service of Penitentiary Execution (SSPE). As a result of negotiations and communication, the SSPE increased the planned budget for health services in the penitentiary system in 2025 to 25 million KGS (compared to 13 million KGS in 2024).
Consultant is monitoring the activities related to the Program on HIV and Hemocontact Viral Hepatitis 2024-2027 in the Republic of Kyrgyzstan regarding people who are incarcerated. The work is in place to ensure inclusion of necessary services for prisoners – needle exchange programs, OAT, and conducting advocacy to ensure state funding for HIV, TB, hepatitis diagnostic services in the penitentiary system, and support for released prisoners.
Georgia
Due to the unstable political situation in the country regarding the adoption of the law on foreign agents, the project activities were not implemented.
Reducing human rights-related barriers to HIV/TB services
Women-led research, “Monitoring of violence against women living with HIV”, including factors preventing support/help seeking behaviors for women living with HIV who experience violence
Reducing human rights-related barriers to HIV/TB services
Developing and launching call for “Gender and HIV” small grants with special eligibility focus on Monitoring situation with human rights of Trans* people
Progress to date
Small Grants Programme with 4 selected projects run by grass-root NGOs in 2022 included:
- “National Trans Coalition” NGO with the project titled “HIV prevention in Armenia through gender mainstreaming” (Armenia);
- “The Public Association “Union for Equity and Health” NGO with the project titled “Gender Equality for sex workers” (Moldova);
- “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Check your health – Equality for Trans Roma and Roma women/girls sex workers” (Serbia);
- “NON-GOVERNMENTAL ORGANIZATION «NASHA DOPOMOGA»” with the project titled “RIGHT TO HEALTH!” (Ukraine).
- The project applicant is the organization “Albanian Association of People Living with HIV/AIDS (PLWHA)” with the project titled “New approach on transforming the spiral of exclusion and marginalization, towards the right of recognition before the law, gender-diverse and reduce the violence in health-care settings for trans persons in Albania”.
- The project applicant is the “National Trans Coalition” NGO with the project titled “Strategic pathway to remove structural barriers for trans* communities to PrEP and PEP services in Armenia”. The proposed project has been designed to establish favorable conditions for improving access of Trans* communities to PrEP and PEP services in Armenia.
- The project applicant is the organization “STAR STAR” Skopje with the project titled “Community Mobilization to Mitigate Funding Cuts and Gender Inequality in National HIV Programs for Sex Workers in North Macedonia”. The project is envisioned as a response to the latest developments in North Macedonia related to provision and delivery of HIV prevention services for key populations.
- The project applicant is the organization “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Supporting health wellbeing and safety of Trans and Intersex Roma, sex workers and HIV+”.
In 2024, grants “Gender and HIV” were implemented in Albania, Georgia, Moldova and Ukraine.
Moldova
GENDERDOC-M, alongside a parent support group, aimed to create a safe and inclusive environment for transgender and gender-nonconforming youth. Two formal partnerships with youth clinics expanded access to health services and 24/7 hotline support. Parent education sessions led to increased understanding, school negotiations for name recognition, and medical referrals. As a result, a strategic plan for 2025 includes engaging health and education ministries to address systemic barriers.
Georgia
The Queer Association Temida established an informal network of trans-friendly professionals across three cities, despite restrictive anti-LGBT laws. The network held two meetings to discuss the legal landscape and continued service delivery. A memorandum with Psychea Mental Health Center helped maintain access to gender-affirming care. A peer educator training course was launched, and two trained educators provided online consultations to 32 beneficiaries, offering support on HIV and gender-affirming care.
Ukraine
The “Help Is Near” project by HPLGBT produced a comprehensive report on barriers and solutions in trans health services, especially for intersectional groups like sex workers and those using psychoactive substances. Recommendations for service decentralization were developed and are planned to be presented to the CCM in early 2025. HPLGBT aims to integrate these recommendations into national funding requests to the Global Fund, ensuring sustained support for marginalized trans communities.
Reducing human rights-related barriers to HIV/TB services
REAct (https://react-aph.org/): Monitoring of human rights violations and discrimination against PLHIV and KPs. Responding to such cases through provision or referring to legal or social services to victims and through advocacy actions. In Georgia, Kyrgyzstan, Moldova and Tajikistan, REAct system was initiated within SoS_project#1.0 in 2020, and in 2022 is transferred to national funding, meanwhile APH continues to provide technical support to users. In Ukraine, REAct was implemented in 2019 and is functional within national GF grant. REAct system is supported by APH in Uzbekistan for 2022-2023, in 5 Balkan countries – for 2022-2024, and in Armenia and Azerbaijan – for 2023-2024. At the same time, regional networks ECOM and ENPUD started to use REAct program for documentation in several countries of the region and are supported for 2022-2024 within SoS_project#2.0 grant.
Progress to date
Cumulatively, during 2022 there were registered 6700+ cases in 13 countries (Albania, Armenia, Bosnia and Herzegovina, Georgia, North Macedonia, Moldova, Montenegro, Kazakhstan, Kyrgyzstan, Tajikistan, Serbia, Ukraine, Uzbekistan) involving 170+ CBOs, as well as regional networks such as ECOM (in Uzbekistan, Tajikistan, Armenia, Kazakhstan, Kyrgyzstan) and ENPUD (Georgia, Moldova, Ukraine, Kyrgyzstan, Kazakhstan, Tajikistan, Belarus).
The following publications are available:
- Statistic country reports by APH on human rights violations based on REAct data collected in 2021 in Kyrgyzstan, in Georgia, in Moldova, in Tajikistan.
- Protectors or Perpetrators: the impact of unlawful policing on human rights and HIV. Join analytical publication in partnership with Frontline AIDS, Alliance for Public Health (Ukraine, Kyrgyzstan, Tajikistan, Moldova, Georgia, Uzbekistan), AIDS Foundation (South Africa), Gender Dynamix.
- Report on the results of the analysis of the Hotline calls by APH: Domestic and other forms of violence against women living with HIV and women in key populations during the COVID-19 pandemic in Tajikistan.
- REAct Statistical Report for the 1st half of 2022 by APH. Violations of the rights of people living with HIV and representatives of vulnerable groups in Georgia.
Situational Report by APH: Drug policy in Georgia and Challenges. - Series of publications by APH based on REAct data within regional campaign “16 days against gender-based violence”.
REAct system is available and functional at the national level in the following counties. It enables documentation of cases of human rights violations: Albania (45 cases), Armenia (182), Azerbaijan (174), B&H (70), Montenegro (60), Kazakhstan (363), North Macedonia (42), Tajikistan (1155), Serbia (24), Uzbekistan (835). More detailed data of 2023 is available in REAct Regional Digest and REAct website.
Cumulatively in 10 countries, 49,9% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions. During 2023 in 10 countries, there were provided 2162 consultations about human rights, 1022 consultations with professional lawyers. In 168 cases REActors helped to draft simple legal documents, such as complains or statement to police, in 236 cases represented client’s interests in medical facilities, assisted in getting medical services and support, in 336 cases – accompanied the client in the initial appeal to the police. There were at least 20 strategic court cases, and at least 162 cases were used for shadow reports to UN Treaty Bodies.
Cumulatively in 8 countries (Armenia, Azerbaijan, Kazakhstan, Albania, Bosnia and Herzegovina, Montenegro, North Macedonia, Serbia) 56,2% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions (https://drive.google.com/drive/folders/1wtJaecXERatg8cmrAE1mzaoshtdLQY_w). Numerous success stories of cases resolutions are available at REAct website.
Solutions
Implementer:
- Select an implementer
- ECECACD
- EHRA
- ENPUD
- ECECACD
- ECOM
- EKPC
- REGMH
- 100% Life
Period:
Reducing human rights-related barriers to HIV/TB services
Reduce criminalization of drug use and personal possession
Progress to date
Two reports were developed on decriminalization of drug use in Georgia and Kyrgyzstan.
ENPUD is working on several strategic cases: in Moldova, unauthorized urine PAS test was prevented regarding an OST patient, as well as arbitrary detention of an OST patient in another case. In Ukraine, two strategic ongoing cases regarding keeping the driver’s license for the OST patient; and restoring activist`s rights and reputation, and punishing the police officers responsible for the provocation. In Kazakhstan, several strategic cases regarding taking cannabis for medical purposes. In Kyrgyzstan, a strategic case regarding provocation by the police with the planting of “evidence”; extortion of a bribe for the opportunity to be at large while “investigative” actions are going on.
Reducing human rights-related barriers to HIV/TB services
Development and promotion of the Guiding principles (recommendations, model legislation etc.) on drug policy for the EECA region with specific advocacy efforts for reforming drug policy and decriminalization of personal drug use
Progress to date
The Guiding Principles document is developed and approved by the ECECACD. The first draft of the document was reviewed and discussed during in-person meeting of Commissioners on November 2, 2022 (the Minutes extract with provided recommendations to the document are available upon request). The document was amended accordingly to the recommendations and sent for the second review by Commissioners. Commissioners provided their recommendations and corrections to the text (the letters and texts with corrections are available upon request). Final amendments was done, the document was completed and finally approved by Commissioners (relevant correspondence is available upon request). The final version of the Guiding principles is under design.
In 2023, the EECA Drug Policy Commission conducted two country visits: to Kyrgyzstan on 19-21 June, 2023, to Moldova on 11-13 September, 2023 to present and promote the ‘Guiding Principles’ during the meetings at the highest political level. Prime Ministers of these countries, Ministers oh Health, Ministers of Internal Affairs, Members of the Parliament, other officials have received a copy of this document. Commissioners provided their expertise and arguments in support of changes to drug legislation based on the pathways described in the document.
In addition, Commissioners participated in several international Conferences to promote Guiding Principles and advocate for a change in drug policy: International Harm Reduction Conference, Melbourne (Australia), European Conference on Law Enforcement and Public Health, Umeå (Sweden), Drug policy discussions in Georgia. August 3, 2023, Public discussion of the state strategy on drugs, December 18, 2023 Kyiv, Ukraine.
Moreover, the recent OHCHR Report Human rights challenges in addressing and countering all aspects of the world drug problem” contains direct referring to Guiding Principles.
Kazakhstan
A high-level meeting in Astana, attended by President Kassym-Jomart Tokayev and ECECACD Commissioners, successfully prevented the closure of opioid agonist therapy (OAT) programs in Kazakhstan. The government secured OAT medicine procurement for 2025, ensuring continued treatment for opioid dependence. https://ececacd.org/high-level-meeting-in-astana-on-drug-policy-and-opioid-agonist-therapy/
Kyrgyzstan
In 2024, Kyrgyzstan replaced the term “registry of people with drug dependency” with “dynamic monitoring,” shifting from a law enforcement focus to a medical record approach. Legislative amendments were made, and a working group drafted seven subordinate legal acts to support this transition, with further government review ongoing into 2025.
https://cbd.minjust.gov.kg/4-5260/edition/1939/ru
https://cbd.minjust.gov.kg/4-5301/edition/3727/ru
Moldova
ECECACD engagement in Moldova throughout 2024 led to discussions on reforming the National Anti-Drug Commission, proposing its transfer to the Cabinet of Ministers. A December 2024 national meeting resulted in a recommendation to develop a new National Drug Strategy in 2025. The National Commission on Drugs officially endorsed this, forming an inter-ministerial working group to oversee its development. https://ececacd.org/planning-drug-policy-reform-in-moldova/
Georgia
In response to Georgia’s rollback towards undemocratic, pro-Russian approaches, we have taken emergency measures to prevent the deterioration of the country’s drug policy situation. A multi-stakeholder dialogue meeting on harm reduction and drug policy was held in May 2024, and “Recommendations to community organizations on risk reduction related to legal acts enacted in 2024” were emergently developed, striving to respond to the crisis. In addition, in December 2024, the Recommendations to community organizations on risk reduction related to some legal acts enacted in 2024, were developed and distributed among key actors and stakeholders to inform Georgian leaders and activists of LGBT community organizations what steps can be taken to reduce the risks appeared after enacting several new laws, particularly the law “On Protection of Family Values and Minors”.
Reducing human rights-related barriers to HIV/TB services
Improve anti-stigma legislation for LGBT
Reducing human rights-related barriers to HIV/TB services
Evidence-based advocacy interventions with the aim of removing legal barriers to, and improve the rights of, migrant access to HIV and TB care in sending and receiving countries of in EECA region: national and regional (EECA) meeting and roundtables with participation of civil society, migrant organizations, healthcare officials and parliamentarians
Progress to date
On December 9, the REGMH with the assistance of the NCC Secretariat held in Dushanbe a Roundtable “Protection of health of migrants from Tajikistan”. The event was timed to presentation of a new study conducted by the REGMH: “Situation and Economic analysis of HIV-related health services in the field of migration in Tajikistan”.
On December 13, 2022, the Regional Expert Group on Migration and Health together with Central Asian Association of People Living with HIV held a Roundtable in Almaty “Health of HIV positive migrants in Kazakhstan”. The aim of the Round Table was to promote effective and timely treatment of international migrants living with HIV. During the meeting, the Situational and Economic analysis on the provision of HIV-related health services for international migrants in Kazakhstan was presented and discussed.
On December 19, REG together with local NGO “Real World. Real People” held a Roundtable in Armenia, Yerevan aimed to buster a discussion and exchange of experience on the provision of services for international HIV-positive migrants between heads of health authorities of the Republic of Armenia, government departments responsible for migration and civil society organizations. At the meeting, a study “Analysis of legal and institutional barriers to accessing HIV services among migrants in the Republic of Armenia” (developed by REG in 2021) was presented.
On October 11, REG held an online meeting “Migrants’ access to HIV services in Central Asia and Caucasus” that gathered representatives of UNAIDS, Central Asian Association of PLHIV (Kazakhstan), TB People (Georgia), NGO “Real World, Real People” (Armenia), IFRC Central Asia, WHO Europe, Elton John AIDS Foundation, NGO Equality Movement (Georgia), AFEW (Kyrgyzstan), IFRC South Caucasus, Global Fund, WHO, and MSF. The goal of the meeting was to initiate a discussion and work out possible solutions to provide access to HIV services for those who urgently left the countries following the political situation.
REGMH held a number of online and offline seminars and rioundtables to present and discuss the results of their studies in Azerbaijan, Tajikistan and Kyrgyzstan. A number of discussions was also held to scale up remote registration of migrants with HIV to get access to HIV services. For now, remote registration is functional in Tajikistan, and the preparatory work is implemented in Armenia, Azerbaijan and Kazakhstan.
In particular, on June, 6 in Dushanbe REGMH held a Round Table on protecting health of Tajik migrants. The purpose of the meeting that gathered together the staff of the AIDS Center, the patients’ community, specialists from NGOs in the region and host countries was to discuss the maintaining of the algorithm for remote registration of citizens of Tajikistan with HIV living abroad, and to formulate further steps to improve access of migrants to HIV services. Deputy Director of the Republican AIDS Center made a proposal to develop and sign a Memorandum for Mutual Recognition of Medical Tests at the level of Republican AIDS Centers in the Central Asian region.
On December 4, REGMH held a Round Table in Yerevan, Armenia. The key focus of the meeting was the provision of HIV services for Armenian citizens living abroad.
On December, 25 REGMH participated in online meeting to discuss current issues of implementation/piloting of “Remote registration of migrants with HIV in Uzbekistan”, organized by a consortium of organizations in Uzbekistan to promote the protocol, including IOM, CCM, AFEW, and REGMH. During the meeting, representative of CCM informed that the protocol was accepted and signed by the Center for State Sanitary and Epidemiological Surveillance of the Republic of Uzbekistan. What is very important, the final version includes recommendations suggested by REGMH making it easier to register a migrant than it was in an initial version of the document.
On June 15, REGMH held its quarterly Working group meeting on remote registration of PLWH living abroad. As a result of the Round Table held earlier in Uzbekistan, the group managed to attract specialists from the Republican AIDS Center and the CCM of Uzbekistan. During the meeting, the Group discussed the issue of accepting medical documentation (certificates, test results) issued by country of migrant’s destination, which are necessary for remote registration; also, the standard for the minimum set of documents for remote registration of citizens in migration (based on WHO’s recommendations) were presented to participants on order to foster the development of remote registration in the EECA countries.
REGMH has launched a series of Webinars “Health of Refugee and Migrants from the EECA countries”, designed both for those who flee and seek help in the host country and for those who organize help in receiving countries. Also, webinars could be of interest to those who research and solve systemic problems.
The first webinar took place on August 09 and was devoted to revision of problems that Ukrainian refugees who use drugs face: “People Who Use Drugs from Ukraine: Challenges and Solutions”.
Migration and Health Summer School was hekd on 21-22 Aug 2023 in Yerevan, Armenia. where participants discussed best practices and solutions for providing medical care to migrants and refugees from the EECA region. Country representatives of REGMH from the EECA region, representatives of health authorities from the EECA countries, experts from regional and international organizations, WHO, UNAIDS, UNDP, and MSF attended the event, totally, 40 participants from 12 countries.
On November 24, 2023 REGMH held a Round table in Bishkek, Kyrgyzstan to discuss current issues of migrant health in the context of HIV. The event brought together experts from relevant ministries and departments, non-governmental and civil sectors, as well as representatives of international organizations. A key part of the round table was the presentation of study’s results conducted by REG in 2023 “Situational and economic analysis in the field of migration and the provision of medical services related to HIV in the Kyrgyz Republic” to identify legal and institutional barriers related to HIV faced by citizens of Kyrgyzstan returning from migration.
Regional Meeting on Migrant Health and HIV Response took place on September 19-20, 2024, in Samarkand. Experts from EECA countries gathered to discuss adapting health services for migrants amidst mass population movements. Organized under the Global Fund framework, the event highlighted key challenges migrants face, including access to HIV/TB treatment, language barriers, and mental health support. The #HelpNOW HUB, which assisted 37,500 Ukrainians in 50 countries, was presented as a best practice model. Participants emphasized the need for migrant-sensitive policies, digital health solutions, and sustainable healthcare partnerships to ensure uninterrupted medical services across borders.
Reducing human rights-related barriers to HIV/TB services
Decriminalization of HIV and unintended HIV transmission
Progress to date
100% Life conducted an analysis of the legal environment in Georgia, Kyrgyz Republic and the Republic of Uzbekistan in order to identify regulatory legal acts that need to be amended to reduce the criminalization of people living with HIV.
During 2023, draft legislative amendments to the regulations in the context of the legal and legislative acts that contribute to the criminalization of HIV in Georgia, Kyrgyzstan, Kazakhstan, and Uzbekistan were developed. These amendments concern both general and specialized norms.
- Draft law “On introducing amendments into the Criminal Code of the Kyrgyz Republic”.
- Draft Resolution of the Cabinet of Minister “On making amendments into some decisions of the Kyrgyz Republic Cabinet of Ministers on issues of employees medical check-up”.
- Draft Resolution of the Cabinet of Ministers “On making amendments to the Decree of the Government of the Kyrgyz Republic “On approval the Guidelines for registration of infectious diseases in the Kyrgyz Republic” dated September 23, 2011, # 583.
- Draft Resolution of the Kyrgyz Republic Cabinet of Ministers “On making amendments to the Kyrgyz Republic Government Decree “On approval of Regulations of the procedure of psychosocial HIV counseling dated October 20, # 683”.
- Draft Order of the Kyrgyz Republic Ministry of Health “On making amendments and addenda into the Guidelines for the issues of HIV counseling and testing approved by Order of KR MoH #411 dated 12.04.2023”.
Advocacy efforts led to revising a government decree that previously mandated the disclosure of personal information of people living with HIV (PLHIV). A new draft resolution ensuring confidentiality was introduced in June 2024, and by November 2024, the Kyrgyz Republic Cabinet of Ministers approved the revised “Procedure of monitoring, recording, and reporting of infectious diseases.” This reform aims to protect PLHIV from discrimination and reduce criminalization risks.
Solutions
Implementer:
- Select an implementer
- SEH
Period:
HSS: Health sector governance and planning
Increasing domestic financing of countries for services to key groups
Progress to date
Targeted activities were held in all project countries to discuss with national and international, governmental and non-governmental stakeholders the changes needed to enable sustainable and uninterrupted funding of HIV-related activities from national resources. Through targeted advocacy, technical support, and an integrated approach to HIV funding, in 2022 the project team managed to allocate approximately 1,7 million USD at the national level to programs for key populations, using social contracting mechanisms: Moldova – 154,126.84 USD; Kazakhstan – 118,529.33 USD; Kyrgyzstan – 61,000 USD; Tajikistan – 19,200.00 USD; Georgia – 357,000 USD; Ukraine – 931,453.96 USD.
Thanks to budget advocacy within the SoS project 2.0, the amount of money allocated from national budgets for HIV services through social contracting mechanisms in EECA project countries amounted to $3 269 959 in 2024. During SoS project 2.0 – $ 6 273 049 were allocated for social contracting in EECA region. The cumulative domestic budget expenditures for servicing key populations in 5 countries of SEE amounted to $1 061 383 in 2024. During SoS project 2.0 – $ 3 236 260 were allocated for social contracting in SEE region.
Solutions
Implementer:
- Select an implementer
- SEH
- SEH
Period:
HSS: Health sector governance and planning
Legal framework for financing HIV services from domestic funds – development and approval
Progress to date
Targeted activities were held in all project countries to discuss with national and international, governmental and non-governmental stakeholders the changes needed to enable sustainable and uninterrupted funding of HIV-related activities from national resources. Through targeted advocacy, technical support, and an integrated approach to HIV funding, in 2022 the project team managed to allocate approximately 1,7 million USD at the national level to programs for key populations, using social contracting mechanisms: Moldova – 154,126.84 USD; Kazakhstan – 118,529.33 USD; Kyrgyzstan – 61,000 USD; Tajikistan – 19,200.00 USD; Georgia – 357,000 USD; Ukraine – 931,453.96 USD.
Over three years of implementation of SoS_project 2.0 has contributed to significant changes in the financing of HIV services in 14 countries in SEE and EECA regions. The project supported the development of service delivery standards, pricing methodologies, and quality control procedures, which are critical for sustainable financing from the state budget.
The practice of social contracting is applied without interruption in 14 countries.
HSS: Health sector governance and planning
Regulation of service packages for key groups
Progress to date
In the reporting period, the Emergency package of services for key and vulnerable groups of the population in the field of HIV, and TB in the context of military conflicts was finalized, including tariffication. On its basis, in 2023, the process of advocacy and promotion of implementation at the level of countries in the EECA region will be launched.
Strategic Brief on Business Continuity (link) and Strategic Brief on Social contracting (link) were developed. In addition, Analysis of Quality of Services Provided in Azerbaijan was held and is available at the link.
Over three years of implementation of SoS_project 2.0 has contributed to significant changes in the financing of HIV services in 14 countries in SEE and EECA regions. The project supported the development of service delivery standards, pricing methodologies, and quality control procedures, which are critical for sustainable financing from the state budget.
The practice of social contracting is applied without interruption in 14 countries.
Solutions
Implementer:
- Select an implementer
- APH
- Positive Initiative
- APH
- APH
Period:
RSSH: Health sector governance and planning
REGIONAL: regional dashboard (with 2 integrated portals) + preliminary results to be reflected on the timeframe / deadlines, at least for this year
Progress to date
ToR for the dashboard is under development; methodologies and approaches to data collection for the social contacting and sustainability and transition portals are being updated.
The concepts and the ToRs for the database, BI analytics module and website to present the information from the dashboard were developed.
RSSH: Health sector governance and planning
National info system with database, service provider app, and client app
Progress to date
ToR is developed, specifications are being developed, team is being trained, development is due to start in April 2023.
The framework for developing the solution – DHIS2 – has been chosen, the implementation/developemnt team was trained to work with DHIS2.
The first version of the national infosystem is developed for Kyrgyzstan (National AIDS Centre), the negotiations regarding the development of the ToR for the adaptation of the system with involvement of other country stakeholders have started.
Tajikistan has been determined as the second target country, negotiations have started regarding forming the requirements for the ToR.
The APH National HIV prevention care and support information system was finalised for and piloted in Kyrgyzstan in close collaboration with the UNDP and the AIDS Centre. The pilot focused on two NGOs, sub recipients of the national Global Fund grant. The pilot utilised desktop and mobile data entry options; allowed to test out the newly developed batch/journal entry application and mode.
The System version was developed for Tajikistan and launched country-wide in collaboration with the AIDS Centre and the UNDP as the prime Global Fund grant recipient in the country. Up to 60 NGOs and trust cabinets (AIDS Centre service points) have started using the system, entering data for several quarters of the year, based on existing sources, as well as ongoing program implementation. The teams are using both desktop and mobile data entry options and are being supported by the APH team as they become more familiar with the system and/or identify additional changes or improvements required.
RSSH: Health sector governance and planning
Virtual social worker
Progress to date
Concept is developed, scripts are under development, research is being carried out to identify the optimal technical framework.
The first version of the eSW solution (web-based) has been developed – English language solution with the key topics of the knowledge database and tested, plans for further development and adaptation/improvement formulated.
The Virtual (Electronic) Social Worker – TWIIN Digital Assistant solution (co-funded by Gilead) was developed and launched in Ukraine. The solution is accessible through the dedicated website – https://twiin.aph.org.ua/en/ and a mobile app had also been developed that allows for easier direct access to the digital assistant, as well as to the knowledge database in form of a walkthrough menu based library which allows for access to the information in offline mode. The piloting started in September 2024 and by the end of the year, TWIIN had provided over 35000 sessions to over 5000 unique users. We procured three interactive screens, placed in three cities in Ukraine, that have provided access to the tool to potential audiences and throughout 2025 these screens will be functioning in several sites across the cities, increasing coverage and raising awareness. We had utilised a wide variety of approaches to promoting the solution, collected extensive feedback and continue to improve the tool on an ongoing basis, as well as making efforts in order to achieve sustainability and scale up the solution.
Objective Description:
OBjective task:
- Select a objective task
- Removing structural barriers to increase of HIV testing in EECA
- Removing structural barriers to ART in EECA
- Launching critical enabling interventions to improve HIV care cascade
- Implementation of COVID-19 response mechanism
- Select a objective task
- Monitoring situation with human rights of KPs, responding to viloations
- Revision of legisation and other regulations on KPs that pose barriers to accessing HIV services:
- Select a objective task
- Developing necessary legal framework and technical solutuions for cost-effective care package for KPs in EECA
- Advocacy for domestic resource allocation for KP services in EECA
Solutions
Implementer:
- Select an implementer
- APH
- APH
Period:
Supporting key group populations in a COVID setting
Provision of HIV prevention services with precautions against COVID-19
Progress to date
Work on shelters has expanded – in addition to 5 shelters for working with women who use drugs in conditions of violence (Ukraine, Serbia, North Macedonia, Kazakhstan), support for flexible shelters for representatives of the LGBT community in Kazakhstan, Uzbekistan, Kyrgyzstan and Tajikistan has been added. The program was distinguished by a special programmatic approach to working with clients – about 3,200 clients received material assistance in the form of food packages (Georgia, Kazakhstan). PPE support in Kaz for migrants and KGP (124,000 disposable masks, 1,000 antiseptics); CLM to provide quality services for clients of OST programs in 7 countries.
Supporting key group populations in a COVID setting
National Contingency Planning
Progress to date
Supporting key group populations in a COVID setting “General contingency planning guide developed in the frames of the C19RM is available here.
Guide by APH for Contingency Planning for Key Population HIV Services during COVID-19 and Other Emergencies for North Macedonia, Serbia, Bosnia and Herzegovina, Montenegro, Moldova, Georgia, Kazakhstan, Uzbekistan, Tajikistan and Kyrgyzstan in English is available at the link https://aph.org.ua/en/eeca/ in the folders with the names of each country.
Solutions
Implementer:
- Select an implementer
- ECOM
- EHRA
- ECOM
- EHRA
Period:
Prevention (Pre-exposure prophylaxis – PrEP)
Inclusion of PrEP into nationally approved service packages for MSM and/or other key populations
Progress to date
ECOM in partnership with WHO regional office for Europe analyzed five national PrEP protocols (Armenia, Kazakhstan, Kyrgyzstan, Georgia and Ukraine) and provided Report with recommendations on the steps needed to include PrEP into nationally approved standard package of servises. The report is under design and will be published by the end of February.
Much work was done in 2023 to present recommendations based on analyzes of PrEP Protocols in 5 countries. Online and offline meetings with stakeholders, monitoring visits (Kazakhstan, Kyrgyzstan) were held, the results were presented at various meetings, conferences, and technical consultations. Based on the analysis of PrEP Protocols and updated WHO recommendations, policy briefs were developed and sent to countries, the purpose of which was to show and not miss the importance of new interventions that can improve PrEP services in countries.
PrEP is available and integrated into the healthcare system as part of the standard service package funded by the government in 5 countries: Armenia, Georgia, Kazakhstan, Kyrgyzstan, and Ukraine.
1. Armenia
PrEP is available as part of the national HIV prevention program and partly funded by the governmentand. PrEP has been officially included in the national HIV prevention guidelines approved by the Ministry of Health of Armenia.
2. Georgia
PrEP is available as part of the national HIV prevention program and partly funded by the governmentand.
3. Kazakhstan
PrEP is available as part of the national HIV prevention program and fully funded by the governmentand.
4. Kyrgyzstan
PrEP is included in the healthcare system and fully funded by the governmentandand.
5. Ukraine
PrEP is available and included in national clinical protocols.
Continued state support is confirmed to ensure the availability of PrEP for key populations.
Measures have been taken to strengthen the position of PrEP within healthcare.
Integrated service delivery and HIV service quality improvement
Community groups conduct community-led assessment of national quality standards in accordance to IDUIT and organize dialogue with service providers and MOH/local authorities
Progress to date
Moldova
PULS Communitar conducted CLM study to evaluate OAT programs in the Republic of Moldova, identify the level of the availability and acceptability of programs, outline achievements, and identify and evaluate difficulties faced by the program participants. Report with findings and conclusions was prepared and presented on the meeting with service providers and decision makers. Next steps and recommendations for CCM were elaborated.
GENDERDOC-M conducted a CLM study to identify the barriers in access to PrEP among MSM/TG. The results were presented to the Key Affected Populations (KAP) committee. After the presentation, it was strongly recommended to showcase these results at the National Dialogue event. The aim is to leverage the platform to advocate for a comprehensive revision of the National Clinical Protocol on Pre-Exposure Prophylaxis (PrEP) in the first quarter of 2024. This strategic move aligns with the commitment to fostering meaningful changes in the national approach to PrEP in response to the insights gained through the CLM survey.
Kazakhstan
Forum of PWUD conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian is prepared. Meeting with CCM is planned to be organized in January 2024.
Georgia
Rubikoni conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Furthermore, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Kyrgyzstan
Equal to equal conducted a study on the client satisfaction with OAT. Report in Russian was prepared. Moreover, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Tajikistan
Intighob (Initiative group based on SPIN PLUS) conducted a study of the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian language was prepared. Moreover, the meetings with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Armenia
“New Generation” conducted Community Based Assessment of HIV Services Provided to MSM Living With HIV In Armenia through a focus group with broad number of experts and MSM community members (including representatives from CCM). The results were included to “Funding Priorities of Civil Society and Communities Most Affected by HIV, Tuberculosis and Malaria” by Global Fund under the number 9 (The funding priorities and minutes from CRG group meeting attached). These priorities are in active use to prepare an application for the Global Fund grant in Armenia. In addition, results are in active use in the National dialogue now.
Integrated service delivery and HIV service quality improvement
Integration of community-led monitoring (CLM) into the health care systems of countries in the EECA region to assure the quality of services for key populations (KPs)
Progress to date
Practical handbook on community-led monitoring tools was developed in English and Russian languages. The checklist with EHRA and other partners for CLM was discussed and agreed upon.
On 2-8 December 2022, specialists from the Eurasian Harm Reduction Association (EHRA) conducted regional online training “Community-Led Monitoring Methods” for the representatives of community organizations in the CEECA region. The training was attended by 38 representatives of organizations from different vulnerable communities in the CEECA region. The aim of the training consisting of three online sessions was to train leaders of self-organizations from different key communities in the CEECA region to understand, which role CLM can play in their advocacy work, how to formulate the proper problem and research question for CLM, and which of the different methodologies can most effectively provide the data needed for advocacy. Video recordings of the training, as well as presentations can be found at the link.
Following the CLM Handbook, developed in 2022, integration of CLM into the healthcare system can be ensured through productive and sustainable participation of community representatives in the decision-making process, mainly within CCM, and through national consultations with CCM and other health sector coordination bodies on key needs for CLM and its findings and recommendations on improving of health services.
CLM has been conducted in all planned countries. Results were presented in 5 countries and protocols were received (Moldova, Georgia, Tajikistan, Kazakhstan and Kyrgyzstan). In Armenia, the results of the CLM are in active use in the National dialogue now. The focus group with broad number of experts and MSM community members (including representatives from CCM) was conducted, and based on the results PrEP was identified as a key priority and included to “Funding Priorities of Civil Society and Communities Most Affected by HIV, Tuberculosis and Malaria” by Global Fund under the number 9 (The funding priorities and minutes from CRG group meeting attached). These priorities are in active use to prepare an application for the Global Fund grant in Armenia.
Following CLM Handbook, developed in 2022, integration of CLM into healthcare system can be ensured through productive and sustainable participation of community representatives in decision-making process, mainly within CCM, and through national consultations with CCM and other health sector coordination bodies on key needs for CLM and its findings and recommendations on improving of health services. Within EHRA activities, CLM results in all countries in Georgia, Moldova, Kyrgyzstan, Kazakhstan and Tajikistan were presented and reviewed in CCMs and/or in other healthcare managing bodies. Protocol/minutes of the CCM meeting or other health authority body, based on the conducted national consultations with CCM and other health sector coordination bodies on key needs for CLM and discussed how results of CLM will help to improve services and integration of them into the healthcare system. What is more, additionally to presentation of CLM results, this year consultants in Georgia, Moldova, Kyrgyzstan and Kazakhstan prepared requests to healthcare managing bodies by asking provide information on how CLM results were being implemented. EHRA prepared a final publication – report, which draws on the three-year SoS 2.0. project of the EHRA to support community-led monitoring (CLM) initiatives for opioid agonist therapy (OAT) and the findings and results of community groups in Georgia, Moldova, Kazakhstan, Kyrgyzstan, and Tajikistan, offering insights into best practices and lessons learnt.
Moldova
PULS Communitar conducted CLM study to evaluate OAT programs in the Republic of Moldova, identify the level of the availability and acceptability of programs, outline achievements, and identify and evaluate difficulties faced by the program participants. Report with findings and conclusions was prepared and presented on the meeting with service providers and decision makers.
GENDERDOC-M conducted a CLM study to identify the barriers in access to PrEP among MSM/TG. The results were presented to the Key Affected Populations (KAP) committee. After the presentation, it was strongly recommended to showcase these results at the National Dialogue event. Following dialogues and agreements with the Protocol revision experts, the recommendations were formally presented on August 23, 2024, during the Round Table on the National Clinical Protocol on PrEP. The updated draft protocol, which includes the proposed recommendations, is currently under review by government authorities. In addition, the approval of new service standards, which will also include CLM, is expected in June 2025.
Kazakhstan
Forum of PWUD conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian is prepared.
Georgia
Rubikoni conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Furthermore, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps. In addition, based on ECOM recommendations, the working group developed CLM mechanisms and a special chapter was included in the Standards for Management of Public Health Interventions (PrEP Protocol). The working group included representatives from the National Centre for Disease Control and Public Health (NCDC), the Research Centre for Infectious Diseases, AIDS and Clinical Immunology, NGOs and MSM representatives, including members of the András team. Letter received from NCDC in support of the modified protocol.
Kyrgyzstan
Equal to equal conducted a study on the client satisfaction with OAT. Report in Russian was prepared. Moreover, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Tajikistan
Intighob (Initiative group based on SPIN PLUS) conducted a study of the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian language was prepared. Moreover, the meetings with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Armenia
“New Generation” conducted Community Based Assessment of HIV Services Provided to MSM Living With HIV In Armenia through a focus group with broad number of experts and MSM community members (including representatives from CCM). The results were included to “Funding Priorities of Civil Society and Communities Most Affected by HIV, Tuberculosis and Malaria” by Global Fund under the number 9 (The funding priorities and minutes from CRG group meeting attached). The National Guidelines on PrEP for HIV infection have been officially approved under Order No. 6241-L by the Minister of Health, dated 13 November 2024. These guidelines are now available on the Ministry of Health’s official website.
Solutions
Implementer:
- Select an implementer
- HAC
- 100% Life
- HAC
- HAC
- SEH
- 100% Life
Period:
HSS: Health products management systems
Technical support in implementation of simplified registration for ARVs
Progress to date
Advocacy plans were developed for Kazakhstan, Kyrgyzstan and Moldova to further contribute to ARV price reduction. Official letters were sent to pharmaceutical companies and government authorities regarding further price reduction for ARVs, keeping the simplified procedures of registration of medicines and medical devices, etc.
The national experts in Kazakhstan, Kyrgyzstan, and Moldova implemented the activities envisaged by the developed advocacy plans.
Advocacy efforts were aimed at optimizing the ARV procurement process, expanding the involvement of the patient community and representatives of key vulnerable groups in advocating for access to drug supply and diagnostic and monitoring. Legal justifications were prepared for key regulatory acts that regulate the process of conducting and organizing the procurement of medicines and medical devices. These documents were presented to the national stakeholders (representatives of SK-Pharmacy, National Institute of Intellectual Property, National Center for Drug Expertise, Kazakh Scientific Center of Dermatology and Infectious Diseases, UNICEF) within the framework of the working meeting on “Cancellation of re-examination and registration of medicines and medical devices on the territory of the Republic of Kazakhstan”.
Amendments related to HIV testing in Kazakhstan and Georgia were approved at the end of 2023. This, with close collaboration with local and international consultants, enabled in 2024 to focus on implementing normative acts through various measures, such as training sessions, advocacy campaigns, and strengthening cooperation among local CSOs and stakeholders into practice.
Local CSOs/community-based organizations, already involved in HIV testing, will play a key role in the decentralization of HIV treatment, further strengthening access to care at the community level.
Amendments related to HIV testing in Kazakhstan and Georgia were approved at the end of 2023. This, with close collaboration with local and international consultants, enabled in 2024 to focus on implementing normative acts through various measures, such as training sessions, advocacy campaigns, and strengthening cooperation among local CSOs and stakeholders into practice.
Local CSOs/community-based organizations, already involved in HIV testing, will play a key role in the decentralization of HIV treatment, further strengthening access to care at the community level.
1. Georgia
Georgia has completed the process of developing and approving regulations for decentralizing HIV testing and treatment. The HIV strategy for 2023–2025 was approved, and amendments to the national HIV/AIDS program have been made, including the creation of new testing and outpatient treatment points in new regions (Telavi, Akhaltsikhe, Poti, Khashuri). Measures for centralized supply of HIV tests have also been introduced. These changes came into force in January 2024.
Amendments approved by the Government of Georgia, on December 30, 2024. Annex 7 of the program regulates HIV services and indicates that decentralized testing with 2 different test kits will be implemented as a pilot together with sub contractor organizations and NGOs working with high risk groups in 8 cities of country – Tbilisi, Telavi, Khashuri, Akhsltsike, Kutaisi, Zugdidi, Poti and Batumi.
2. Kazakhstan
In Kazakhstan, in 3 cities: Almaty, Pavlodar and Ustkamenogorsk HIV testing is available through CSO, community based organizations: “You are not alone”, “Answer” and “Kemel Arma Foundation”. The document was registered in the Ministry of Justice of the Republic of Kazakhstan on December 4, 2023 № 33715. The adopted and entered into force document approving tariffs for HIV servies. In addition, the Roadmap to prevent HIV infection in the Republic of Kazakhstan for 2023-2026 was approved by Order of the Ministry of Health No. 155 dated March 16, 2023.
1. Georgia
Georgia has completed the process of developing and approving regulations for decentralizing HIV testing and treatment. The HIV strategy for 2023–2025 was approved, and amendments to the national HIV/AIDS program have been made, including the creation of new testing and outpatient treatment points in new regions (Telavi, Akhaltsikhe, Poti, Khashuri). Measures for centralized supply of HIV tests have also been introduced. These changes came into force in January 2024.
Amendments approved by the Government of Georgia, on December 30, 2024. Annex 7 of the program regulates HIV services and indicates that decentralized testing with 2 different test kits will be implemented as a pilot together with sub contractor organizations and NGOs working with high risk groups in 8 cities of country – Tbilisi, Telavi, Khashuri, Akhsltsike, Kutaisi, Zugdidi, Poti and Batumi.
2. Kazakhstan
In Kazakhstan, in 3 cities: Almaty, Pavlodar and Ustkamenogorsk HIV testing is available through CSO, community based organizations: “You are not alone”, “Answer” and “Kemel Arma Foundation”. The document was registered in the Ministry of Justice of the Republic of Kazakhstan on December 4, 2023 № 33715. The adopted and entered into force document approving tariffs for HIV servies. In addition, the Roadmap to prevent HIV infection in the Republic of Kazakhstan for 2023-2026 was approved by Order of the Ministry of Health No. 155 dated March 16, 2023.
ECAT meeting was held on December 4–6 in Tbilisi, Georgia.
Reports on procurement monitoring of CD4 and VL tests as well as the rapid tests for HIV implemented in 2023 are published.
HSS: Health products management systems
Technical support in optimization of medicine procurement cycles
Progress to date
Priorities for improvements of PSM systems in Armenia, Georgia and Kazakhstan were discussed and agreed for further activities in 2023-2024. In Kazakhstan, MOH provided a list of its activities aimed to preserve state registration procedure and expressed the need to develop relevant legislation. In Georgia, access to the Global Fund procurement mechanism is of the highest priority. In Armenia, long-term agreements for ARVs and streamlining procurement practices from bottom to the top level in terms of centralization/decentralization and improvement of medicines registration procedure are of importance.
Georgia developed legally binding draft Drug Agency letter with supporting technical analysis allowing to significantly simplify receiving waivers for medicines import for Georgia.
Kazakhstan developed draft MoH order to mitigate some risks for medicines tendering procedures for Kazakhstan.
Armenia developed draft Law and draft Governmental decree enabling launching a medicines reimbursement reform for Armenia.
In Kazakhstan, comprehensive justification documents were prepared to demonstrate the benefits and necessity of transferring procurement responsibilities to the Sole Distributor. The legal rationale was presented to a wide range of stakeholders at the working meeting “On expanding access to essential medicines for people living with HIV by amending the legal acts regulating the procurement of medicines” held in Q4 2024.
In Kyrgyzstan, an advocacy strategy was developed based on an analysis of the procurement of ARV tests, HIV diagnostic and treatment monitoring products procured with public funds and humanitarian supplies funded by the Global Fund (GF) and UNDP. Official letters were also sent to the State Enterprise “Kyrgyzpharmacy” and the GF, UNDP outlining potential measures to optimize procurement processes and reduce the cost of ARVs and diagnostic tests. In addition, a number of informal discussions were held with the Kyrgyzpharmacy SE, the Republican Center for HIV/AIDS Control and GF/UNDP on further optimization of procurement strategies, expansion of the range of ARVs and diagnostic tests procured with public funds, and the possibility of reducing the cost of certain ARVs and diagnostic tools. A meeting was also held with experts engaged by the GF and the GF/UNDP to prepare for the transfer of GF grant management to national agencies.
In Moldova, to identify potential obstacles and opportunities for the introduction of a procurement mechanism through international procurement agencies, a comprehensive review of the current legislation on procurement of medical devices and medicines was conducted. An assessment of the current clinical protocol was conducted to develop recommendations for the inclusion of ART drug resistance monitoring. These recommendations were presented to the CCM HIV Working Group, and efforts are ongoing to advocate for their inclusion in the 2025 revision of the National HIV Protocol.
ECAT meeting was held on December 4–6 in Tbilisi, Georgia.
Reports on procurement monitoring of CD4 and VL tests as well as the rapid tests for HIV implemented in 2023 are published.
Armenia
The draft legal framework for the national supply chain system in Armenia (available at the link https://www.e-draft.am/en/projects/7783), according to Samvel Kharazyan, Head of State Health Agency of the Ministry of Health Armenia, was successfully approved by the relevant authorities within the ordinary national bureaucracy regulations. This includes the adoption of necessary regulations needed to launch a reform starting from April 1, 2025.
Georgia
The legal framework for the national supply chain system in Georgia has been reviewed and the document with relevant suggestions has been submitted to the MOH of Georgia for approval.
Kazakhstan
Kazakhstan has made significant progress in improving the legal framework for the national supply chain system, having drafted and submitted suggestions to the MOH for approval. Additionally, changes to our relevant Order No. 110 have been published for public discussion in Kazakhstan.
HSS: Health products management systems
Advocacy for engagement of patient community experts into national working groups to develop and adopt medicine procurement lists and technical procurement documentation
Progress to date
Advocacy plans were developed for Kazakhstan, Kyrgyzstan and Moldova to further contribute to ARV price reduction. Official letters were sent to pharmaceutical companies and government authorities regarding further price reduction for ARVs, keeping the simplified procedures of registration of medicines and medical devices, etc.
The national experts in Kazakhstan, Kyrgyzstan, and Moldova implemented the activities envisaged by the developed advocacy plans.
Online training/webinar “Building understanding of ARV procurement process” was held and online training/webinar “Building skills in advocacy, effective communication, legislative issues, right to adequate drug supply, monitoring, and transparency skills”. Based on the results of the online training/webinars, the prepared materials were compiled into a training manual, which were sent to the training participants.
Amendments related to HIV testing in Kazakhstan and Georgia were approved at the end of 2023. This, with close collaboration with local and international consultants, enabled in 2024 to focus on implementing normative acts through various measures, such as training sessions, advocacy campaigns, and strengthening cooperation among local CSOs and stakeholders into practice.
Local CSOs/community-based organizations, already involved in HIV testing, will play a key role in the decentralization of HIV treatment, further strengthening access to care at the community level.
1. Georgia
Georgia has completed the process of developing and approving regulations for decentralizing HIV testing and treatment. The HIV strategy for 2023–2025 was approved, and amendments to the national HIV/AIDS program have been made, including the creation of new testing and outpatient treatment points in new regions (Telavi, Akhaltsikhe, Poti, Khashuri). Measures for centralized supply of HIV tests have also been introduced. These changes came into force in January 2024.
Amendments approved by the Government of Georgia, on December 30, 2024. Annex 7 of the program regulates HIV services and indicates that decentralized testing with 2 different test kits will be implemented as a pilot together with sub contractor organizations and NGOs working with high risk groups in 8 cities of country – Tbilisi, Telavi, Khashuri, Akhsltsike, Kutaisi, Zugdidi, Poti and Batumi.
2. Kazakhstan
In Kazakhstan, in 3 cities: Almaty, Pavlodar and Ustkamenogorsk HIV testing is available through CSO, community based organizations: “You are not alone”, “Answer” and “Kemel Arma Foundation”. The document was registered in the Ministry of Justice of the Republic of Kazakhstan on December 4, 2023 № 33715. The adopted and entered into force document approving tariffs for HIV servies. In addition, the Roadmap to prevent HIV infection in the Republic of Kazakhstan for 2023-2026 was approved by Order of the Ministry of Health No. 155 dated March 16, 2023.
In Kazakhstan, comprehensive justification documents were prepared to demonstrate the benefits and necessity of transferring procurement responsibilities to the Sole Distributor. The legal rationale was presented to a wide range of stakeholders at the working meeting “On expanding access to essential medicines for people living with HIV by amending the legal acts regulating the procurement of medicines” held in Q4 2024.
In Kyrgyzstan, an advocacy strategy was developed based on an analysis of the procurement of ARV tests, HIV diagnostic and treatment monitoring products procured with public funds and humanitarian supplies funded by the Global Fund (GF) and UNDP. Official letters were also sent to the State Enterprise “Kyrgyzpharmacy” and the GF, UNDP outlining potential measures to optimize procurement processes and reduce the cost of ARVs and diagnostic tests. In addition, a number of informal discussions were held with the Kyrgyzpharmacy SE, the Republican Center for HIV/AIDS Control and GF/UNDP on further optimization of procurement strategies, expansion of the range of ARVs and diagnostic tests procured with public funds, and the possibility of reducing the cost of certain ARVs and diagnostic tools. A meeting was also held with experts engaged by the GF and the GF/UNDP to prepare for the transfer of GF grant management to national agencies.
In Moldova, to identify potential obstacles and opportunities for the introduction of a procurement mechanism through international procurement agencies, a comprehensive review of the current legislation on procurement of medical devices and medicines was conducted. An assessment of the current clinical protocol was conducted to develop recommendations for the inclusion of ART drug resistance monitoring. These recommendations were presented to the CCM HIV Working Group, and efforts are ongoing to advocate for their inclusion in the 2025 revision of the National HIV Protocol.
ECAT meeting was held on December 4–6 in Tbilisi, Georgia.
Reports on procurement monitoring of CD4 and VL tests as well as the rapid tests for HIV implemented in 2023 are published.
HSS: Health products management systems
Technical support in implementation of long-term contracts for ARV procurement
Progress to date
Advocacy plans were developed for Kazakhstan, Kyrgyzstan and Moldova to further contribute to ARV price reduction. Official letters were sent to pharmaceutical companies and government authorities regarding further price reduction for ARVs, keeping the simplified procedures of registration of medicines and medical devices, etc.
The national experts in Kazakhstan, Kyrgyzstan, and Moldova implemented the activities envisaged by the developed advocacy plans.
Advocacy efforts were aimed at optimizing the ARV procurement process, expanding the involvement of the patient community and representatives of key vulnerable groups in advocating for access to drug supply and diagnostic and monitoring. Legal justifications were prepared for key regulatory acts that regulate the process of conducting and organizing the procurement of medicines and medical devices. These documents were presented to the national stakeholders (representatives of SK-Pharmacy, National Institute of Intellectual Property, National Center for Drug Expertise, Kazakh Scientific Center of Dermatology and Infectious Diseases, UNICEF) within the framework of the working meeting on “Cancellation of re-examination and registration of medicines and medical devices on the territory of the Republic of Kazakhstan”.
In Kazakhstan, comprehensive justification documents were prepared to demonstrate the benefits and necessity of transferring procurement responsibilities to the Sole Distributor. The legal rationale was presented to a wide range of stakeholders at the working meeting “On expanding access to essential medicines for people living with HIV by amending the legal acts regulating the procurement of medicines” held in Q4 2024.
HSS: Health products management systems
Decentralization of HIV treatment through integration to primary healthcare
Progress to date
Synthesis Report on assessment of health systems to decentralize HIV treatment services in 5 countries of the EECA is developed and can be found at the link.
The road maps were finalized in Armenia, Georgia, Moldova, Kazakhstan, and Kyrgyzstan.
In Kazakhstan, a roadmap for HIV decentralization was elaborated, and national discussions were initiated. During this process, a partnership was developed between the involved national consultant and different local stakeholders and partners, including UNICEF, which is playing a significant role in terms of access to HIV diagnostics and medicines.
In November 2023, was organized a study visit by the GF for colleagues from the AIDS Center and other state agencies from Kazakhstan to Georgia to learn about the Georgian experience. Based on the visit, the normative and legal amendments to National protocols regarding decentralization were discussed, but development and approval were postponed until 2024.
The main reason for the postponement is the validation of test systems produced by local manufacturers in Kazakhstan that are not prequalified by the WHO.
Amendments related to HIV testing in Kazakhstan and Georgia were approved at the end of 2023. This, with close collaboration with local and international consultants, enabled in 2024 to focus on implementing normative acts through various measures, such as training sessions, advocacy campaigns, and strengthening cooperation among local CSOs and stakeholders into practice.
Local CSOs/community-based organizations, already involved in HIV testing, will play a key role in the decentralization of HIV treatment, further strengthening access to care at the community level.
1. Georgia
Georgia has completed the process of developing and approving regulations for decentralizing HIV testing and treatment. The HIV strategy for 2023–2025 was approved, and amendments to the national HIV/AIDS program have been made, including the creation of new testing and outpatient treatment points in new regions (Telavi, Akhaltsikhe, Poti, Khashuri). Measures for centralized supply of HIV tests have also been introduced. These changes came into force in January 2024.
Amendments approved by the Government of Georgia, on December 30, 2024. Annex 7 of the program regulates HIV services and indicates that decentralized testing with 2 different test kits will be implemented as a pilot together with sub contractor organizations and NGOs working with high risk groups in 8 cities of country – Tbilisi, Telavi, Khashuri, Akhsltsike, Kutaisi, Zugdidi, Poti and Batumi.
2. Kazakhstan
In Kazakhstan, in 3 cities: Almaty, Pavlodar and Ustkamenogorsk HIV testing is available through CSO, community based organizations: “You are not alone”, “Answer” and “Kemel Arma Foundation”. The document was registered in the Ministry of Justice of the Republic of Kazakhstan on December 4, 2023 № 33715. The adopted and entered into force document approving tariffs for HIV servies. In addition, the Roadmap to prevent HIV infection in the Republic of Kazakhstan for 2023-2026 was approved by Order of the Ministry of Health No. 155 dated March 16, 2023.
Georgia has successfully approved several regulatory documents related to the decentralization of HIV treatment services, ensuring integration of these services into primary healthcare systems. These efforts align with WHO recommendations and have been implemented through various legal and normative amendments. The HIV strategy for 2023-2025 was approved by the Order of the Minister of Labor, Health, and Social Protection of IDPs from the Occupied Territories of Georgia dated September 6, 2023, No. 65/N (https://matsne.gov.ge/ka/document/view/5909178?publication=0), and additional amendments for decentralizing HIV treatment services, including the introduction of new regional centers for testing and outpatient treatment, were implemented. Additionally, a significant new initiative to allow civil society organizations to provide HIV treatment has been launched, which will be instrumental in further decentralizing services and increasing accessibility. These measures were officially enacted in December 2023 and January 2024.
In 2024, new regions for HIV diagnosis and outpatient treatment were added in Georgia. These new locations were trained by medical staff from the AIDS Center, NCDC and the Georgian Harm Reduction Network. The new regions for the decentralization of HIV/AIDS diagnosis and outpatient treatment are: Telavi, Akhaltsikhe, Poti and Khashuri.
These points highlight significant achievements and changes in the decentralization of HIV services in Georgia.
Kazakhstan has made significant strides in decentralizing HIV treatment services, aligning with WHO recommendations. In November 2023, the Ministry of Health approved a methodology for distributing HIV services within the guaranteed free medical care system, which includes defining the “tariff per person” for high-risk groups. This ensures access to essential HIV care.
A number of regulatory acts are approved.
- Standard for the Organization of Medical Care for HIV Infection in the Republic of Kazakhstan is focused on a few very important directions including the process of HIV treatment decentralization in primary health care facilities. Approval is expected in 2025.
- On January 24, 2025 the order of the Ministry of Health #№ 27833, “On the approval of the rules for providing specialized medical care in outpatient settings” was approved, which focuses on organizing specialized medical services including HIV testing and treatment on primary health care settings. Clauses 3 and 3.1 provide for decentralized treatment (including mobile medical points and medical trains as well as distant medical services). This would allow for NGOs having medical licenses to use their mobile laboratories for HIV testing and treatment with distant counseling of medical practitioners in the remote and rural areas.
- On November 11, 2024, amendments were made to the Order of the Acting Minister of Health of the Republic of Kazakhstan No. 169 “On the approval of the methodology for distributing the volume of services and/or funds to healthcare entities for the provision of medical care within the framework of the guaranteed volume of free medical care and/or the system of mandatory social health insurance”. Clause 6.7 provides for governmental funding of specialized healthcare services for PLHA and KPs in the friendly offices. These regulatory provisions alongside with the trainings for medical practitioners (sponsored by other donors) and services paid by the government (drugs, payment to staff, etc.) enable effective decentralization of HIV treatment in Kazakhstan. CSOs/community-based organizations, already involved in HIV testing, will play a significant role in the decentralization of HIV treatment, further strengthening access to care at the community level.
HSS: Health products management systems
Community-led advocacy of elimination of identified critical discrepancies with the WHO prevention, testing and treatment guidelines
Progress to date
Current testing and treatment protocols analysis is finished in 7 countries (Armenia, Moldova, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan, and Ukraine) and recommendations to align the national protocols with the WHO guidelines are provided. The report is available at the link.
WHO has held the analysis of HIV testing guidelines in 6 countries of EECA – Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Uzbekistan. The report is available at the link.
National HIV testing and ART-optimized strategies based on and aligned with the WHO recommendations were developed for 4 EECA countries – Armenia, Kazakhstan, Kyrgyzstan, Moldova.
In Armenia, Kazakhstan, Kyrgyzstan, and Moldova, all key actions related to the development and implementation of HIV testing and ART optimization strategies, in line with WHO recommendations, have been completed. According to the results of the assessment in 2022, there was a need to replace Georgia with another country to implement activities for 2023 and 2024 since the Georgian testing and treatment protocol is generally in line with the 2021 WHO recommendations for the use of ARV drugs for the prevention and treatment of HIV, and as well as other aspects of the clinical management of HIV. During project meetings different optios were discussed, and the desicion was taken to continue the activities in Armenia instead of Georgia.
Kazakhstan
- Approved – Order of the Ministry of Health of the Republic of Kazakhstan No. 774 dated 08.11.2024. This Оrder amended the Order of the Ministry of Health of the Republic of Kazakhstan dated 16.03.2023 No. 155 in the context of changes and updates in terms of implementation of the items of the Roadmap “On Implementation of Measures for HIV Prevention in the Republic of Kazakhstan for 2025-2026”, in particular:
- Amendments to paragraph 23 of the Order of the Minister of Health of the Republic of Kazakhstan dated November 30, 2020, No. KR DSM-224/2020 “On Approval of the Standard for the Organization of Medical and Social Assistance in the Field of Mental Health to the Population of the Republic of Kazakhstan” (registered in the Register of State Registration of Normative Legal Acts No. 21712) regarding the provision of PTAO services at the hospital level are scheduled for the 3rd quarter of 2026.
- Amendments and additions to the Clinical Protocols: “HIV infection in adults”, ‘HIV infection in children’, ‘HIV/TB co-infection’, taking into account the update of the best international practices, is scheduled for the 4th quarter of 2025.
- Approved – Order of the Minister of Health of the Republic of Kazakhstan dated June 24, 2024 № 29 on amendments to the Order of the Minister of Health of the Republic of Kazakhstan dated December 3, 2020, No. KR DSM-231/2020 “On Approval of the Rules for Investigation of Cases of HIV Infection among the Population”.
- Approved – Order of the Ministry of Health of the Republic of Kazakhstan dated July 11, 2024 No. 55 “On Amendments and Additions to the Order of the Ministry of Health of the Republic of Kazakhstan dated October 19, 2020 No. KR DSM-137/2020 ‘On Approval of the Rules for Conducting Measures for the Prevention of HIV Infection’.
- Drafted – Amendments to the Code of the Republic of Kazakhstan dated July 7, 2020 “On the Health of the People and the Health Care System” on HIV infection”. It is expected that at the beginning of 2025, it will be approved.
Moldova
- Approved – National Clinical Protocol “Treatment of Viral Hepatitis C in Adults” approved by the Order of the Ministry of Health of the Republic of Moldova dated 11.10.2024.
- Drafted – National Clinical Protocol “Pre-exposure prophylaxis of HLV infection (PrEP)”.
Solutions
Implementer:
- Select an implementer
- PAS
- WHO
- 100% Life
- SEH
- PAS
- WHO
- SEH
Period:
Integrated service delivery and HIV service quality improvement
Country level support to adoption and implementation of HTS guidelines: (a) National working groups technical assistance support; (b) Revision of functional responsibilities regarding HTS of HIV specialized settings, relevant testing points and lab(s), and other level institutions including primary care entities; (c) Training of new entities/people engaged in testing procedures; (d) Training for lab professionals to engage more in monitoring and improving the quality of testing procedures; (e) Conduct comparative cost analysis of RDT-based vs current diagnostic algorithm in two countries – to support investment case at policy level; (f) TA for HIV testing algorithm verification activities in 2 selected countries
Progress to date
Costing Methodology for HIV infection testing costs based on current HIV testing strategies and RDT-based testing costs and data collection tool are developed, data on Kazakhstan and Georgia are collected, the reports are under finalization.
PAS in collaboration with WHO Euro and WHO CO, on September 19-21, 2023, in Ankara, Turkey, organized the study tour and training: Laboratory aspects of transition to new HIV testing algorithms. The main scope of the events was to discuss the ways to improve HIV testing services in line with WHO recommendations and to enable countries to exchange their best experiences of the revision of national HIV testing strategies. The event was attended by: representatives of the National HIV Programs responsible for HIV testing strategies and laboratory specialists responsible for laboratory diagnostics of HIV, monitoring and testing quality at the national level from Turkiye, Ukraine, Moldova, Kazakhstan, Kyrgyzstan, Uzbekistan, Tajikistan and Azerbaijan; WHO EURO office, PAS Center, APH.
A two days training for laboratory specialists in HIV testing in Kazakhstan on November 30 – December 01, 2023. During the training, the participants discussed what will be the role of the reference laboratory, the role of laboratories in the regions, the changed responsibilities of laboratory specialists, the ensuring of the quality of the testing, the monitoring and evaluation of the testing etc.
A two days training for laboratory specialists in HIV testing in Georgia on December 07-08, 2023. The training was dedicated to the discussion and planning of the verification study of the HIV testing algorithm using rapid tests.
HIV testing policies are fully aligned with HIV recommendations in Georgia: 3-test based testing strategy without Western blot (WB) and decentralization of confirmatory testing to 8 regional centers took place in 2023-2024, and reflected in the State Health Programme of Georgia (approved by the Resolution No. 529 of the Government of Georgia on 29 December 2023). The verification study is completed in Georgia, the first draft report has been produced.
As part of the project, support was provided to national partners in developing relevant activities in the Roadmap to prevent HIV infection in the Republic of Kazakhstan for 2023-2026 approved by Order of the Ministry of Health No. 155 dated March 16, 2023. Chapter 3 “Laboratory diagnostics” includes a validation study, change in the HIV testing algorithm in accordance with WHO recommendations, a phased decentralization of HIV diagnosis confirmation, and an expansion of rapid testing at the primary health care and community levels. All these activities began to be implemented in 2023, including a verification study, and will be completed in 2025-2026.
In addition to Georgia and Kazakhstan, WHO technical assistance was provided to Armenia, where a HIV verification study was conducted in 2023, and a pilot project to introduce a new testing algorithm was completed in 2024. The country-wide introduction of the new algorithm is planned for 2025.
HIV testing policies are fully aligned with HIV recommendations in Georgia: 3-test based testing strategy without Western blot (WB) and decentralization of confirmatory testing to 8 regional centers took place in 2023-2024, and reflected in the State Health Programme of Georgia (approved by the Resolution No. 529 of the Government of Georgia on 29 December 2023). The verification study is completed in Georgia, the first draft report has been produced.
As part of the project, support was provided to national partners in developing relevant activities in the Roadmap to prevent HIV infection in the Republic of Kazakhstan for 2023-2026 approved by Order of the Ministry of Health No. 155 dated March 16, 2023. Chapter 3 “Laboratory diagnostics” includes a validation study, change in the HIV testing algorithm in accordance with WHO recommendations, a phased decentralization of HIV diagnosis confirmation, and an expansion of rapid testing at the primary health care and community levels. All these activities began to be implemented in 2023, including a verification study, and will be completed in 2025-2026.
In addition to Georgia and Kazakhstan, WHO technical assistance was provided to Armenia, where a HIV verification study was conducted in 2023, and a pilot project to introduce a new testing algorithm was completed in 2024. The country-wide introduction of the new algorithm is planned for 2025.
HSS: Health products management systems
Community-led advocacy of elimination of identified critical discrepancies with the WHO prevention, testing and treatment guidelines
Progress to date
Current testing and treatment protocols analysis is finished in 7 countries (Armenia, Moldova, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan, and Ukraine) and recommendations to align the national protocols with the WHO guidelines are provided. The report is available at the link.
WHO has held the analysis of HIV testing guidelines in 6 countries of EECA – Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Uzbekistan. The report is available at the link.
National HIV testing and ART-optimized strategies based on and aligned with the WHO recommendations were developed for 4 EECA countries – Armenia, Kazakhstan, Kyrgyzstan, Moldova.
In Armenia, Kazakhstan, Kyrgyzstan, and Moldova, all key actions related to the development and implementation of HIV testing and ART optimization strategies, in line with WHO recommendations, have been completed. According to the results of the assessment in 2022, there was a need to replace Georgia with another country to implement activities for 2023 and 2024 since the Georgian testing and treatment protocol is generally in line with the 2021 WHO recommendations for the use of ARV drugs for the prevention and treatment of HIV, and as well as other aspects of the clinical management of HIV. During project meetings different optios were discussed, and the desicion was taken to continue the activities in Armenia instead of Georgia.
Kazakhstan
- Approved – Order of the Ministry of Health of the Republic of Kazakhstan No. 774 dated 08.11.2024. This Оrder amended the Order of the Ministry of Health of the Republic of Kazakhstan dated 16.03.2023 No. 155 in the context of changes and updates in terms of implementation of the items of the Roadmap “On Implementation of Measures for HIV Prevention in the Republic of Kazakhstan for 2025-2026”, in particular:
- Amendments to paragraph 23 of the Order of the Minister of Health of the Republic of Kazakhstan dated November 30, 2020, No. KR DSM-224/2020 “On Approval of the Standard for the Organization of Medical and Social Assistance in the Field of Mental Health to the Population of the Republic of Kazakhstan” (registered in the Register of State Registration of Normative Legal Acts No. 21712) regarding the provision of PTAO services at the hospital level are scheduled for the 3rd quarter of 2026.
- Amendments and additions to the Clinical Protocols: “HIV infection in adults”, ‘HIV infection in children’, ‘HIV/TB co-infection’, taking into account the update of the best international practices, is scheduled for the 4th quarter of 2025.
- Approved – Order of the Minister of Health of the Republic of Kazakhstan dated June 24, 2024 № 29 on amendments to the Order of the Minister of Health of the Republic of Kazakhstan dated December 3, 2020, No. KR DSM-231/2020 “On Approval of the Rules for Investigation of Cases of HIV Infection among the Population”.
- Approved – Order of the Ministry of Health of the Republic of Kazakhstan dated July 11, 2024 No. 55 “On Amendments and Additions to the Order of the Ministry of Health of the Republic of Kazakhstan dated October 19, 2020 No. KR DSM-137/2020 ‘On Approval of the Rules for Conducting Measures for the Prevention of HIV Infection’.
- Drafted – Amendments to the Code of the Republic of Kazakhstan dated July 7, 2020 “On the Health of the People and the Health Care System” on HIV infection”. It is expected that at the beginning of 2025, it will be approved.
Moldova
- Approved – National Clinical Protocol “Treatment of Viral Hepatitis C in Adults” approved by the Order of the Ministry of Health of the Republic of Moldova dated 11.10.2024.
- Drafted – National Clinical Protocol “Pre-exposure prophylaxis of HLV infection (PrEP)”.
HSS: Health products management systems
Decentralization of HIV testing services through integration to primary healthcare
Progress to date
Synthesis Report on assessment of readiness of health systems to decentralize HIV testing services in 5 countries of the EECA region is developed and can be found at the link.
The road maps were finalized in Armenia, Georgia, Moldova, Kazakhstan, and Kyrgyzstan.
Amendments related to HIV testing in Kazakhstan and Georgia were approved at the end of 2023. This, with close collaboration with local and international consultants, enabled in 2024 to focus on implementing normative acts through various measures, such as training sessions, advocacy campaigns, and strengthening cooperation among local CSOs and stakeholders into practice.
Local CSOs/community-based organizations, already involved in HIV testing, will play a key role in the decentralization of HIV treatment, further strengthening access to care at the community level.
1. Georgia
Georgia has completed the process of developing and approving regulations for decentralizing HIV testing and treatment. The HIV strategy for 2023–2025 was approved, and amendments to the national HIV/AIDS program have been made, including the creation of new testing and outpatient treatment points in new regions (Telavi, Akhaltsikhe, Poti, Khashuri). Measures for centralized supply of HIV tests have also been introduced. These changes came into force in January 2024.
Amendments approved by the Government of Georgia, on December 30, 2024. Annex 7 of the program regulates HIV services and indicates that decentralized testing with 2 different test kits will be implemented as a pilot together with sub contractor organizations and NGOs working with high risk groups in 8 cities of country – Tbilisi, Telavi, Khashuri, Akhsltsike, Kutaisi, Zugdidi, Poti and Batumi.
2. Kazakhstan
In Kazakhstan, in 3 cities: Almaty, Pavlodar and Ustkamenogorsk HIV testing is available through CSO, community based organizations: “You are not alone”, “Answer” and “Kemel Arma Foundation”. The document was registered in the Ministry of Justice of the Republic of Kazakhstan on December 4, 2023 № 33715. The adopted and entered into force document approving tariffs for HIV servies. In addition, the Roadmap to prevent HIV infection in the Republic of Kazakhstan for 2023-2026 was approved by Order of the Ministry of Health No. 155 dated March 16, 2023.
HSS: Health products management systems
Introduction of self-testing, community-based testing and decentralized testing into national policy documents and clinical guidelines, and harmonized testing policies and processes with new WHO recommendations, including with TA provided by the WHO Regional Office, Europe
Progress to date
In Georgia new HTS guideliness was approved, in Kazakhstan was submitted for approval. The new testing strategies include the use of rapid tests for HIV testing, the decentralization of testing (the involvement of PHC, NGOs, specialized medical institutions), the exclusion of the use of the western blot test for confirmation.
HIV testing policies are fully aligned with HIV recommendations in Georgia: 3-test based testing strategy without Western blot (WB) and decentralization of confirmatory testing to 8 regional centers took place in 2023-2024, and reflected in the State Health Programme of Georgia (approved by the Resolution No. 529 of the Government of Georgia on 29 December 2023). The verification study is completed in Georgia, the first draft report has been produced.
As part of the project, support was provided to national partners in developing relevant activities in the Roadmap to prevent HIV infection in the Republic of Kazakhstan for 2023-2026 approved by Order of the Ministry of Health No. 155 dated March 16, 2023. Chapter 3 “Laboratory diagnostics” includes a validation study, change in the HIV testing algorithm in accordance with WHO recommendations, a phased decentralization of HIV diagnosis confirmation, and an expansion of rapid testing at the primary health care and community levels. All these activities began to be implemented in 2023, including a verification study, and will be completed in 2025-2026.
In addition to Georgia and Kazakhstan, WHO technical assistance was provided to Armenia, where a HIV verification study was conducted in 2023, and a pilot project to introduce a new testing algorithm was completed in 2024. The country-wide introduction of the new algorithm is planned for 2025.
The SoS project has been instrumental in advancing self-testing and community-based HIV testing in SEE through persistent advocacy, strategic meetings, and expert consultations. Our partners have actively engaged with ministries and public health institutes to push for the integration of self-testing into national HIV strategies and the expansion of community-based testing services.
HSS: Health products management systems
Decentralization of HIV testing services through integration to primary healthcare
Progress to date
Synthesis Report on assessment of readiness of health systems to decentralize HIV testing services in 5 countries of the EECA region is developed and can be found at the link.
The road maps were finalized in Kazakhstan.
In Kazakhstan, a roadmap for HIV decentralization was elaborated, and national discussions were initiated. During this process, a partnership was developed between the involved national consultant and different local stakeholders and partners, including UNICEF, which is playing a significant role in terms of access to HIV diagnostics and medicines.
In November 2023, was organized a study visit by the GF for colleagues from the AIDS Center and other state agencies from Kazakhstan to Georgia to learn about the Georgian experience. Based on the visit, the normative and legal amendments to National protocols regarding decentralization were discussed, but development and approval were postponed until 2024.
The main reason for the postponement is the validation of test systems produced by local manufacturers in Kazakhstan that are not prequalified by the WHO.
Amendments related to HIV testing in Kazakhstan were approved at the end of 2023. This, with close collaboration with local and international consultants, enabled in 2024 to focus on implementing normative acts through various measures, such as training sessions, advocacy campaigns, and strengthening cooperation among local CSOs and stakeholders into practice.
Local CSOs/community-based organizations, already involved in HIV testing, will play a key role in the decentralization of HIV treatment, further strengthening access to care at the community level.
Kazakhstan
In Kazakhstan, in 3 cities: Almaty, Pavlodar and Ustkamenogorsk HIV testing is available through CSO, community based organizations: “You are not alone”, “Answer” and “Kemel Arma Foundation”. The document was registered in the Ministry of Justice of the Republic of Kazakhstan on December 4, 2023 № 33715. The adopted and entered into force document approving tariffs for HIV servies. In addition, the Roadmap to prevent HIV infection in the Republic of Kazakhstan for 2023-2026 was approved by Order of the Ministry of Health No. 155 dated March 16, 2023.
Solutions
Implementer:
- Select an implementer
- REGMH
- FreeZone
- EKPC
- APH
- ECOM
- ENPUD
- CAAPLA
- ECOM
Period:
Reducing human rights-related barriers to HIV/TB services
Legal environment and situation analysis as well as mapping of civil society partners in the area of access by migrants to HIV and TB services
Progress to date
On December 9, the REGMH with the assistance of the NCC Secretariat held in Dushanbe a Roundtable “Protection of health of migrants from Tajikistan”. The event was timed to presentation of a new study conducted by the REGMH: “Situation and Economic analysis of HIV-related health services in the field of migration in Tajikistan”.
On December 13, 2022, the Regional Expert Group on Migration and Health together with Central Asian Association of People Living with HIV held a Roundtable in Almaty “Health of HIV positive migrants in Kazakhstan”. The aim of the Round Table was to promote effective and timely treatment of international migrants living with HIV. During the meeting, the Situational and Economic analysis on the provision of HIV-related health services for international migrants in Kazakhstan was presented and discussed.
On December 19, REG together with local NGO “Real World. Real People” held a Roundtable in Armenia, Yerevan aimed to buster a discussion and exchange of experience on the provision of services for international HIV-positive migrants between heads of health authorities of the Republic of Armenia, government departments responsible for migration and civil society organizations. At the meeting, a study “Analysis of legal and institutional barriers to accessing HIV services among migrants in the Republic of Armenia” (developed by REG in 2021) was presented.
Also, in Q4 REG has launched a study is Kyrgyzstan.
On October 11, REG held an online meeting “Migrants’ access to HIV services in Central Asia and Caucasus” that gathered representatives of UNAIDS, Central Asian Association of PLHIV (Kazakhstan), TB People (Georgia), NGO “Real World, Real People” (Armenia), IFRC Central Asia, WHO Europe, Elton John AIDS Foundation, NGO Equality Movement (Georgia), AFEW (Kyrgyzstan), IFRC South Caucasus, Global Fund, WHO, and MSF. The goal of the meeting was to initiate a discussion and work out possible solutions to provide access to HIV services for those who urgently left the countries following the political situation.
Situation and Economic analysis of HIV-related health services in the field of migration in Tajikistan and Kyrgyzstan were held and are available at the links: Tajikistan, Kyrgyzstan.
In addition, the report “Ukrainian Refugees in European Countries: Barriers, Solutions and Best Practices. Access to HIV and Tuberculosis Care” was developed and is available at the link.
Reducing human rights-related barriers to HIV/TB services
Ensure a monitoring system for the implementation of the human right to health in prisons through national preventive mechanisms
Progress to date
An analysis of the current situation regarding the development and implementation of tools to ensure access to harm reduction services with a focus on OST was conducted by FreeZone in Georgia and in Kyrgyzstan.
An analysis of the current functioning of NPMs was carried out by FreeZone in Moldova and Kazakhstan.
For Moldova and Kazakhstan, Information on key indicators of the incidence of socially dangerous diseases in penitentiary institutions was collected, namely data on the total number of convicts held in penitentiary institutions; detailed information on the number of people living with HIV infection; the number of detected cases of tuberculosis; the number of convicts who were provided with treatment for viral hepatitis. The results can be found at the links: Moldova, Kazakhstan.
In Georgia, the Overdose prevention training module was developed for prison staff. The Module is aimed at training the prison employees involved in the release preparation programs. The training module contains both theoretical material, as well as practical exercises. The Module details overdose prevention mechanisms and interventions that are necessary in case to prevent death.
In Kyrgyzstan, meetings were held with the Ministry of Justice, the Ministry of Finance, etc. on the expanding health services, including HIV services in the penitentiary institutions; extended discussions were initiated at the Country Coordination Committee meetings and round tables on issues related to expanding government funding for penitentiary institutions.
In Moldova, temporary accreditation of the training program for the profession of “peer-to-peer consultant” in penal institutions of Moldova was obtained, and activities related to advocating for the inclusion of the position of “peer-to-peer consultant” in the list of positions in penitentiary institutions were provided.
In Kazakhstan, on November 30, 2023, a meeting was organized to discuss the current issues of compulsory social health insurance, the guaranteed volume of free medical care services for representatives of the PWUD community, drug provision, and diagnosis of diseases among prisoners. To intensify community participation in the mechanisms to ensure the implementation of state policy on combating TB and HIV/AIDS, the prisoners and ex-prisoners community member was included in the CLM Working Group during the Country Coordination Committee meeting on November 3rd, 2023.
In Ukraine, communication was ensured with the relevant government bodies (Center for Health Protection of the Ministry of Health of Ukraine, the Health Center of the State Criminal-Executive Service of Ukraine, and others) to advocate for the updated SOP standard. Discussions were initiated for the preliminary approval of the SOP “Diagnostics, treatment and support of PLHIV (and suspected HIV) in medical points of the Health Center of the State Criminal-Executive Service of Ukraine”. An updated SOP was presented and discussed within the Working Group on ensuring the continuity of services in the penitentiary institutions. An order of the Health Center of the State Criminal-Executive Service of Ukraine on the approval of SOP has been prepared, signed, and published.
Moldova
10 training sessions for selected peer-to-peer consultants were held on the basis of the Peer Counselor’s Manual to train consultants among prisoners. Each session lasted 6 hours and included theoretical and practical components of counselor training. As a result of this training, two prisoners from Penitentiary Institution #4 and, Penitentiary Institution #7 were prepared as peer counselors (1 Male, 1 Female) and started provision of services to inmates on a voluntary basis.
Kazakhstan
Cooperation between NGO “Kazakhstan Union of People Living with HIV” and Department of organization of medical care of the Ministry of Health of the Republic of Kazakhstan and Committee of Criminal Executive System of the Ministry of Internal Affairs of the Republic of Kazakhstan was established, that led to improved service provision for prisoners. Increase in the state order for work with people released from prison was advocated.
Kyrgyzstan
In order to increase state funding for health care services in the penitentiary system, negotiations were held with representatives of the State Service of Penitentiary Execution (SSPE). As a result of negotiations and communication, the SSPE increased the planned budget for health services in the penitentiary system in 2025 to 25 million KGS (compared to 13 million KGS in 2024).
Consultant is monitoring the activities related to the Program on HIV and Hemocontact Viral Hepatitis 2024-2027 in the Republic of Kyrgyzstan regarding people who are incarcerated. The work is in place to ensure inclusion of necessary services for prisoners – needle exchange programs, OAT, and conducting advocacy to ensure state funding for HIV, TB, hepatitis diagnostic services in the penitentiary system, and support for released prisoners.
Georgia
Due to the unstable political situation in the country regarding the adoption of the law on foreign agents, the project activities were not implemented.
Reducing human rights-related barriers to HIV/TB services
Developing and launching call for “Gender and HIV” small grants with special eligibility focus on Monitoring situation with human rights of Trans* people
Progress to date
Small Grants Programme with 4 selected projects run by grass-root NGOs in 2022 included:
- “National Trans Coalition” NGO with the project titled “HIV prevention in Armenia through gender mainstreaming” (Armenia);
- “The Public Association “Union for Equity and Health” NGO with the project titled “Gender Equality for sex workers” (Moldova);
- “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Check your health – Equality for Trans Roma and Roma women/girls sex workers” (Serbia);
- “NON-GOVERNMENTAL ORGANIZATION «NASHA DOPOMOGA»” with the project titled “RIGHT TO HEALTH!” (Ukraine).
- The project applicant is the organization “Albanian Association of People Living with HIV/AIDS (PLWHA)” with the project titled “New approach on transforming the spiral of exclusion and marginalization, towards the right of recognition before the law, gender-diverse and reduce the violence in health-care settings for trans persons in Albania”.
- The project applicant is the “National Trans Coalition” NGO with the project titled “Strategic pathway to remove structural barriers for trans* communities to PrEP and PEP services in Armenia”. The proposed project has been designed to establish favorable conditions for improving access of Trans* communities to PrEP and PEP services in Armenia.
- The project applicant is the organization “STAR STAR” Skopje with the project titled “Community Mobilization to Mitigate Funding Cuts and Gender Inequality in National HIV Programs for Sex Workers in North Macedonia”. The project is envisioned as a response to the latest developments in North Macedonia related to provision and delivery of HIV prevention services for key populations.
- The project applicant is the organization “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Supporting health wellbeing and safety of Trans and Intersex Roma, sex workers and HIV+”.
In 2024, grants “Gender and HIV” were implemented in Albania, Georgia, Moldova and Ukraine.
Moldova
GENDERDOC-M, alongside a parent support group, aimed to create a safe and inclusive environment for transgender and gender-nonconforming youth. Two formal partnerships with youth clinics expanded access to health services and 24/7 hotline support. Parent education sessions led to increased understanding, school negotiations for name recognition, and medical referrals. As a result, a strategic plan for 2025 includes engaging health and education ministries to address systemic barriers.
Georgia
The Queer Association Temida established an informal network of trans-friendly professionals across three cities, despite restrictive anti-LGBT laws. The network held two meetings to discuss the legal landscape and continued service delivery. A memorandum with Psychea Mental Health Center helped maintain access to gender-affirming care. A peer educator training course was launched, and two trained educators provided online consultations to 32 beneficiaries, offering support on HIV and gender-affirming care.
Ukraine
The “Help Is Near” project by HPLGBT produced a comprehensive report on barriers and solutions in trans health services, especially for intersectional groups like sex workers and those using psychoactive substances. Recommendations for service decentralization were developed and are planned to be presented to the CCM in early 2025. HPLGBT aims to integrate these recommendations into national funding requests to the Global Fund, ensuring sustained support for marginalized trans communities.
Reducing human rights-related barriers to HIV/TB services
REAct (https://react-aph.org/): Monitoring of human rights violations and discrimination against PLHIV and KPs. Responding to such cases through provision or referring to legal or social services to victims and through advocacy actions. In Georgia, Kyrgyzstan, Moldova and Tajikistan, REAct system was initiated within SoS_project#1.0 in 2020, and in 2022 is transferred to national funding, meanwhile APH continues to provide technical support to users. In Ukraine, REAct was implemented in 2019 and is functional within national GF grant. REAct system is supported by APH in Uzbekistan for 2022-2023, in 5 Balkan countries – for 2022-2024, and in Armenia and Azerbaijan – for 2023-2024. At the same time, regional networks ECOM and ENPUD started to use REAct program for documentation in several countries of the region and are supported for 2022-2024 within SoS_project#2.0 grant.
Progress to date
Cumulatively, during 2022 there were registered 6700+ cases in 13 countries (Albania, Armenia, Bosnia and Herzegovina, Georgia, North Macedonia, Moldova, Montenegro, Kazakhstan, Kyrgyzstan, Tajikistan, Serbia, Ukraine, Uzbekistan) involving 170+ CBOs, as well as regional networks such as ECOM (in Uzbekistan, Tajikistan, Armenia, Kazakhstan, Kyrgyzstan) and ENPUD (Georgia, Moldova, Ukraine, Kyrgyzstan, Kazakhstan, Tajikistan, Belarus).
The following publications are available:
- Statistic country reports by APH on human rights violations based on REAct data collected in 2021 in Kyrgyzstan, in Georgia, in Moldova, in Tajikistan.
- Protectors or Perpetrators: the impact of unlawful policing on human rights and HIV. Join analytical publication in partnership with Frontline AIDS, Alliance for Public Health (Ukraine, Kyrgyzstan, Tajikistan, Moldova, Georgia, Uzbekistan), AIDS Foundation (South Africa), Gender Dynamix.
- Report on the results of the analysis of the Hotline calls by APH: Domestic and other forms of violence against women living with HIV and women in key populations during the COVID-19 pandemic in Tajikistan.
- REAct Statistical Report for the 1st half of 2022 by APH. Violations of the rights of people living with HIV and representatives of vulnerable groups in Georgia.
Situational Report by APH: Drug policy in Georgia and Challenges. - Series of publications by APH based on REAct data within regional campaign “16 days against gender-based violence”.
REAct system is available and functional at the national level in the following counties. It enables documentation of cases of human rights violations: Albania (45 cases), Armenia (182), Azerbaijan (174), B&H (70), Montenegro (60), Kazakhstan (363), North Macedonia (42), Tajikistan (1155), Serbia (24), Uzbekistan (835). More detailed data of 2023 is available in REAct Regional Digest and REAct website.
Cumulatively in 10 countries, 49,9% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions. During 2023 in 10 countries, there were provided 2162 consultations about human rights, 1022 consultations with professional lawyers. In 168 cases REActors helped to draft simple legal documents, such as complains or statement to police, in 236 cases represented client’s interests in medical facilities, assisted in getting medical services and support, in 336 cases – accompanied the client in the initial appeal to the police. There were at least 20 strategic court cases, and at least 162 cases were used for shadow reports to UN Treaty Bodies.
Cumulatively in 8 countries (Armenia, Azerbaijan, Kazakhstan, Albania, Bosnia and Herzegovina, Montenegro, North Macedonia, Serbia) 56,2% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions (https://drive.google.com/drive/folders/1wtJaecXERatg8cmrAE1mzaoshtdLQY_w). Numerous success stories of cases resolutions are available at REAct website.
Reducing human rights-related barriers to HIV/TB services
Through the use of the Stigma Index 2.0 , measure HIV-related stigma and discrimination experienced by PLHIV in countries of the EECA region by delivering training for interviewers and researchers to familiarize them with the methodology and survey instrument, and in conducting interviews and entering data into the RedСap database system, as well as to develop and disseminate the survey report
Progress to date
Protocols for Stigma Index Research are developed in Armenia and Georgia. The filed phase will start in 2023.
In all three countries the Protocols are approved. Moreover, the Stigma Index Researches are fully completed in Armenia and Georgia.
The reports has been approved by the Global Partnership and presented to all stakeholders. In Kazakhstan, the protocol is approved and the field stage of the research is successfully completed with a final sample of over 1430 surveyed respondents. Currently, within the project, the Research Team has commenced the analysis of the collected data and is preparing the initial draft of the Research Report.
Stigma Index Researches are fully completed in Armenia, Georgia and in Kazakhstan.
Reducing human rights-related barriers to HIV/TB services
Legal environment assessment on MSM and trans people in 4 countries
Progress to date
The goal of this comparative analysis of legislative barriers preventing LGBT people from fully realizing their rights in 12 CEECA countries is to show progress or, on the contrary, regression in terms of the development of legislation and law enforcement practice, enabling or preventing LGBT people from realizing their human rights.
An updated analysis of activities from the end of 2021 to the beginning of 2023 shows the main changes and provides a list of key advocacy recommendations on where the attention of national teams and international organizations is needed to improve the human rights situation in 12 countries of the region.
In 2024, ECOM conducted a legal Environment Assessment in 4 countries of EECA. This comparative country analysis aimed to identify legal barriers and issues in areas where the necessary legislation already exists, but does not fully ensure the implementation of rights and freedoms for gay men, other MSM and trans people.
All reports consist of these chapters:
- International obligations of the country and their implementation;
- Table: Compliance of Domestic legislation with international standards;
- Analysis of legal regulations related to SOGI and HIV and their application;
- Recommendations.
All reports were published on ECOM’s website.
- Legal Environment Assessment in Armenia;
- Legal Environment Assessment in Georgia;
- Legal Environment Assessment in Kazakhstan;
- Legal Environment Assessment in Moldova.
Solutions
Implementer:
- Select an implementer
- REGMH
- 100% Life
Period:
Reducing human rights-related barriers to HIV/TB services
Evidence-based advocacy interventions with the aim of removing legal barriers to, and improve the rights of, migrant access to HIV and TB care in sending and receiving countries of in EECA region: national and regional (EECA) meeting and roundtables with participation of civil society, migrant organizations, healthcare officials and parliamentarians
Progress to date
On December 9, the REGMH with the assistance of the NCC Secretariat held in Dushanbe a Roundtable “Protection of health of migrants from Tajikistan”. The event was timed to presentation of a new study conducted by the REGMH: “Situation and Economic analysis of HIV-related health services in the field of migration in Tajikistan”.
On December 13, 2022, the Regional Expert Group on Migration and Health together with Central Asian Association of People Living with HIV held a Roundtable in Almaty “Health of HIV positive migrants in Kazakhstan”. The aim of the Round Table was to promote effective and timely treatment of international migrants living with HIV. During the meeting, the Situational and Economic analysis on the provision of HIV-related health services for international migrants in Kazakhstan was presented and discussed.
On December 19, REG together with local NGO “Real World. Real People” held a Roundtable in Armenia, Yerevan aimed to buster a discussion and exchange of experience on the provision of services for international HIV-positive migrants between heads of health authorities of the Republic of Armenia, government departments responsible for migration and civil society organizations. At the meeting, a study “Analysis of legal and institutional barriers to accessing HIV services among migrants in the Republic of Armenia” (developed by REG in 2021) was presented.
On October 11, REG held an online meeting “Migrants’ access to HIV services in Central Asia and Caucasus” that gathered representatives of UNAIDS, Central Asian Association of PLHIV (Kazakhstan), TB People (Georgia), NGO “Real World, Real People” (Armenia), IFRC Central Asia, WHO Europe, Elton John AIDS Foundation, NGO Equality Movement (Georgia), AFEW (Kyrgyzstan), IFRC South Caucasus, Global Fund, WHO, and MSF. The goal of the meeting was to initiate a discussion and work out possible solutions to provide access to HIV services for those who urgently left the countries following the political situation.
REGMH held a number of online and offline seminars and rioundtables to present and discuss the results of their studies in Azerbaijan, Tajikistan and Kyrgyzstan. A number of discussions was also held to scale up remote registration of migrants with HIV to get access to HIV services. For now, remote registration is functional in Tajikistan, and the preparatory work is implemented in Armenia, Azerbaijan and Kazakhstan.
In particular, on June, 6 in Dushanbe REGMH held a Round Table on protecting health of Tajik migrants. The purpose of the meeting that gathered together the staff of the AIDS Center, the patients’ community, specialists from NGOs in the region and host countries was to discuss the maintaining of the algorithm for remote registration of citizens of Tajikistan with HIV living abroad, and to formulate further steps to improve access of migrants to HIV services. Deputy Director of the Republican AIDS Center made a proposal to develop and sign a Memorandum for Mutual Recognition of Medical Tests at the level of Republican AIDS Centers in the Central Asian region.
On December 4, REGMH held a Round Table in Yerevan, Armenia. The key focus of the meeting was the provision of HIV services for Armenian citizens living abroad.
On December, 25 REGMH participated in online meeting to discuss current issues of implementation/piloting of “Remote registration of migrants with HIV in Uzbekistan”, organized by a consortium of organizations in Uzbekistan to promote the protocol, including IOM, CCM, AFEW, and REGMH. During the meeting, representative of CCM informed that the protocol was accepted and signed by the Center for State Sanitary and Epidemiological Surveillance of the Republic of Uzbekistan. What is very important, the final version includes recommendations suggested by REGMH making it easier to register a migrant than it was in an initial version of the document.
On June 15, REGMH held its quarterly Working group meeting on remote registration of PLWH living abroad. As a result of the Round Table held earlier in Uzbekistan, the group managed to attract specialists from the Republican AIDS Center and the CCM of Uzbekistan. During the meeting, the Group discussed the issue of accepting medical documentation (certificates, test results) issued by country of migrant’s destination, which are necessary for remote registration; also, the standard for the minimum set of documents for remote registration of citizens in migration (based on WHO’s recommendations) were presented to participants on order to foster the development of remote registration in the EECA countries.
REGMH has launched a series of Webinars “Health of Refugee and Migrants from the EECA countries”, designed both for those who flee and seek help in the host country and for those who organize help in receiving countries. Also, webinars could be of interest to those who research and solve systemic problems.
The first webinar took place on August 09 and was devoted to revision of problems that Ukrainian refugees who use drugs face: “People Who Use Drugs from Ukraine: Challenges and Solutions”.
Migration and Health Summer School was hekd on 21-22 Aug 2023 in Yerevan, Armenia. where participants discussed best practices and solutions for providing medical care to migrants and refugees from the EECA region. Country representatives of REGMH from the EECA region, representatives of health authorities from the EECA countries, experts from regional and international organizations, WHO, UNAIDS, UNDP, and MSF attended the event, totally, 40 participants from 12 countries.
On November 24, 2023 REGMH held a Round table in Bishkek, Kyrgyzstan to discuss current issues of migrant health in the context of HIV. The event brought together experts from relevant ministries and departments, non-governmental and civil sectors, as well as representatives of international organizations. A key part of the round table was the presentation of study’s results conducted by REG in 2023 “Situational and economic analysis in the field of migration and the provision of medical services related to HIV in the Kyrgyz Republic” to identify legal and institutional barriers related to HIV faced by citizens of Kyrgyzstan returning from migration.
Regional Meeting on Migrant Health and HIV Response took place on September 19-20, 2024, in Samarkand. Experts from EECA countries gathered to discuss adapting health services for migrants amidst mass population movements. Organized under the Global Fund framework, the event highlighted key challenges migrants face, including access to HIV/TB treatment, language barriers, and mental health support. The #HelpNOW HUB, which assisted 37,500 Ukrainians in 50 countries, was presented as a best practice model. Participants emphasized the need for migrant-sensitive policies, digital health solutions, and sustainable healthcare partnerships to ensure uninterrupted medical services across borders.
Reducing human rights-related barriers to HIV/TB services
Decriminalization of HIV and unintended HIV transmission
Progress to date
100% Life conducted an analysis of the legal environment in Georgia, Kyrgyz Republic and the Republic of Uzbekistan in order to identify regulatory legal acts that need to be amended to reduce the criminalization of people living with HIV.
During 2023, draft legislative amendments to the regulations in the context of the legal and legislative acts that contribute to the criminalization of HIV in Georgia, Kyrgyzstan, Kazakhstan, and Uzbekistan were developed. These amendments concern both general and specialized norms.
- Draft Law “On amendments and additions to the Criminal Code of the Republic of Kazakhstan on liability for infection with the human immunodeficiency virus (HIV)”
- Legal justification for excluding HIV/AIDS from the Order of the Deputy Prime Minister – Minister of Labor and Social Protection of the Population of the Republic of Kazakhstan dated June 22, 2023 No. 230 “On Approval of the Rules for the Activities of Organizations Providing Special Social Services”
- Legal justification for amending the requirements to the health of citizens (military personnel) for military service according to the columns in the Order of the Minister of Defense of the Republic of Kazakhstan dated December 22, 2020 No. 722 “On approval of the requirements to the health of persons for service in the Armed Forces, other troops and military formations of the Republic of Kazakhstan”.
Advocacy efforts focused on decriminalizing HIV transmission by amending Article 118 of the Criminal Code. A unified strategy was developed through consultations with the PLHIV community and experts, resulting in an updated legislative dossier submitted to the Ministry of Justice and Internal Affairs. Government responses indicated a willingness to consider the amendments, and negotiations with legislative authorities showed support for further dialogue on decriminalization.
Solutions
Implementer:
- Select an implementer
- SEH
Period:
HSS: Health sector governance and planning
Increasing domestic financing of countries for services to key groups
Progress to date
Targeted activities were held in all project countries to discuss with national and international, governmental and non-governmental stakeholders the changes needed to enable sustainable and uninterrupted funding of HIV-related activities from national resources. Through targeted advocacy, technical support, and an integrated approach to HIV funding, in 2022 the project team managed to allocate approximately 1,7 million USD at the national level to programs for key populations, using social contracting mechanisms: Moldova – 154,126.84 USD; Kazakhstan – 118,529.33 USD; Kyrgyzstan – 61,000 USD; Tajikistan – 19,200.00 USD; Georgia – 357,000 USD; Ukraine – 931,453.96 USD.
Thanks to budget advocacy within the SoS project 2.0, the amount of money allocated from national budgets for HIV services through social contracting mechanisms in EECA project countries amounted to $3 269 959 in 2024. During SoS project 2.0 – $ 6 273 049 were allocated for social contracting in EECA region. The cumulative domestic budget expenditures for servicing key populations in 5 countries of SEE amounted to $1 061 383 in 2024. During SoS project 2.0 – $ 3 236 260 were allocated for social contracting in SEE region.
Solutions
Implementer:
- Select an implementer
- SEH
- SEH
Period:
HSS: Health sector governance and planning
Legal framework for financing HIV services from domestic funds – development and approval
Progress to date
Targeted activities were held in all project countries to discuss with national and international, governmental and non-governmental stakeholders the changes needed to enable sustainable and uninterrupted funding of HIV-related activities from national resources. Through targeted advocacy, technical support, and an integrated approach to HIV funding, in 2022 the project team managed to allocate approximately 1,7 million USD at the national level to programs for key populations, using social contracting mechanisms: Moldova – 154,126.84 USD; Kazakhstan – 118,529.33 USD; Kyrgyzstan – 61,000 USD; Tajikistan – 19,200.00 USD; Georgia – 357,000 USD; Ukraine – 931,453.96 USD.
Over three years of implementation of SoS_project 2.0 has contributed to significant changes in the financing of HIV services in 14 countries in SEE and EECA regions. The project supported the development of service delivery standards, pricing methodologies, and quality control procedures, which are critical for sustainable financing from the state budget.
The practice of social contracting is applied without interruption in 14 countries.
HSS: Health sector governance and planning
Regulation of service packages for key groups
Progress to date
In the reporting period, the Emergency package of services for key and vulnerable groups of the population in the field of HIV, and TB in the context of military conflicts was finalized, including tariffication. On its basis, in 2023, the process of advocacy and promotion of implementation at the level of countries in the EECA region will be launched.
Strategic Brief on Business Continuity (link) and Strategic Brief on Social contracting (link) were developed. In addition, Analysis of Quality of Services Provided in Azerbaijan was held and is available at the link.
Over three years of implementation of SoS_project 2.0 has contributed to significant changes in the financing of HIV services in 14 countries in SEE and EECA regions. The project supported the development of service delivery standards, pricing methodologies, and quality control procedures, which are critical for sustainable financing from the state budget.
The practice of social contracting is applied without interruption in 14 countries.
Objective Description:
OBjective task:
- Select a objective task
- Removing structural barriers to increase of HIV testing in EECA
- Removing structural barriers to ART in EECA
- Launching critical enabling interventions to improve HIV care cascade
- Implementation of COVID-19 response mechanism
- Select a objective task
- Monitoring situation with human rights of KPs, responding to viloations
- Revision of legisation and other regulations on KPs that pose barriers to accessing HIV services:
- Select a objective task
- Developing necessary legal framework and technical solutuions for cost-effective care package for KPs in EECA
- Advocacy for domestic resource allocation for KP services in EECA
Solutions
Implementer:
- Select an implementer
- APH
- APH
Period:
Supporting key group populations in a COVID setting
Provision of HIV prevention services with precautions against COVID-19
Progress to date
Work on shelters has expanded – in addition to 5 shelters for working with women who use drugs in conditions of violence (Ukraine, Serbia, North Macedonia, Kazakhstan), support for flexible shelters for representatives of the LGBT community in Kazakhstan, Uzbekistan, Kyrgyzstan and Tajikistan has been added. The program was distinguished by a special programmatic approach to working with clients – about 3,200 clients received material assistance in the form of food packages (Georgia, Kazakhstan). PPE support in Kaz for migrants and KGP (124,000 disposable masks, 1,000 antiseptics); CLM to provide quality services for clients of OST programs in 7 countries.
Supporting key group populations in a COVID setting
National Contingency Planning
Progress to date
Supporting key group populations in a COVID setting “General contingency planning guide developed in the frames of the C19RM is available here.
Guide by APH for Contingency Planning for Key Population HIV Services during COVID-19 and Other Emergencies for North Macedonia, Serbia, Bosnia and Herzegovina, Montenegro, Moldova, Georgia, Kazakhstan, Uzbekistan, Tajikistan and Kyrgyzstan in English is available at the link https://aph.org.ua/en/eeca/ in the folders with the names of each country.
Solutions
Implementer:
- Select an implementer
- ECOM
- EHRA
- ECOM
- EHRA
Period:
Prevention (Pre-exposure prophylaxis – PrEP)
Inclusion of PrEP into nationally approved service packages for MSM and/or other key populations
Progress to date
ECOM in partnership with WHO regional office for Europe analyzed five national PrEP protocols (Armenia, Kazakhstan, Kyrgyzstan, Georgia and Ukraine) and provided Report with recommendations on the steps needed to include PrEP into nationally approved standard package of servises. The report is under design and will be published by the end of February.
Much work was done in 2023 to present recommendations based on analyzes of PrEP Protocols in 5 countries. Online and offline meetings with stakeholders, monitoring visits (Kazakhstan, Kyrgyzstan) were held, the results were presented at various meetings, conferences, and technical consultations. Based on the analysis of PrEP Protocols and updated WHO recommendations, policy briefs were developed and sent to countries, the purpose of which was to show and not miss the importance of new interventions that can improve PrEP services in countries.
PrEP is available and integrated into the healthcare system as part of the standard service package funded by the government in 5 countries: Armenia, Georgia, Kazakhstan, Kyrgyzstan, and Ukraine.
1. Armenia
PrEP is available as part of the national HIV prevention program and partly funded by the governmentand. PrEP has been officially included in the national HIV prevention guidelines approved by the Ministry of Health of Armenia.
2. Georgia
PrEP is available as part of the national HIV prevention program and partly funded by the governmentand.
3. Kazakhstan
PrEP is available as part of the national HIV prevention program and fully funded by the governmentand.
4. Kyrgyzstan
PrEP is included in the healthcare system and fully funded by the governmentandand.
5. Ukraine
PrEP is available and included in national clinical protocols.
Continued state support is confirmed to ensure the availability of PrEP for key populations.
Measures have been taken to strengthen the position of PrEP within healthcare.
Integrated service delivery and HIV service quality improvement
Community groups conduct community-led assessment of national quality standards in accordance to IDUIT and organize dialogue with service providers and MOH/local authorities
Progress to date
Moldova
PULS Communitar conducted CLM study to evaluate OAT programs in the Republic of Moldova, identify the level of the availability and acceptability of programs, outline achievements, and identify and evaluate difficulties faced by the program participants. Report with findings and conclusions was prepared and presented on the meeting with service providers and decision makers. Next steps and recommendations for CCM were elaborated.
GENDERDOC-M conducted a CLM study to identify the barriers in access to PrEP among MSM/TG. The results were presented to the Key Affected Populations (KAP) committee. After the presentation, it was strongly recommended to showcase these results at the National Dialogue event. The aim is to leverage the platform to advocate for a comprehensive revision of the National Clinical Protocol on Pre-Exposure Prophylaxis (PrEP) in the first quarter of 2024. This strategic move aligns with the commitment to fostering meaningful changes in the national approach to PrEP in response to the insights gained through the CLM survey.
Kazakhstan
Forum of PWUD conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian is prepared. Meeting with CCM is planned to be organized in January 2024.
Georgia
Rubikoni conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Furthermore, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Kyrgyzstan
Equal to equal conducted a study on the client satisfaction with OAT. Report in Russian was prepared. Moreover, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Tajikistan
Intighob (Initiative group based on SPIN PLUS) conducted a study of the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian language was prepared. Moreover, the meetings with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Armenia
“New Generation” conducted Community Based Assessment of HIV Services Provided to MSM Living With HIV In Armenia through a focus group with broad number of experts and MSM community members (including representatives from CCM). The results were included to “Funding Priorities of Civil Society and Communities Most Affected by HIV, Tuberculosis and Malaria” by Global Fund under the number 9 (The funding priorities and minutes from CRG group meeting attached). These priorities are in active use to prepare an application for the Global Fund grant in Armenia. In addition, results are in active use in the National dialogue now.
Integrated service delivery and HIV service quality improvement
Integration of community-led monitoring (CLM) into the health care systems of countries in the EECA region to assure the quality of services for key populations (KPs)
Progress to date
Practical handbook on community-led monitoring tools was developed in English and Russian languages. The checklist with EHRA and other partners for CLM was discussed and agreed upon.
On 2-8 December 2022, specialists from the Eurasian Harm Reduction Association (EHRA) conducted regional online training “Community-Led Monitoring Methods” for the representatives of community organizations in the CEECA region. The training was attended by 38 representatives of organizations from different vulnerable communities in the CEECA region. The aim of the training consisting of three online sessions was to train leaders of self-organizations from different key communities in the CEECA region to understand, which role CLM can play in their advocacy work, how to formulate the proper problem and research question for CLM, and which of the different methodologies can most effectively provide the data needed for advocacy. Video recordings of the training, as well as presentations can be found at the link.
Following the CLM Handbook, developed in 2022, integration of CLM into the healthcare system can be ensured through productive and sustainable participation of community representatives in the decision-making process, mainly within CCM, and through national consultations with CCM and other health sector coordination bodies on key needs for CLM and its findings and recommendations on improving of health services.
CLM has been conducted in all planned countries. Results were presented in 5 countries and protocols were received (Moldova, Georgia, Tajikistan, Kazakhstan and Kyrgyzstan). In Armenia, the results of the CLM are in active use in the National dialogue now. The focus group with broad number of experts and MSM community members (including representatives from CCM) was conducted, and based on the results PrEP was identified as a key priority and included to “Funding Priorities of Civil Society and Communities Most Affected by HIV, Tuberculosis and Malaria” by Global Fund under the number 9 (The funding priorities and minutes from CRG group meeting attached). These priorities are in active use to prepare an application for the Global Fund grant in Armenia.
Following CLM Handbook, developed in 2022, integration of CLM into healthcare system can be ensured through productive and sustainable participation of community representatives in decision-making process, mainly within CCM, and through national consultations with CCM and other health sector coordination bodies on key needs for CLM and its findings and recommendations on improving of health services. Within EHRA activities, CLM results in all countries in Georgia, Moldova, Kyrgyzstan, Kazakhstan and Tajikistan were presented and reviewed in CCMs and/or in other healthcare managing bodies. Protocol/minutes of the CCM meeting or other health authority body, based on the conducted national consultations with CCM and other health sector coordination bodies on key needs for CLM and discussed how results of CLM will help to improve services and integration of them into the healthcare system. What is more, additionally to presentation of CLM results, this year consultants in Georgia, Moldova, Kyrgyzstan and Kazakhstan prepared requests to healthcare managing bodies by asking provide information on how CLM results were being implemented. EHRA prepared a final publication – report, which draws on the three-year SoS 2.0. project of the EHRA to support community-led monitoring (CLM) initiatives for opioid agonist therapy (OAT) and the findings and results of community groups in Georgia, Moldova, Kazakhstan, Kyrgyzstan, and Tajikistan, offering insights into best practices and lessons learnt.
Moldova
PULS Communitar conducted CLM study to evaluate OAT programs in the Republic of Moldova, identify the level of the availability and acceptability of programs, outline achievements, and identify and evaluate difficulties faced by the program participants. Report with findings and conclusions was prepared and presented on the meeting with service providers and decision makers.
GENDERDOC-M conducted a CLM study to identify the barriers in access to PrEP among MSM/TG. The results were presented to the Key Affected Populations (KAP) committee. After the presentation, it was strongly recommended to showcase these results at the National Dialogue event. Following dialogues and agreements with the Protocol revision experts, the recommendations were formally presented on August 23, 2024, during the Round Table on the National Clinical Protocol on PrEP. The updated draft protocol, which includes the proposed recommendations, is currently under review by government authorities. In addition, the approval of new service standards, which will also include CLM, is expected in June 2025.
Kazakhstan
Forum of PWUD conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian is prepared.
Georgia
Rubikoni conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Furthermore, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps. In addition, based on ECOM recommendations, the working group developed CLM mechanisms and a special chapter was included in the Standards for Management of Public Health Interventions (PrEP Protocol). The working group included representatives from the National Centre for Disease Control and Public Health (NCDC), the Research Centre for Infectious Diseases, AIDS and Clinical Immunology, NGOs and MSM representatives, including members of the András team. Letter received from NCDC in support of the modified protocol.
Kyrgyzstan
Equal to equal conducted a study on the client satisfaction with OAT. Report in Russian was prepared. Moreover, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Tajikistan
Intighob (Initiative group based on SPIN PLUS) conducted a study of the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian language was prepared. Moreover, the meetings with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Armenia
“New Generation” conducted Community Based Assessment of HIV Services Provided to MSM Living With HIV In Armenia through a focus group with broad number of experts and MSM community members (including representatives from CCM). The results were included to “Funding Priorities of Civil Society and Communities Most Affected by HIV, Tuberculosis and Malaria” by Global Fund under the number 9 (The funding priorities and minutes from CRG group meeting attached). The National Guidelines on PrEP for HIV infection have been officially approved under Order No. 6241-L by the Minister of Health, dated 13 November 2024. These guidelines are now available on the Ministry of Health’s official website.
Solutions
Implementer:
- Select an implementer
- SEH
- 100% Life
- 100% Life
Period:
HSS: Health products management systems
Decentralization of HIV treatment through integration to primary healthcare
Progress to date
Synthesis Report on assessment of health systems to decentralize HIV treatment services in 5 countries of the EECA is developed and can be found at the link.
The road maps were finalized in Armenia, Georgia, Moldova, Kazakhstan, and Kyrgyzstan.
The HIV strategy for 2023–2025 was approved in September 2023 and HIV/AIDS management document (program code: 27 03 02 07). The document is available at the link.
Georgia has successfully approved several regulatory documents related to the decentralization of HIV treatment services, ensuring integration of these services into primary healthcare systems. These efforts align with WHO recommendations and have been implemented through various legal and normative amendments. The HIV strategy for 2023-2025 was approved by the Order of the Minister of Labor, Health, and Social Protection of IDPs from the Occupied Territories of Georgia dated September 6, 2023, No. 65/N (link ), and additional amendments for decentralising HIV treatment services, including the introduction of new regional centers for testing and outpatient treatment, were implemented. Additionally, a significant new initiative to allow civil society organizations to provide HIV treatment has been launched, which will be instrumental in further decentralizing services and increasing accessibility. This, with close collaboration with local and international consultants, enabled in 2024 to focus on implementing normative acts through various measures, such as training sessions, advocacy campaigns, and strengthening cooperation among local CSOs and stakeholders into practice.
Local CSOs/community-based organizations, already involved in HIV testing, will play a key role in the decentralization of HIV treatment, further strengthening access to care at the community level.
Georgia has completed the process of developing and approving regulations for decentralizing HIV testing and treatment. The HIV strategy for 2023–2025 was approved, and amendments to the national HIV/AIDS program have been made, including the creation of new testing and outpatient treatment points in new regions (Telavi, Akhaltsikhe, Poti, Khashuri). Measures for centralized supply of HIV tests have also been introduced. These changes came into force in January 2024.
Amendments approved by the Government of Georgia, on December 30, 2024. Annex 7 of the program regulates HIV services and indicates that decentralized testing with 2 different test kits will be implemented as a pilot together with sub contractor organizations and NGOs working with high risk groups in 8 cities of country – Tbilisi, Telavi, Khashuri, Akhsltsike, Kutaisi, Zugdidi, Poti and Batumi.
In 2024, new regions for HIV diagnosis and outpatient treatment were added in Georgia. These new locations were trained by medical staff from the AIDS Center, NCDC and the Georgian Harm Reduction Network. The new regions for the decentralization of HIV/AIDS diagnosis and outpatient treatment are: Telavi, Akhaltsikhe, Poti and Khashuri.
HSS: Health products management systems
Technical support in optimization of medicine procurement cycles
Progress to date
Priorities for improvements of PSM systems in Armenia, Georgia and Kazakhstan were discussed and agreed for further activities in 2023-2024. In Kazakhstan, MOH provided a list of its activities aimed to preserve state registration procedure and expressed the need to develop relevant legislation. In Georgia, access to the Global Fund procurement mechanism is of the highest priority. In Armenia, long-term agreements for ARVs and streamlining procurement practices from bottom to the top level in terms of centralization/decentralization and improvement of medicines registration procedure are of importance.
Georgia developed legally binding draft Drug Agency letter with supporting technical analysis allowing to significantly simplify receiving waivers for medicines import for Georgia.
Kazakhstan developed draft MoH order to mitigate some risks for medicines tendering procedures for Kazakhstan.
Armenia developed draft Law and draft Governmental decree enabling launching a medicines reimbursement reform for Armenia.
In Kazakhstan, comprehensive justification documents were prepared to demonstrate the benefits and necessity of transferring procurement responsibilities to the Sole Distributor. The legal rationale was presented to a wide range of stakeholders at the working meeting “On expanding access to essential medicines for people living with HIV by amending the legal acts regulating the procurement of medicines” held in Q4 2024.
In Kyrgyzstan, an advocacy strategy was developed based on an analysis of the procurement of ARV tests, HIV diagnostic and treatment monitoring products procured with public funds and humanitarian supplies funded by the Global Fund (GF) and UNDP. Official letters were also sent to the State Enterprise “Kyrgyzpharmacy” and the GF, UNDP outlining potential measures to optimize procurement processes and reduce the cost of ARVs and diagnostic tests. In addition, a number of informal discussions were held with the Kyrgyzpharmacy SE, the Republican Center for HIV/AIDS Control and GF/UNDP on further optimization of procurement strategies, expansion of the range of ARVs and diagnostic tests procured with public funds, and the possibility of reducing the cost of certain ARVs and diagnostic tools. A meeting was also held with experts engaged by the GF and the GF/UNDP to prepare for the transfer of GF grant management to national agencies.
In Moldova, to identify potential obstacles and opportunities for the introduction of a procurement mechanism through international procurement agencies, a comprehensive review of the current legislation on procurement of medical devices and medicines was conducted. An assessment of the current clinical protocol was conducted to develop recommendations for the inclusion of ART drug resistance monitoring. These recommendations were presented to the CCM HIV Working Group, and efforts are ongoing to advocate for their inclusion in the 2025 revision of the National HIV Protocol.
ECAT meeting was held on December 4–6 in Tbilisi, Georgia.
Reports on procurement monitoring of CD4 and VL tests as well as the rapid tests for HIV implemented in 2023 are published.
Armenia
The draft legal framework for the national supply chain system in Armenia (available at the link https://www.e-draft.am/en/projects/7783), according to Samvel Kharazyan, Head of State Health Agency of the Ministry of Health Armenia, was successfully approved by the relevant authorities within the ordinary national bureaucracy regulations. This includes the adoption of necessary regulations needed to launch a reform starting from April 1, 2025.
Georgia
The legal framework for the national supply chain system in Georgia has been reviewed and the document with relevant suggestions has been submitted to the MOH of Georgia for approval.
Kazakhstan
Kazakhstan has made significant progress in improving the legal framework for the national supply chain system, having drafted and submitted suggestions to the MOH for approval. Additionally, changes to our relevant Order No. 110 have been published for public discussion in Kazakhstan.
HSS: Health products management systems
Community-led advocacy of elimination of identified critical discrepancies with the WHO prevention, testing and treatment guidelines
Progress to date
Current testing and treatment protocols analysis is finished in 7 countries (Armenia, Moldova, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan, and Ukraine) and recommendations to align the national protocols with the WHO guidelines are provided. The report is available at the link.
WHO has held the analysis of HIV testing guidelines in 6 countries of EECA – Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Uzbekistan. The report is available at the link.
National HIV testing and ART-optimized strategies based on and aligned with the WHO recommendations were developed for 4 EECA countries – Armenia, Kazakhstan, Kyrgyzstan, Moldova.
In Armenia, Kazakhstan, Kyrgyzstan, and Moldova, all key actions related to the development and implementation of HIV testing and ART optimization strategies, in line with WHO recommendations, have been completed. According to the results of the assessment in 2022, there was a need to replace Georgia with another country to implement activities for 2023 and 2024 since the Georgian testing and treatment protocol is generally in line with the 2021 WHO recommendations for the use of ARV drugs for the prevention and treatment of HIV, and as well as other aspects of the clinical management of HIV. During project meetings different optios were discussed, and the desicion was taken to continue the activities in Armenia instead of Georgia.
Kazakhstan
- Approved – Order of the Ministry of Health of the Republic of Kazakhstan No. 774 dated 08.11.2024. This Оrder amended the Order of the Ministry of Health of the Republic of Kazakhstan dated 16.03.2023 No. 155 in the context of changes and updates in terms of implementation of the items of the Roadmap “On Implementation of Measures for HIV Prevention in the Republic of Kazakhstan for 2025-2026”, in particular:
- Amendments to paragraph 23 of the Order of the Minister of Health of the Republic of Kazakhstan dated November 30, 2020, No. KR DSM-224/2020 “On Approval of the Standard for the Organization of Medical and Social Assistance in the Field of Mental Health to the Population of the Republic of Kazakhstan” (registered in the Register of State Registration of Normative Legal Acts No. 21712) regarding the provision of PTAO services at the hospital level are scheduled for the 3rd quarter of 2026.
- Amendments and additions to the Clinical Protocols: “HIV infection in adults”, ‘HIV infection in children’, ‘HIV/TB co-infection’, taking into account the update of the best international practices, is scheduled for the 4th quarter of 2025.
- Approved – Order of the Minister of Health of the Republic of Kazakhstan dated June 24, 2024 № 29 on amendments to the Order of the Minister of Health of the Republic of Kazakhstan dated December 3, 2020, No. KR DSM-231/2020 “On Approval of the Rules for Investigation of Cases of HIV Infection among the Population”.
- Approved – Order of the Ministry of Health of the Republic of Kazakhstan dated July 11, 2024 No. 55 “On Amendments and Additions to the Order of the Ministry of Health of the Republic of Kazakhstan dated October 19, 2020 No. KR DSM-137/2020 ‘On Approval of the Rules for Conducting Measures for the Prevention of HIV Infection’.
- Drafted – Amendments to the Code of the Republic of Kazakhstan dated July 7, 2020 “On the Health of the People and the Health Care System” on HIV infection”. It is expected that at the beginning of 2025, it will be approved.
Moldova
- Approved – National Clinical Protocol “Treatment of Viral Hepatitis C in Adults” approved by the Order of the Ministry of Health of the Republic of Moldova dated 11.10.2024.
- Drafted – National Clinical Protocol “Pre-exposure prophylaxis of HLV infection (PrEP)”.
Solutions
Implementer:
- Select an implementer
- PAS
- WHO
- 100% Life
- SEH
- PAS
- WHO
- SEH
Period:
Integrated service delivery and HIV service quality improvement
Country level support to adoption and implementation of HTS guidelines: (a) National working groups technical assistance support; (b) Revision of functional responsibilities regarding HTS of HIV specialized settings, relevant testing points and lab(s), and other level institutions including primary care entities; (c) Training of new entities/people engaged in testing procedures; (d) Training for lab professionals to engage more in monitoring and improving the quality of testing procedures; (e) Conduct comparative cost analysis of RDT-based vs current diagnostic algorithm in two countries – to support investment case at policy level; (f) TA for HIV testing algorithm verification activities in 2 selected countries
Progress to date
Costing Methodology for HIV infection testing costs based on current HIV testing strategies and RDT-based testing costs and data collection tool are developed, data on Kazakhstan and Georgia are collected, the reports are under finalization.
PAS in collaboration with WHO Euro and WHO CO, on September 19-21, 2023, in Ankara, Turkey, organized the study tour and training: Laboratory aspects of transition to new HIV testing algorithms. The main scope of the events was to discuss the ways to improve HIV testing services in line with WHO recommendations and to enable countries to exchange their best experiences of the revision of national HIV testing strategies. The event was attended by: representatives of the National HIV Programs responsible for HIV testing strategies and laboratory specialists responsible for laboratory diagnostics of HIV, monitoring and testing quality at the national level from Turkiye, Ukraine, Moldova, Kazakhstan, Kyrgyzstan, Uzbekistan, Tajikistan and Azerbaijan; WHO EURO office, PAS Center, APH.
A two days training for laboratory specialists in HIV testing in Kazakhstan on November 30 – December 01, 2023. During the training, the participants discussed what will be the role of the reference laboratory, the role of laboratories in the regions, the changed responsibilities of laboratory specialists, the ensuring of the quality of the testing, the monitoring and evaluation of the testing etc.
A two days training for laboratory specialists in HIV testing in Georgia on December 07-08, 2023. The training was dedicated to the discussion and planning of the verification study of the HIV testing algorithm using rapid tests.
HIV testing policies are fully aligned with HIV recommendations in Georgia: 3-test based testing strategy without Western blot (WB) and decentralization of confirmatory testing to 8 regional centers took place in 2023-2024, and reflected in the State Health Programme of Georgia (approved by the Resolution No. 529 of the Government of Georgia on 29 December 2023). The verification study is completed in Georgia, the first draft report has been produced.
As part of the project, support was provided to national partners in developing relevant activities in the Roadmap to prevent HIV infection in the Republic of Kazakhstan for 2023-2026 approved by Order of the Ministry of Health No. 155 dated March 16, 2023. Chapter 3 “Laboratory diagnostics” includes a validation study, change in the HIV testing algorithm in accordance with WHO recommendations, a phased decentralization of HIV diagnosis confirmation, and an expansion of rapid testing at the primary health care and community levels. All these activities began to be implemented in 2023, including a verification study, and will be completed in 2025-2026.
In addition to Georgia and Kazakhstan, WHO technical assistance was provided to Armenia, where a HIV verification study was conducted in 2023, and a pilot project to introduce a new testing algorithm was completed in 2024. The country-wide introduction of the new algorithm is planned for 2025.
HIV testing policies are fully aligned with HIV recommendations in Georgia: 3-test based testing strategy without Western blot (WB) and decentralization of confirmatory testing to 8 regional centers took place in 2023-2024, and reflected in the State Health Programme of Georgia (approved by the Resolution No. 529 of the Government of Georgia on 29 December 2023). The verification study is completed in Georgia, the first draft report has been produced.
As part of the project, support was provided to national partners in developing relevant activities in the Roadmap to prevent HIV infection in the Republic of Kazakhstan for 2023-2026 approved by Order of the Ministry of Health No. 155 dated March 16, 2023. Chapter 3 “Laboratory diagnostics” includes a validation study, change in the HIV testing algorithm in accordance with WHO recommendations, a phased decentralization of HIV diagnosis confirmation, and an expansion of rapid testing at the primary health care and community levels. All these activities began to be implemented in 2023, including a verification study, and will be completed in 2025-2026.
In addition to Georgia and Kazakhstan, WHO technical assistance was provided to Armenia, where a HIV verification study was conducted in 2023, and a pilot project to introduce a new testing algorithm was completed in 2024. The country-wide introduction of the new algorithm is planned for 2025.
HSS: Health products management systems
Community-led advocacy of elimination of identified critical discrepancies with the WHO prevention, testing and treatment guidelines
Progress to date
Current testing and treatment protocols analysis is finished in 7 countries (Armenia, Moldova, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan, and Ukraine) and recommendations to align the national protocols with the WHO guidelines are provided. The report is available at the link.
WHO has held the analysis of HIV testing guidelines in 6 countries of EECA – Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Uzbekistan. The report is available at the link.
National HIV testing and ART-optimized strategies based on and aligned with the WHO recommendations were developed for 4 EECA countries – Armenia, Kazakhstan, Kyrgyzstan, Moldova.
In Armenia, Kazakhstan, Kyrgyzstan, and Moldova, all key actions related to the development and implementation of HIV testing and ART optimization strategies, in line with WHO recommendations, have been completed. According to the results of the assessment in 2022, there was a need to replace Georgia with another country to implement activities for 2023 and 2024 since the Georgian testing and treatment protocol is generally in line with the 2021 WHO recommendations for the use of ARV drugs for the prevention and treatment of HIV, and as well as other aspects of the clinical management of HIV. During project meetings different optios were discussed, and the desicion was taken to continue the activities in Armenia instead of Georgia.
Kazakhstan
- Approved – Order of the Ministry of Health of the Republic of Kazakhstan No. 774 dated 08.11.2024. This Оrder amended the Order of the Ministry of Health of the Republic of Kazakhstan dated 16.03.2023 No. 155 in the context of changes and updates in terms of implementation of the items of the Roadmap “On Implementation of Measures for HIV Prevention in the Republic of Kazakhstan for 2025-2026”, in particular:
- Amendments to paragraph 23 of the Order of the Minister of Health of the Republic of Kazakhstan dated November 30, 2020, No. KR DSM-224/2020 “On Approval of the Standard for the Organization of Medical and Social Assistance in the Field of Mental Health to the Population of the Republic of Kazakhstan” (registered in the Register of State Registration of Normative Legal Acts No. 21712) regarding the provision of PTAO services at the hospital level are scheduled for the 3rd quarter of 2026.
- Amendments and additions to the Clinical Protocols: “HIV infection in adults”, ‘HIV infection in children’, ‘HIV/TB co-infection’, taking into account the update of the best international practices, is scheduled for the 4th quarter of 2025.
- Approved – Order of the Minister of Health of the Republic of Kazakhstan dated June 24, 2024 № 29 on amendments to the Order of the Minister of Health of the Republic of Kazakhstan dated December 3, 2020, No. KR DSM-231/2020 “On Approval of the Rules for Investigation of Cases of HIV Infection among the Population”.
- Approved – Order of the Ministry of Health of the Republic of Kazakhstan dated July 11, 2024 No. 55 “On Amendments and Additions to the Order of the Ministry of Health of the Republic of Kazakhstan dated October 19, 2020 No. KR DSM-137/2020 ‘On Approval of the Rules for Conducting Measures for the Prevention of HIV Infection’.
- Drafted – Amendments to the Code of the Republic of Kazakhstan dated July 7, 2020 “On the Health of the People and the Health Care System” on HIV infection”. It is expected that at the beginning of 2025, it will be approved.
Moldova
- Approved – National Clinical Protocol “Treatment of Viral Hepatitis C in Adults” approved by the Order of the Ministry of Health of the Republic of Moldova dated 11.10.2024.
- Drafted – National Clinical Protocol “Pre-exposure prophylaxis of HLV infection (PrEP)”.
HSS: Health products management systems
Decentralization of HIV testing services through integration to primary healthcare
Progress to date
Synthesis Report on assessment of readiness of health systems to decentralize HIV testing services in 5 countries of the EECA region is developed and can be found at the link.
The road maps were finalized in Armenia, Georgia, Moldova, Kazakhstan, and Kyrgyzstan.
Amendments related to HIV testing in Kazakhstan and Georgia were approved at the end of 2023. This, with close collaboration with local and international consultants, enabled in 2024 to focus on implementing normative acts through various measures, such as training sessions, advocacy campaigns, and strengthening cooperation among local CSOs and stakeholders into practice.
Local CSOs/community-based organizations, already involved in HIV testing, will play a key role in the decentralization of HIV treatment, further strengthening access to care at the community level.
1. Georgia
Georgia has completed the process of developing and approving regulations for decentralizing HIV testing and treatment. The HIV strategy for 2023–2025 was approved, and amendments to the national HIV/AIDS program have been made, including the creation of new testing and outpatient treatment points in new regions (Telavi, Akhaltsikhe, Poti, Khashuri). Measures for centralized supply of HIV tests have also been introduced. These changes came into force in January 2024.
Amendments approved by the Government of Georgia, on December 30, 2024. Annex 7 of the program regulates HIV services and indicates that decentralized testing with 2 different test kits will be implemented as a pilot together with sub contractor organizations and NGOs working with high risk groups in 8 cities of country – Tbilisi, Telavi, Khashuri, Akhsltsike, Kutaisi, Zugdidi, Poti and Batumi.
2. Kazakhstan
In Kazakhstan, in 3 cities: Almaty, Pavlodar and Ustkamenogorsk HIV testing is available through CSO, community based organizations: “You are not alone”, “Answer” and “Kemel Arma Foundation”. The document was registered in the Ministry of Justice of the Republic of Kazakhstan on December 4, 2023 № 33715. The adopted and entered into force document approving tariffs for HIV servies. In addition, the Roadmap to prevent HIV infection in the Republic of Kazakhstan for 2023-2026 was approved by Order of the Ministry of Health No. 155 dated March 16, 2023.
HSS: Health products management systems
Introduction of self-testing, community-based testing and decentralized testing into national policy documents and clinical guidelines, and harmonized testing policies and processes with new WHO recommendations, including with TA provided by the WHO Regional Office, Europe
Progress to date
In Georgia new HTS guideliness was approved, in Kazakhstan was submitted for approval. The new testing strategies include the use of rapid tests for HIV testing, the decentralization of testing (the involvement of PHC, NGOs, specialized medical institutions), the exclusion of the use of the western blot test for confirmation.
HIV testing policies are fully aligned with HIV recommendations in Georgia: 3-test based testing strategy without Western blot (WB) and decentralization of confirmatory testing to 8 regional centers took place in 2023-2024, and reflected in the State Health Programme of Georgia (approved by the Resolution No. 529 of the Government of Georgia on 29 December 2023). The verification study is completed in Georgia, the first draft report has been produced.
As part of the project, support was provided to national partners in developing relevant activities in the Roadmap to prevent HIV infection in the Republic of Kazakhstan for 2023-2026 approved by Order of the Ministry of Health No. 155 dated March 16, 2023. Chapter 3 “Laboratory diagnostics” includes a validation study, change in the HIV testing algorithm in accordance with WHO recommendations, a phased decentralization of HIV diagnosis confirmation, and an expansion of rapid testing at the primary health care and community levels. All these activities began to be implemented in 2023, including a verification study, and will be completed in 2025-2026.
In addition to Georgia and Kazakhstan, WHO technical assistance was provided to Armenia, where a HIV verification study was conducted in 2023, and a pilot project to introduce a new testing algorithm was completed in 2024. The country-wide introduction of the new algorithm is planned for 2025.
The SoS project has been instrumental in advancing self-testing and community-based HIV testing in SEE through persistent advocacy, strategic meetings, and expert consultations. Our partners have actively engaged with ministries and public health institutes to push for the integration of self-testing into national HIV strategies and the expansion of community-based testing services.
HSS: Health products management systems
Decentralization of HIV testing services through integration to primary healthcare
Progress to date
Synthesis Report on assessment of readiness of health systems to decentralize HIV testing services in 5 countries of the EECA region is developed and can be found at the link.
The road maps were finalized in Georgia.
The HIV strategy for 2023–2025 was approved in September 2023 and HIV/AIDS management document (program code: 27 03 02 07). The document is available at the link.
Based on the HIV strategy document and road map on a national level, the normative and legal amendments were drafted in Georgia (the draft of the HIV-infection/AIDS 2024 state Health program 2024) and were submitted for approval 29.12.2023 by the Ordinance of the Government of Georgia. The document is available at the link.
Amendments related to HIV testing in Georgia were approved at the end of 2023. This, with close collaboration with local and international consultants, enabled in 2024 to focus on implementing normative acts through various measures, such as training sessions, advocacy campaigns, and strengthening cooperation among local CSOs and stakeholders into practice.
Local CSOs/community-based organisations, already involved in HIV testing, will play a key role in the decentralisation of HIV treatment, further strengthening access to care at the community level.
Georgia
Georgia has completed the process of developing and approving regulations for decentralizing HIV testing and treatment. The HIV strategy for 2023–2025 was approved, and amendments to the national HIV/AIDS program have been made, including the creation of new testing and outpatient treatment points in new regions (Telavi, Akhaltsikhe, Poti, Khashuri). Measures for centralized supply of HIV tests have also been introduced. These changes came into force in January 2024.
Amendments approved by the Government of Georgia, on December 30, 2024. Annex 7 of the program regulates HIV services and indicates that decentralized testing with 2 different test kits will be implemented as a pilot together with sub contractor organizations and NGOs working with high risk groups in 8 cities of country – Tbilisi, Telavi, Khashuri, Akhsltsike, Kutaisi, Zugdidi, Poti and Batumi.
Solutions
Implementer:
- Select an implementer
- APH
- ENPUD
- CAAPLA
- FreeZone
- EWNA
- EKPC
Period:
Reducing human rights-related barriers to HIV/TB services
REAct (https://react-aph.org/): Monitoring of human rights violations and discrimination against PLHIV and KPs. Responding to such cases through provision or referring to legal or social services to victims and through advocacy actions. In Georgia, Kyrgyzstan, Moldova and Tajikistan, REAct system was initiated within SoS_project#1.0 in 2020, and in 2022 is transferred to national funding, meanwhile APH continues to provide technical support to users. In Ukraine, REAct was implemented in 2019 and is functional within national GF grant. REAct system is supported by APH in Uzbekistan for 2022-2023, in 5 Balkan countries – for 2022-2024, and in Armenia and Azerbaijan – for 2023-2024. At the same time, regional networks ECOM and ENPUD started to use REAct program for documentation in several countries of the region and are supported for 2022-2024 within SoS_project#2.0 grant.
Progress to date
Cumulatively, during 2022 there were registered 6700+ cases in 13 countries (Albania, Armenia, Bosnia and Herzegovina, Georgia, North Macedonia, Moldova, Montenegro, Kazakhstan, Kyrgyzstan, Tajikistan, Serbia, Ukraine, Uzbekistan) involving 170+ CBOs, as well as regional networks such as ECOM (in Uzbekistan, Tajikistan, Armenia, Kazakhstan, Kyrgyzstan) and ENPUD (Georgia, Moldova, Ukraine, Kyrgyzstan, Kazakhstan, Tajikistan, Belarus).
The following publications are available:
- Statistic country reports by APH on human rights violations based on REAct data collected in 2021 in Kyrgyzstan, in Georgia, in Moldova, in Tajikistan.
- Protectors or Perpetrators: the impact of unlawful policing on human rights and HIV. Join analytical publication in partnership with Frontline AIDS, Alliance for Public Health (Ukraine, Kyrgyzstan, Tajikistan, Moldova, Georgia, Uzbekistan), AIDS Foundation (South Africa), Gender Dynamix.
- Report on the results of the analysis of the Hotline calls by APH: Domestic and other forms of violence against women living with HIV and women in key populations during the COVID-19 pandemic in Tajikistan.
- REAct Statistical Report for the 1st half of 2022 by APH. Violations of the rights of people living with HIV and representatives of vulnerable groups in Georgia.
Situational Report by APH: Drug policy in Georgia and Challenges. - Series of publications by APH based on REAct data within regional campaign “16 days against gender-based violence”.
REAct system is available and functional at the national level in the following counties. It enables documentation of cases of human rights violations: Albania (45 cases), Armenia (182), Azerbaijan (174), B&H (70), Montenegro (60), Kazakhstan (363), North Macedonia (42), Tajikistan (1155), Serbia (24), Uzbekistan (835). More detailed data of 2023 is available in REAct Regional Digest and REAct website.
Cumulatively in 10 countries, 49,9% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions. During 2023 in 10 countries, there were provided 2162 consultations about human rights, 1022 consultations with professional lawyers. In 168 cases REActors helped to draft simple legal documents, such as complains or statement to police, in 236 cases represented client’s interests in medical facilities, assisted in getting medical services and support, in 336 cases – accompanied the client in the initial appeal to the police. There were at least 20 strategic court cases, and at least 162 cases were used for shadow reports to UN Treaty Bodies.
Cumulatively in 8 countries (Armenia, Azerbaijan, Kazakhstan, Albania, Bosnia and Herzegovina, Montenegro, North Macedonia, Serbia) 56,2% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions (https://drive.google.com/drive/folders/1wtJaecXERatg8cmrAE1mzaoshtdLQY_w). Numerous success stories of cases resolutions are available at REAct website.
Reducing human rights-related barriers to HIV/TB services
Through the use of the Stigma Index 2.0 , measure HIV-related stigma and discrimination experienced by PLHIV in countries of the EECA region by delivering training for interviewers and researchers to familiarize them with the methodology and survey instrument, and in conducting interviews and entering data into the RedСap database system, as well as to develop and disseminate the survey report
Progress to date
Protocols for Stigma Index Research are developed in Armenia and Georgia. The filed phase will start in 2023.
In all three countries the Protocols are approved. Moreover, the Stigma Index Researches are fully completed in Armenia and Georgia.
The reports has been approved by the Global Partnership and presented to all stakeholders. In Kazakhstan, the protocol is approved and the field stage of the research is successfully completed with a final sample of over 1430 surveyed respondents. Currently, within the project, the Research Team has commenced the analysis of the collected data and is preparing the initial draft of the Research Report.
Stigma Index Researches are fully completed in Armenia, Georgia and in Kazakhstan.
Reducing human rights-related barriers to HIV/TB services
Ensure a monitoring system for the implementation of the human right to health in prisons through national preventive mechanisms
Progress to date
An analysis of the current situation regarding the development and implementation of tools to ensure access to harm reduction services with a focus on OST was conducted by FreeZone in Georgia and in Kyrgyzstan.
An analysis of the current functioning of NPMs was carried out by FreeZone in Moldova and Kazakhstan.
For Moldova and Kazakhstan, Information on key indicators of the incidence of socially dangerous diseases in penitentiary institutions was collected, namely data on the total number of convicts held in penitentiary institutions; detailed information on the number of people living with HIV infection; the number of detected cases of tuberculosis; the number of convicts who were provided with treatment for viral hepatitis. The results can be found at the links: Moldova, Kazakhstan.
In Georgia, the Overdose prevention training module was developed for prison staff. The Module is aimed at training the prison employees involved in the release preparation programs. The training module contains both theoretical material, as well as practical exercises. The Module details overdose prevention mechanisms and interventions that are necessary in case to prevent death.
In Kyrgyzstan, meetings were held with the Ministry of Justice, the Ministry of Finance, etc. on the expanding health services, including HIV services in the penitentiary institutions; extended discussions were initiated at the Country Coordination Committee meetings and round tables on issues related to expanding government funding for penitentiary institutions.
In Moldova, temporary accreditation of the training program for the profession of “peer-to-peer consultant” in penal institutions of Moldova was obtained, and activities related to advocating for the inclusion of the position of “peer-to-peer consultant” in the list of positions in penitentiary institutions were provided.
In Kazakhstan, on November 30, 2023, a meeting was organized to discuss the current issues of compulsory social health insurance, the guaranteed volume of free medical care services for representatives of the PWUD community, drug provision, and diagnosis of diseases among prisoners. To intensify community participation in the mechanisms to ensure the implementation of state policy on combating TB and HIV/AIDS, the prisoners and ex-prisoners community member was included in the CLM Working Group during the Country Coordination Committee meeting on November 3rd, 2023.
In Ukraine, communication was ensured with the relevant government bodies (Center for Health Protection of the Ministry of Health of Ukraine, the Health Center of the State Criminal-Executive Service of Ukraine, and others) to advocate for the updated SOP standard. Discussions were initiated for the preliminary approval of the SOP “Diagnostics, treatment and support of PLHIV (and suspected HIV) in medical points of the Health Center of the State Criminal-Executive Service of Ukraine”. An updated SOP was presented and discussed within the Working Group on ensuring the continuity of services in the penitentiary institutions. An order of the Health Center of the State Criminal-Executive Service of Ukraine on the approval of SOP has been prepared, signed, and published.
Moldova
10 training sessions for selected peer-to-peer consultants were held on the basis of the Peer Counselor’s Manual to train consultants among prisoners. Each session lasted 6 hours and included theoretical and practical components of counselor training. As a result of this training, two prisoners from Penitentiary Institution #4 and, Penitentiary Institution #7 were prepared as peer counselors (1 Male, 1 Female) and started provision of services to inmates on a voluntary basis.
Kazakhstan
Cooperation between NGO “Kazakhstan Union of People Living with HIV” and Department of organization of medical care of the Ministry of Health of the Republic of Kazakhstan and Committee of Criminal Executive System of the Ministry of Internal Affairs of the Republic of Kazakhstan was established, that led to improved service provision for prisoners. Increase in the state order for work with people released from prison was advocated.
Kyrgyzstan
In order to increase state funding for health care services in the penitentiary system, negotiations were held with representatives of the State Service of Penitentiary Execution (SSPE). As a result of negotiations and communication, the SSPE increased the planned budget for health services in the penitentiary system in 2025 to 25 million KGS (compared to 13 million KGS in 2024).
Consultant is monitoring the activities related to the Program on HIV and Hemocontact Viral Hepatitis 2024-2027 in the Republic of Kyrgyzstan regarding people who are incarcerated. The work is in place to ensure inclusion of necessary services for prisoners – needle exchange programs, OAT, and conducting advocacy to ensure state funding for HIV, TB, hepatitis diagnostic services in the penitentiary system, and support for released prisoners.
Georgia
Due to the unstable political situation in the country regarding the adoption of the law on foreign agents, the project activities were not implemented.
Reducing human rights-related barriers to HIV/TB services
Women-led research, “Sexual and reproductive health and rights (SRHR) of women living with HIV”
Reducing human rights-related barriers to HIV/TB services
Developing and launching call for “Gender and HIV” small grants with special eligibility focus on Monitoring situation with human rights of Trans* people
Progress to date
Small Grants Programme with 4 selected projects run by grass-root NGOs in 2022 included:
- “National Trans Coalition” NGO with the project titled “HIV prevention in Armenia through gender mainstreaming” (Armenia);
- “The Public Association “Union for Equity and Health” NGO with the project titled “Gender Equality for sex workers” (Moldova);
- “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Check your health – Equality for Trans Roma and Roma women/girls sex workers” (Serbia);
- “NON-GOVERNMENTAL ORGANIZATION «NASHA DOPOMOGA»” with the project titled “RIGHT TO HEALTH!” (Ukraine).
- The project applicant is the organization “Albanian Association of People Living with HIV/AIDS (PLWHA)” with the project titled “New approach on transforming the spiral of exclusion and marginalization, towards the right of recognition before the law, gender-diverse and reduce the violence in health-care settings for trans persons in Albania”.
- The project applicant is the “National Trans Coalition” NGO with the project titled “Strategic pathway to remove structural barriers for trans* communities to PrEP and PEP services in Armenia”. The proposed project has been designed to establish favorable conditions for improving access of Trans* communities to PrEP and PEP services in Armenia.
- The project applicant is the organization “STAR STAR” Skopje with the project titled “Community Mobilization to Mitigate Funding Cuts and Gender Inequality in National HIV Programs for Sex Workers in North Macedonia”. The project is envisioned as a response to the latest developments in North Macedonia related to provision and delivery of HIV prevention services for key populations.
- The project applicant is the organization “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Supporting health wellbeing and safety of Trans and Intersex Roma, sex workers and HIV+”.
In 2024, grants “Gender and HIV” were implemented in Albania, Georgia, Moldova and Ukraine.
Moldova
GENDERDOC-M, alongside a parent support group, aimed to create a safe and inclusive environment for transgender and gender-nonconforming youth. Two formal partnerships with youth clinics expanded access to health services and 24/7 hotline support. Parent education sessions led to increased understanding, school negotiations for name recognition, and medical referrals. As a result, a strategic plan for 2025 includes engaging health and education ministries to address systemic barriers.
Georgia
The Queer Association Temida established an informal network of trans-friendly professionals across three cities, despite restrictive anti-LGBT laws. The network held two meetings to discuss the legal landscape and continued service delivery. A memorandum with Psychea Mental Health Center helped maintain access to gender-affirming care. A peer educator training course was launched, and two trained educators provided online consultations to 32 beneficiaries, offering support on HIV and gender-affirming care.
Ukraine
The “Help Is Near” project by HPLGBT produced a comprehensive report on barriers and solutions in trans health services, especially for intersectional groups like sex workers and those using psychoactive substances. Recommendations for service decentralization were developed and are planned to be presented to the CCM in early 2025. HPLGBT aims to integrate these recommendations into national funding requests to the Global Fund, ensuring sustained support for marginalized trans communities.
Solutions
Implementer:
- Select an implementer
- 100% Life
- ECECACD
- EHRA
- ENPUD
- ECECACD
Period:
Reducing human rights-related barriers to HIV/TB services
Decriminalization of HIV and unintended HIV transmission
Progress to date
100% Life conducted an analysis of the legal environment in Georgia, Kyrgyz Republic and the Republic of Uzbekistan in order to identify regulatory legal acts that need to be amended to reduce the criminalization of people living with HIV.
During 2023, draft legislative amendments to the regulations in the context of the legal and legislative acts that contribute to the criminalization of HIV in Georgia, Kyrgyzstan, Kazakhstan, and Uzbekistan were developed. These amendments concern both general and specialized norms.
- Draft Law “On Amendments to the Criminal Code of Georgia on Liability for Human Immunodeficiency Virus (HIV) Infection”
- Draft Law “On Cancellation of the Law of Georgia “On HIV/AIDS”
Advocacy in Georgia aimed at repealing the Law on HIV/AIDS by submitting a Draft Law “On Cancellation of the Law of Georgia “On HIV/AIDS” to the Unified Coordinating Council for Measures Against HIV/AIDS, Tuberculosis, and Malaria. The Council confirmed its commitment to reviewing and sharing the draft, but due to postponed meetings, formal discussion was delayed. However, responses from the Ministry of Labor, Health, and Social Protection and the People’s Defender confirmed that the draft law had reached high-level discussions, however is not considered as a legislative priority under current circumstances.
Reducing human rights-related barriers to HIV/TB services
Reduce criminalization of drug use and personal possession
Progress to date
Two reports were developed on decriminalization of drug use in Georgia and Kyrgyzstan.
ENPUD is working on several strategic cases: in Moldova, unauthorized urine PAS test was prevented regarding an OST patient, as well as arbitrary detention of an OST patient in another case. In Ukraine, two strategic ongoing cases regarding keeping the driver’s license for the OST patient; and restoring activist`s rights and reputation, and punishing the police officers responsible for the provocation. In Kazakhstan, several strategic cases regarding taking cannabis for medical purposes. In Kyrgyzstan, a strategic case regarding provocation by the police with the planting of “evidence”; extortion of a bribe for the opportunity to be at large while “investigative” actions are going on.
Reducing human rights-related barriers to HIV/TB services
Development and promotion of the Guiding principles (recommendations, model legislation etc.) on drug policy for the EECA region with specific advocacy efforts for reforming drug policy and decriminalization of personal drug use
Progress to date
The Guiding Principles document is developed and approved by the ECECACD. The first draft of the document was reviewed and discussed during in-person meeting of Commissioners on November 2, 2022 (the Minutes extract with provided recommendations to the document are available upon request). The document was amended accordingly to the recommendations and sent for the second review by Commissioners. Commissioners provided their recommendations and corrections to the text (the letters and texts with corrections are available upon request). Final amendments was done, the document was completed and finally approved by Commissioners (relevant correspondence is available upon request). The final version of the Guiding principles is under design.
In 2023, the EECA Drug Policy Commission conducted two country visits: to Kyrgyzstan on 19-21 June, 2023, to Moldova on 11-13 September, 2023 to present and promote the ‘Guiding Principles’ during the meetings at the highest political level. Prime Ministers of these countries, Ministers oh Health, Ministers of Internal Affairs, Members of the Parliament, other officials have received a copy of this document. Commissioners provided their expertise and arguments in support of changes to drug legislation based on the pathways described in the document.
In addition, Commissioners participated in several international Conferences to promote Guiding Principles and advocate for a change in drug policy: International Harm Reduction Conference, Melbourne (Australia), European Conference on Law Enforcement and Public Health, Umeå (Sweden), Drug policy discussions in Georgia. August 3, 2023, Public discussion of the state strategy on drugs, December 18, 2023 Kyiv, Ukraine.
Moreover, the recent OHCHR Report Human rights challenges in addressing and countering all aspects of the world drug problem” contains direct referring to Guiding Principles.
Kazakhstan
A high-level meeting in Astana, attended by President Kassym-Jomart Tokayev and ECECACD Commissioners, successfully prevented the closure of opioid agonist therapy (OAT) programs in Kazakhstan. The government secured OAT medicine procurement for 2025, ensuring continued treatment for opioid dependence. https://ececacd.org/high-level-meeting-in-astana-on-drug-policy-and-opioid-agonist-therapy/
Kyrgyzstan
In 2024, Kyrgyzstan replaced the term “registry of people with drug dependency” with “dynamic monitoring,” shifting from a law enforcement focus to a medical record approach. Legislative amendments were made, and a working group drafted seven subordinate legal acts to support this transition, with further government review ongoing into 2025.
https://cbd.minjust.gov.kg/4-5260/edition/1939/ru
https://cbd.minjust.gov.kg/4-5301/edition/3727/ru
Moldova
ECECACD engagement in Moldova throughout 2024 led to discussions on reforming the National Anti-Drug Commission, proposing its transfer to the Cabinet of Ministers. A December 2024 national meeting resulted in a recommendation to develop a new National Drug Strategy in 2025. The National Commission on Drugs officially endorsed this, forming an inter-ministerial working group to oversee its development. https://ececacd.org/planning-drug-policy-reform-in-moldova/
Georgia
In response to Georgia’s rollback towards undemocratic, pro-Russian approaches, we have taken emergency measures to prevent the deterioration of the country’s drug policy situation. A multi-stakeholder dialogue meeting on harm reduction and drug policy was held in May 2024, and “Recommendations to community organizations on risk reduction related to legal acts enacted in 2024” were emergently developed, striving to respond to the crisis. In addition, in December 2024, the Recommendations to community organizations on risk reduction related to some legal acts enacted in 2024, were developed and distributed among key actors and stakeholders to inform Georgian leaders and activists of LGBT community organizations what steps can be taken to reduce the risks appeared after enacting several new laws, particularly the law “On Protection of Family Values and Minors”.
Solutions
Implementer:
- Select an implementer
- SEH
Period:
HSS: Health sector governance and planning
Increasing domestic financing of countries for services to key groups
Progress to date
Targeted activities were held in all project countries to discuss with national and international, governmental and non-governmental stakeholders the changes needed to enable sustainable and uninterrupted funding of HIV-related activities from national resources. Through targeted advocacy, technical support, and an integrated approach to HIV funding, in 2022 the project team managed to allocate approximately 1,7 million USD at the national level to programs for key populations, using social contracting mechanisms: Moldova – 154,126.84 USD; Kazakhstan – 118,529.33 USD; Kyrgyzstan – 61,000 USD; Tajikistan – 19,200.00 USD; Georgia – 357,000 USD; Ukraine – 931,453.96 USD.
Thanks to budget advocacy within the SoS project 2.0, the amount of money allocated from national budgets for HIV services through social contracting mechanisms in EECA project countries amounted to $3 269 959 in 2024. During SoS project 2.0 – $ 6 273 049 were allocated for social contracting in EECA region. The cumulative domestic budget expenditures for servicing key populations in 5 countries of SEE amounted to $1 061 383 in 2024. During SoS project 2.0 – $ 3 236 260 were allocated for social contracting in SEE region.
Solutions
Implementer:
- Select an implementer
- SEH
- SEH
Period:
HSS: Health sector governance and planning
Legal framework for financing HIV services from domestic funds – development and approval
Progress to date
Targeted activities were held in all project countries to discuss with national and international, governmental and non-governmental stakeholders the changes needed to enable sustainable and uninterrupted funding of HIV-related activities from national resources. Through targeted advocacy, technical support, and an integrated approach to HIV funding, in 2022 the project team managed to allocate approximately 1,7 million USD at the national level to programs for key populations, using social contracting mechanisms: Moldova – 154,126.84 USD; Kazakhstan – 118,529.33 USD; Kyrgyzstan – 61,000 USD; Tajikistan – 19,200.00 USD; Georgia – 357,000 USD; Ukraine – 931,453.96 USD.
Over three years of implementation of SoS_project 2.0 has contributed to significant changes in the financing of HIV services in 14 countries in SEE and EECA regions. The project supported the development of service delivery standards, pricing methodologies, and quality control procedures, which are critical for sustainable financing from the state budget.
The practice of social contracting is applied without interruption in 14 countries.
HSS: Health sector governance and planning
Regulation of service packages for key groups
Progress to date
In the reporting period, the Emergency package of services for key and vulnerable groups of the population in the field of HIV, and TB in the context of military conflicts was finalized, including tariffication. On its basis, in 2023, the process of advocacy and promotion of implementation at the level of countries in the EECA region will be launched.
Strategic Brief on Business Continuity (link) and Strategic Brief on Social contracting (link) were developed. In addition, Analysis of Quality of Services Provided in Azerbaijan was held and is available at the link.
Over three years of implementation of SoS_project 2.0 has contributed to significant changes in the financing of HIV services in 14 countries in SEE and EECA regions. The project supported the development of service delivery standards, pricing methodologies, and quality control procedures, which are critical for sustainable financing from the state budget.
The practice of social contracting is applied without interruption in 14 countries.
Objective Description:
OBjective task:
- Select a objective task
- Removing structural barriers to increase of HIV testing in EECA
- Removing structural barriers to ART in EECA
- Launching critical enabling interventions to improve HIV care cascade
- Emergency response to support Ukraine refugees from among PLHA and KPs fleeing from russian war on Ukraine
- Implementation of COVID-19 response mechanism
- Select a objective task
- Monitoring situation with human rights of KPs, responding to viloations
- Revision of legisation and other regulations on KPs that pose barriers to accessing HIV services:
- Select a objective task
- IT solutions to improve the efficiency of service delivery within the HIV care cascade and ensure the sustainability of HIV services
- Developing necessary legal framework and technical solutuions for cost-effective care package for KPs in EECA
- Advocacy for domestic resource allocation for KP services in EECA
Solutions
Implementer:
- Select an implementer
- APH
- APH
Period:
Integrated service delivery and HIV service quality improvement
Organization and support of two shelters (Kyiv and Ivano-Frankivsk regions), one-time support for 4 shelters, material payments to OST clients
Progress to date
60 stationary places for living in shelters in Kyiv and Ivano-Frankivsk regions were organized with support of food, transportation, coverage of a basic package of medicines and household goods, clothing for 405 people from key groups and members of their families. Provided technical support to 4 shelters (Poltava, Cherkasy, Kryvyi Rih and Zhytomyr). 70 payments were made for the payment of rent and provision of proper social and living conditions for the participants of the OST program. 22 payments were made to victims of violence from the Russian occupiers. In total, more than 1,500 people were covered by the program.
This project was supported in 2022.
Integrated service delivery and HIV service quality improvement
Provision of support to refugees among KPs and PLHIV as a part of emergency response: Ensuring better access to services for people who have moved to other countries due to the war (incl communication, navigation, case management): launch and sustaining of an international support service (HelpNow), two HelpNow hubs, a web portal with crucial regularly updated information and online medical consultations solution
Progress to date
Activity currently being funded from alternative sources.
After the GF financial support of the initative ended, in 2023 it was supported by Aidsfonds, which allowed for seamless continuation of work in full scale for 10 months; several more months were focused on finalising the program and establishing a Polish-based Foundation “Help Now Hub” to enable the opportunity to further support refugees and other groups requiring relevant support in Poland and beyond. At the same time, even after the funding had ended, the teams partially continue(d) to provide support and maintain the communication/information resources on a volutarily basis.
Solutions
Implementer:
- Select an implementer
- APH
- APH
Period:
Supporting key group populations in a COVID setting
Provision of HIV prevention services with precautions against COVID-19
Progress to date
Work on shelters has expanded – in addition to 5 shelters for working with women who use drugs in conditions of violence (Ukraine, Serbia, North Macedonia, Kazakhstan), support for flexible shelters for representatives of the LGBT community in Kazakhstan, Uzbekistan, Kyrgyzstan and Tajikistan has been added. The program was distinguished by a special programmatic approach to working with clients – about 3,200 clients received material assistance in the form of food packages (Georgia, Kazakhstan). PPE support in Kaz for migrants and KGP (124,000 disposable masks, 1,000 antiseptics); CLM to provide quality services for clients of OST programs in 7 countries.
Supporting key group populations in a COVID setting
Procurement and distribution of Ag-RDTs
Progress to date
Purchased 120 thousand rapid antigen tests for COVID (Bosnia and Herzegovina, Serbia, Tajikistan, Ukraine) and 4,000 PCR tests for Ukraine to test key population groups and their close contacts.
Solutions
Implementer:
- Select an implementer
- APH
- ECOM
- APH
- EHRA
- APH
Period:
Prevention (Pre-exposure prophylaxis – PrEP)
Implementation of PrEP with long acting ARV
Progress to date
During 2022 we managed to create two working groups regarding the development of a pilot project on long-acting PrEP for key population groups (KPG) in Ukraine or other country in the EECA region with pharmaceutical companies – ViiV Healthcare (ViiV) regarding long-acting cabotegravir (CAB-LA) and GILEAD regarding long-acting lenacapavir (LA PrEP). Our main goal during communication is to provide 100 representatives of KPG with long-acting PrEP as part of a comprehensive approach to HIV prevention with technical support from the Alliance for Public Health and donation of a drug from a pharmaceutical company as an additional HIV prevention option for people at high risk of HIV infection.
Due to significant part to the SoS 2 project advocacy, Ukraine is the first country in EECA to receive CAB LA PrEP for 100 MSM in Kyiv and Lviv during a two-year cycle funded by PEPFAR. This intervention is implemented by the Public Health Center of the Ministry of Health of Ukraine through the National PrEP Program in partnership with APH. The SoS 2.0 project together with Alliance.Global created an information campaign, the main purpose of which is to create demand and awareness of CAB LA among clients (https://long.prep.com.ua/)
With the advocacy support of the SoS 2.0 project, Ukraine became the first EECA country to introduce long-acting cabotegravir (CAB LA). The UPHC, in partnership with the Alliance and other partners, provided the service to 125 clients in Kyiv and Lviv. The pilot project was planned to be expanded to 500 courses by 2025 with the support of PEPFAR. The SoS 2.0 project supported the information campaign. With the help of the LongPrEP account’s campaign videos on TikTok, more than 1 million people in Ukraine were reached, which resulted in more than 1,400,000 views of our campaign videos.
Prevention (Pre-exposure prophylaxis – PrEP)
Inclusion of PrEP into nationally approved service packages for MSM and/or other key populations
Progress to date
ECOM in partnership with WHO regional office for Europe analyzed five national PrEP protocols (Armenia, Kazakhstan, Kyrgyzstan, Georgia and Ukraine) and provided Report with recommendations on the steps needed to include PrEP into nationally approved standard package of servises. The report is under design and will be published by the end of February.
Much work was done in 2023 to present recommendations based on analyzes of PrEP Protocols in 5 countries. Online and offline meetings with stakeholders, monitoring visits (Kazakhstan, Kyrgyzstan) were held, the results were presented at various meetings, conferences, and technical consultations. Based on the analysis of PrEP Protocols and updated WHO recommendations, policy briefs were developed and sent to countries, the purpose of which was to show and not miss the importance of new interventions that can improve PrEP services in countries.
PrEP is available and integrated into the healthcare system as part of the standard service package funded by the government in 5 countries: Armenia, Georgia, Kazakhstan, Kyrgyzstan, and Ukraine.
1. Armenia
PrEP is available as part of the national HIV prevention program and partly funded by the governmentand. PrEP has been officially included in the national HIV prevention guidelines approved by the Ministry of Health of Armenia.
2. Georgia
PrEP is available as part of the national HIV prevention program and partly funded by the governmentand.
3. Kazakhstan
PrEP is available as part of the national HIV prevention program and fully funded by the governmentand.
4. Kyrgyzstan
PrEP is included in the healthcare system and fully funded by the governmentandand.
5. Ukraine
PrEP is available and included in national clinical protocols.
Continued state support is confirmed to ensure the availability of PrEP for key populations.
Measures have been taken to strengthen the position of PrEP within healthcare.
Integrated service delivery and HIV service quality improvement
Pilot stimulant users ST model/program and evaluate its effectiveness to enable its adaptation and finalization for proposal to governments in the countries of the region
Progress to date
Research protocol developed and submitted for review to the IRB.
Integrated service delivery and HIV service quality improvement
Assessment of OAT sustainability
Progress to date
Assessment of the sustainability of the opioid agonist therapy programme in the context of transition from donor support to domestic funding was conducted in Moldova and Tajikistan. The reports are being finalized and sent for design, they’ll be published by the end of Q1 2023. The assessments in Albania, Kyrgyzstan and Ukraine are ongoing and will be finalized in 2023.
PULS Communitar conducted CLM study to evaluate OAT programs in the Republic of Moldova, identify the level of the availability and acceptability of programs, outline achievements, and identify and evaluate difficulties faced by the program participants. Report with findings and conclusions was prepared and presented on the meeting with service providers and decision makers. Next steps and recommendations for CCM were elaborated.
GENDERDOC-M conducted a CLM study to identify the barriers in access to PrEP among MSM/TG. The results were presented to the Key Affected Populations (KAP) committee. After the presentation, it was strongly recommended to showcase these results at the National Dialogue event. The aim is to leverage the platform to advocate for a comprehensive revision of the National Clinical Protocol on Pre-Exposure Prophylaxis (PrEP) in the first quarter of 2024. This strategic move aligns with the commitment to fostering meaningful changes in the national approach to PrEP in response to the insights gained through the CLM survey.
Forum of PWUD conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian is prepared. Meeting with CCM is planned to be organized in January 2024.
Rubikoni conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Furthermore, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Equal to equal conducted a study on the client satisfaction with OAT. Report in Russian was prepared. Moreover, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Intighob (Initiative group based on SPIN PLUS) conducted a study of the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian language was prepared. Moreover, the meetings with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
“New Generation” conducted Community Based Assessment of HIV Services Provided to MSM Living With HIV In Armenia through a focus group with broad number of experts and MSM community members (including representatives from CCM). The results were included to “Funding Priorities of Civil Society and Communities Most Affected by HIV, Tuberculosis and Malaria” by Global Fund under the number 9 (The funding priorities and minutes from CRG group meeting attached). These priorities are in active use to prepare an application for the Global Fund grant in Armenia. In addition, results are in active use in the National dialogue now.
Integrated service delivery and HIV service quality improvement
Operational research / pilot on ST for stimulant users. Piloting the model/program and evaluating its effectiveness to enable its adaptation and finalization for proposing to governments in the countries of the region
Progress to date
In 2023, the study/pilot protocol was finalised and approved by the IRB, the implementation sites were selected, teams were trained and attended a study visit to the Czech Republic, the medication was procured and delivered to the sites.
During 2022-2023 all preparatory actions were taken (protocol developed and approved by the IRB; all logistic and organisational preparations were held; sites were identified (4 to begin with and 3 additional added later on – Rivne, Zhytomyr, Ivano-Frankivsk, Kyiv, Kharkiv, Cherkasy); drugs were procured and supplied) to enable the pilot to be implemented.
In 2024 the pilot was launched and 103 people were enrolled in the program throughout the implementation period. At the moment of the start of the program, there were no legislative documents in the country, regulating any treatment of people who use stimulant drugs. Since the start of the program, all the preparatory processes and related discussions on various levels, had activated the relevant stakeholders to start thinking and acting in this direction and in 2024 the Ministry of Health issued an order that explicitly states that pharmacostimulants can be used to support stimulant users with ADHD, while preliminarily the only approach that was considered in the country for working with this group of users was psychological support, not pharmacotherapy. (https://moz.gov.ua/uk/decrees/nakaz-moz-ukrayini-vid-13-01-2025-84-pro-zatverdzhennya-standartu-medichnoyi-dopomogi-psihichni-ta-povedinkovi-rozladi-vnaslidok-vzhivannya-psihoaktivnih-rechovin-ta-stimulyatoriv-za-viklyuchennyam-opioyidiv)
The pilot was closely monitored and data was analysed on an ongoing basis; it was presented at a number of regional and global events, including Lisbon Addictions 2024, INHSU 2024, EHRC 2024, CND; the experience was discussed with UNODC at a number of occasions, including as a part of a working group on pharmacotherapy for stimulant users; work is being done to produce videomaterials about the pilot to include into a UNODC course on this topic; regional community networks and TA providers had been regularly updated on the key milestones and progress of the intervention; national stakeholders in the region were informed of the process and its potential and opportunity/possibility to adapt and implement in other countries.
Solutions
Implementer:
- Select an implementer
- 100% Life
Period:
HSS: Health products management systems
Community-led advocacy of elimination of identified critical discrepancies with the WHO prevention, testing and treatment guidelines
Progress to date
Current testing and treatment protocols analysis is finished in 7 countries (Armenia, Moldova, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan, and Ukraine) and recommendations to align the national protocols with the WHO guidelines are provided. The report is available at the link.
WHO has held the analysis of HIV testing guidelines in 6 countries of EECA – Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Uzbekistan. The report is available at the link.
National HIV testing and ART-optimized strategies based on and aligned with the WHO recommendations were developed for 4 EECA countries – Armenia, Kazakhstan, Kyrgyzstan, Moldova.
In Armenia, Kazakhstan, Kyrgyzstan, and Moldova, all key actions related to the development and implementation of HIV testing and ART optimization strategies, in line with WHO recommendations, have been completed. According to the results of the assessment in 2022, there was a need to replace Georgia with another country to implement activities for 2023 and 2024 since the Georgian testing and treatment protocol is generally in line with the 2021 WHO recommendations for the use of ARV drugs for the prevention and treatment of HIV, and as well as other aspects of the clinical management of HIV. During project meetings different optios were discussed, and the desicion was taken to continue the activities in Armenia instead of Georgia.
Armenia
- Approved – Order of the Ministry of Health of Armenia No. 6241-L dated 11/13/2024 on implementation of the clinical protocol “Pre-Exposure Prophylaxis of HIV Infection” in Armenia. The Order entered into force on November 13, 2024.
- Approved – Clinical protocol “Pre-Exposure Prophylaxis of HIV Infection”.
An official letter-response from the Ministry of Health of Armenia dated on November 26, 2024 confirms the approval of the PrEP protocol and contains the information on other legal acts that are developed and will be approved in 2025 is also attached.
Solutions
Implementer:
- Select an implementer
- 100% Life
Period:
HSS: Health products management systems
Community-led advocacy of elimination of identified critical discrepancies with the WHO prevention, testing and treatment guidelines
Progress to date
Current testing and treatment protocols analysis is finished in 7 countries (Armenia, Moldova, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan, and Ukraine) and recommendations to align the national protocols with the WHO guidelines are provided. The report is available at the link.
WHO has held the analysis of HIV testing guidelines in 6 countries of EECA – Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Uzbekistan. The report is available at the link.
National HIV testing and ART-optimized strategies based on and aligned with the WHO recommendations were developed for 4 EECA countries – Armenia, Kazakhstan, Kyrgyzstan, Moldova.
In Armenia, Kazakhstan, Kyrgyzstan, and Moldova, all key actions related to the development and implementation of HIV testing and ART optimization strategies, in line with WHO recommendations, have been completed. According to the results of the assessment in 2022, there was a need to replace Georgia with another country to implement activities for 2023 and 2024 since the Georgian testing and treatment protocol is generally in line with the 2021 WHO recommendations for the use of ARV drugs for the prevention and treatment of HIV, and as well as other aspects of the clinical management of HIV. During project meetings different optios were discussed, and the desicion was taken to continue the activities in Armenia instead of Georgia.
Armenia
- Approved – Order of the Ministry of Health of Armenia No. 6241-L dated 11/13/2024 on implementation of the clinical protocol “Pre-Exposure Prophylaxis of HIV Infection” in Armenia. The Order entered into force on November 13, 2024.
- Approved – Clinical protocol “Pre-Exposure Prophylaxis of HIV Infection”.
An official letter-response from the Ministry of Health of Armenia dated on November 26, 2024 confirms the approval of the PrEP protocol and contains the information on other legal acts that are developed and will be approved in 2025.
Solutions
Implementer:
- Select an implementer
- REGMH
- EKPC
- APH
- ENPUD
Period:
Reducing human rights-related barriers to HIV/TB services
Legal environment and situation analysis as well as mapping of civil society partners in the area of access by migrants to HIV and TB services
Progress to date
On December 9, the REGMH with the assistance of the NCC Secretariat held in Dushanbe a Roundtable “Protection of health of migrants from Tajikistan”. The event was timed to presentation of a new study conducted by the REGMH: “Situation and Economic analysis of HIV-related health services in the field of migration in Tajikistan”.
On December 13, 2022, the Regional Expert Group on Migration and Health together with Central Asian Association of People Living with HIV held a Roundtable in Almaty “Health of HIV positive migrants in Kazakhstan”. The aim of the Round Table was to promote effective and timely treatment of international migrants living with HIV. During the meeting, the Situational and Economic analysis on the provision of HIV-related health services for international migrants in Kazakhstan was presented and discussed.
On December 19, REG together with local NGO “Real World. Real People” held a Roundtable in Armenia, Yerevan aimed to buster a discussion and exchange of experience on the provision of services for international HIV-positive migrants between heads of health authorities of the Republic of Armenia, government departments responsible for migration and civil society organizations. At the meeting, a study “Analysis of legal and institutional barriers to accessing HIV services among migrants in the Republic of Armenia” (developed by REG in 2021) was presented.
Also, in Q4 REG has launched a study is Kyrgyzstan.
On October 11, REG held an online meeting “Migrants’ access to HIV services in Central Asia and Caucasus” that gathered representatives of UNAIDS, Central Asian Association of PLHIV (Kazakhstan), TB People (Georgia), NGO “Real World, Real People” (Armenia), IFRC Central Asia, WHO Europe, Elton John AIDS Foundation, NGO Equality Movement (Georgia), AFEW (Kyrgyzstan), IFRC South Caucasus, Global Fund, WHO, and MSF. The goal of the meeting was to initiate a discussion and work out possible solutions to provide access to HIV services for those who urgently left the countries following the political situation.
Situation and Economic analysis of HIV-related health services in the field of migration in Tajikistan and Kyrgyzstan were held and are available at the links: Tajikistan, Kyrgyzstan.
In addition, the report “Ukrainian Refugees in European Countries: Barriers, Solutions and Best Practices. Access to HIV and Tuberculosis Care” was developed and is available at the link.
Reducing human rights-related barriers to HIV/TB services
Developing and launching call for “Gender and HIV” small grants with special eligibility focus on Monitoring situation with human rights of Trans* people
Progress to date
Small Grants Programme with 4 selected projects run by grass-root NGOs in 2022 included:
- “National Trans Coalition” NGO with the project titled “HIV prevention in Armenia through gender mainstreaming” (Armenia);
- “The Public Association “Union for Equity and Health” NGO with the project titled “Gender Equality for sex workers” (Moldova);
- “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Check your health – Equality for Trans Roma and Roma women/girls sex workers” (Serbia);
- “NON-GOVERNMENTAL ORGANIZATION «NASHA DOPOMOGA»” with the project titled “RIGHT TO HEALTH!” (Ukraine).
- The project applicant is the organization “Albanian Association of People Living with HIV/AIDS (PLWHA)” with the project titled “New approach on transforming the spiral of exclusion and marginalization, towards the right of recognition before the law, gender-diverse and reduce the violence in health-care settings for trans persons in Albania”.
- The project applicant is the “National Trans Coalition” NGO with the project titled “Strategic pathway to remove structural barriers for trans* communities to PrEP and PEP services in Armenia”. The proposed project has been designed to establish favorable conditions for improving access of Trans* communities to PrEP and PEP services in Armenia.
- The project applicant is the organization “STAR STAR” Skopje with the project titled “Community Mobilization to Mitigate Funding Cuts and Gender Inequality in National HIV Programs for Sex Workers in North Macedonia”. The project is envisioned as a response to the latest developments in North Macedonia related to provision and delivery of HIV prevention services for key populations.
- The project applicant is the organization “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Supporting health wellbeing and safety of Trans and Intersex Roma, sex workers and HIV+”.
In 2024, grants “Gender and HIV” were implemented in Albania, Georgia, Moldova and Ukraine.
Moldova
GENDERDOC-M, alongside a parent support group, aimed to create a safe and inclusive environment for transgender and gender-nonconforming youth. Two formal partnerships with youth clinics expanded access to health services and 24/7 hotline support. Parent education sessions led to increased understanding, school negotiations for name recognition, and medical referrals. As a result, a strategic plan for 2025 includes engaging health and education ministries to address systemic barriers.
Georgia
The Queer Association Temida established an informal network of trans-friendly professionals across three cities, despite restrictive anti-LGBT laws. The network held two meetings to discuss the legal landscape and continued service delivery. A memorandum with Psychea Mental Health Center helped maintain access to gender-affirming care. A peer educator training course was launched, and two trained educators provided online consultations to 32 beneficiaries, offering support on HIV and gender-affirming care.
Ukraine
The “Help Is Near” project by HPLGBT produced a comprehensive report on barriers and solutions in trans health services, especially for intersectional groups like sex workers and those using psychoactive substances. Recommendations for service decentralization were developed and are planned to be presented to the CCM in early 2025. HPLGBT aims to integrate these recommendations into national funding requests to the Global Fund, ensuring sustained support for marginalized trans communities.
Reducing human rights-related barriers to HIV/TB services
REAct (https://react-aph.org/): Monitoring of human rights violations and discrimination against PLHIV and KPs. Responding to such cases through provision or referring to legal or social services to victims and through advocacy actions. In Georgia, Kyrgyzstan, Moldova and Tajikistan, REAct system was initiated within SoS_project#1.0 in 2020, and in 2022 is transferred to national funding, meanwhile APH continues to provide technical support to users. In Ukraine, REAct was implemented in 2019 and is functional within national GF grant. REAct system is supported by APH in Uzbekistan for 2022-2023, in 5 Balkan countries – for 2022-2024, and in Armenia and Azerbaijan – for 2023-2024. At the same time, regional networks ECOM and ENPUD started to use REAct program for documentation in several countries of the region and are supported for 2022-2024 within SoS_project#2.0 grant.
Progress to date
Cumulatively, during 2022 there were registered 6700+ cases in 13 countries (Albania, Armenia, Bosnia and Herzegovina, Georgia, North Macedonia, Moldova, Montenegro, Kazakhstan, Kyrgyzstan, Tajikistan, Serbia, Ukraine, Uzbekistan) involving 170+ CBOs, as well as regional networks such as ECOM (in Uzbekistan, Tajikistan, Armenia, Kazakhstan, Kyrgyzstan) and ENPUD (Georgia, Moldova, Ukraine, Kyrgyzstan, Kazakhstan, Tajikistan, Belarus).
The following publications are available:
- Statistic country reports by APH on human rights violations based on REAct data collected in 2021 in Kyrgyzstan, in Georgia, in Moldova, in Tajikistan.
- Protectors or Perpetrators: the impact of unlawful policing on human rights and HIV. Join analytical publication in partnership with Frontline AIDS, Alliance for Public Health (Ukraine, Kyrgyzstan, Tajikistan, Moldova, Georgia, Uzbekistan), AIDS Foundation (South Africa), Gender Dynamix.
- Report on the results of the analysis of the Hotline calls by APH: Domestic and other forms of violence against women living with HIV and women in key populations during the COVID-19 pandemic in Tajikistan.
- REAct Statistical Report for the 1st half of 2022 by APH. Violations of the rights of people living with HIV and representatives of vulnerable groups in Georgia.
Situational Report by APH: Drug policy in Georgia and Challenges. - Series of publications by APH based on REAct data within regional campaign “16 days against gender-based violence”.
REAct system is available and functional at the national level in the following counties. It enables documentation of cases of human rights violations: Albania (45 cases), Armenia (182), Azerbaijan (174), B&H (70), Montenegro (60), Kazakhstan (363), North Macedonia (42), Tajikistan (1155), Serbia (24), Uzbekistan (835). More detailed data of 2023 is available in REAct Regional Digest and REAct website.
Cumulatively in 10 countries, 49,9% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions. During 2023 in 10 countries, there were provided 2162 consultations about human rights, 1022 consultations with professional lawyers. In 168 cases REActors helped to draft simple legal documents, such as complains or statement to police, in 236 cases represented client’s interests in medical facilities, assisted in getting medical services and support, in 336 cases – accompanied the client in the initial appeal to the police. There were at least 20 strategic court cases, and at least 162 cases were used for shadow reports to UN Treaty Bodies.
Cumulatively in 8 countries (Armenia, Azerbaijan, Kazakhstan, Albania, Bosnia and Herzegovina, Montenegro, North Macedonia, Serbia) 56,2% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions (https://drive.google.com/drive/folders/1wtJaecXERatg8cmrAE1mzaoshtdLQY_w). Numerous success stories of cases resolutions are available at REAct website.
Solutions
Implementer:
- Select an implementer
- REGMH
Period:
Reducing human rights-related barriers to HIV/TB services
Evidence-based advocacy interventions with the aim of removing legal barriers to, and improve the rights of, migrant access to HIV and TB care in sending and receiving countries of in EECA region: national and regional (EECA) meeting and roundtables with participation of civil society, migrant organizations, healthcare officials and parliamentarians
Progress to date
On December 9, the REGMH with the assistance of the NCC Secretariat held in Dushanbe a Roundtable “Protection of health of migrants from Tajikistan”. The event was timed to presentation of a new study conducted by the REGMH: “Situation and Economic analysis of HIV-related health services in the field of migration in Tajikistan”.
On December 13, 2022, the Regional Expert Group on Migration and Health together with Central Asian Association of People Living with HIV held a Roundtable in Almaty “Health of HIV positive migrants in Kazakhstan”. The aim of the Round Table was to promote effective and timely treatment of international migrants living with HIV. During the meeting, the Situational and Economic analysis on the provision of HIV-related health services for international migrants in Kazakhstan was presented and discussed.
On December 19, REG together with local NGO “Real World. Real People” held a Roundtable in Armenia, Yerevan aimed to buster a discussion and exchange of experience on the provision of services for international HIV-positive migrants between heads of health authorities of the Republic of Armenia, government departments responsible for migration and civil society organizations. At the meeting, a study “Analysis of legal and institutional barriers to accessing HIV services among migrants in the Republic of Armenia” (developed by REG in 2021) was presented.
On October 11, REG held an online meeting “Migrants’ access to HIV services in Central Asia and Caucasus” that gathered representatives of UNAIDS, Central Asian Association of PLHIV (Kazakhstan), TB People (Georgia), NGO “Real World, Real People” (Armenia), IFRC Central Asia, WHO Europe, Elton John AIDS Foundation, NGO Equality Movement (Georgia), AFEW (Kyrgyzstan), IFRC South Caucasus, Global Fund, WHO, and MSF. The goal of the meeting was to initiate a discussion and work out possible solutions to provide access to HIV services for those who urgently left the countries following the political situation.
REGMH held a number of online and offline seminars and rioundtables to present and discuss the results of their studies in Azerbaijan, Tajikistan and Kyrgyzstan. A number of discussions was also held to scale up remote registration of migrants with HIV to get access to HIV services. For now, remote registration is functional in Tajikistan, and the preparatory work is implemented in Armenia, Azerbaijan and Kazakhstan.
In particular, on June, 6 in Dushanbe REGMH held a Round Table on protecting health of Tajik migrants. The purpose of the meeting that gathered together the staff of the AIDS Center, the patients’ community, specialists from NGOs in the region and host countries was to discuss the maintaining of the algorithm for remote registration of citizens of Tajikistan with HIV living abroad, and to formulate further steps to improve access of migrants to HIV services. Deputy Director of the Republican AIDS Center made a proposal to develop and sign a Memorandum for Mutual Recognition of Medical Tests at the level of Republican AIDS Centers in the Central Asian region.
On December 4, REGMH held a Round Table in Yerevan, Armenia. The key focus of the meeting was the provision of HIV services for Armenian citizens living abroad.
On December, 25 REGMH participated in online meeting to discuss current issues of implementation/piloting of “Remote registration of migrants with HIV in Uzbekistan”, organized by a consortium of organizations in Uzbekistan to promote the protocol, including IOM, CCM, AFEW, and REGMH. During the meeting, representative of CCM informed that the protocol was accepted and signed by the Center for State Sanitary and Epidemiological Surveillance of the Republic of Uzbekistan. What is very important, the final version includes recommendations suggested by REGMH making it easier to register a migrant than it was in an initial version of the document.
On June 15, REGMH held its quarterly Working group meeting on remote registration of PLWH living abroad. As a result of the Round Table held earlier in Uzbekistan, the group managed to attract specialists from the Republican AIDS Center and the CCM of Uzbekistan. During the meeting, the Group discussed the issue of accepting medical documentation (certificates, test results) issued by country of migrant’s destination, which are necessary for remote registration; also, the standard for the minimum set of documents for remote registration of citizens in migration (based on WHO’s recommendations) were presented to participants on order to foster the development of remote registration in the EECA countries.
REGMH has launched a series of Webinars “Health of Refugee and Migrants from the EECA countries”, designed both for those who flee and seek help in the host country and for those who organize help in receiving countries. Also, webinars could be of interest to those who research and solve systemic problems.
The first webinar took place on August 09 and was devoted to revision of problems that Ukrainian refugees who use drugs face: “People Who Use Drugs from Ukraine: Challenges and Solutions”.
Migration and Health Summer School was hekd on 21-22 Aug 2023 in Yerevan, Armenia. where participants discussed best practices and solutions for providing medical care to migrants and refugees from the EECA region. Country representatives of REGMH from the EECA region, representatives of health authorities from the EECA countries, experts from regional and international organizations, WHO, UNAIDS, UNDP, and MSF attended the event, totally, 40 participants from 12 countries.
On November 24, 2023 REGMH held a Round table in Bishkek, Kyrgyzstan to discuss current issues of migrant health in the context of HIV. The event brought together experts from relevant ministries and departments, non-governmental and civil sectors, as well as representatives of international organizations. A key part of the round table was the presentation of study’s results conducted by REG in 2023 “Situational and economic analysis in the field of migration and the provision of medical services related to HIV in the Kyrgyz Republic” to identify legal and institutional barriers related to HIV faced by citizens of Kyrgyzstan returning from migration.
Regional Meeting on Migrant Health and HIV Response took place on September 19-20, 2024, in Samarkand. Experts from EECA countries gathered to discuss adapting health services for migrants amidst mass population movements. Organized under the Global Fund framework, the event highlighted key challenges migrants face, including access to HIV/TB treatment, language barriers, and mental health support. The #HelpNOW HUB, which assisted 37,500 Ukrainians in 50 countries, was presented as a best practice model. Participants emphasized the need for migrant-sensitive policies, digital health solutions, and sustainable healthcare partnerships to ensure uninterrupted medical services across borders.
Solutions
Implementer:
- Select an implementer
- SEH
Period:
HSS: Health sector governance and planning
Increasing domestic financing of countries for services to key groups
Progress to date
Targeted activities were held in all project countries to discuss with national and international, governmental and non-governmental stakeholders the changes needed to enable sustainable and uninterrupted funding of HIV-related activities from national resources. Through targeted advocacy, technical support, and an integrated approach to HIV funding, in 2022 the project team managed to allocate approximately 1,7 million USD at the national level to programs for key populations, using social contracting mechanisms: Moldova – 154,126.84 USD; Kazakhstan – 118,529.33 USD; Kyrgyzstan – 61,000 USD; Tajikistan – 19,200.00 USD; Georgia – 357,000 USD; Ukraine – 931,453.96 USD.
Thanks to budget advocacy within the SoS project 2.0, the amount of money allocated from national budgets for HIV services through social contracting mechanisms in EECA project countries amounted to $3 269 959 in 2024. During SoS project 2.0 – $ 6 273 049 were allocated for social contracting in EECA region. The cumulative domestic budget expenditures for servicing key populations in 5 countries of SEE amounted to $1 061 383 in 2024. During SoS project 2.0 – $ 3 236 260 were allocated for social contracting in SEE region.
Solutions
Implementer:
- Select an implementer
- SEH
- SEH
Period:
HSS: Health sector governance and planning
Legal framework for financing HIV services from domestic funds – development and approval
Progress to date
Targeted activities were held in all project countries to discuss with national and international, governmental and non-governmental stakeholders the changes needed to enable sustainable and uninterrupted funding of HIV-related activities from national resources. Through targeted advocacy, technical support, and an integrated approach to HIV funding, in 2022 the project team managed to allocate approximately 1,7 million USD at the national level to programs for key populations, using social contracting mechanisms: Moldova – 154,126.84 USD; Kazakhstan – 118,529.33 USD; Kyrgyzstan – 61,000 USD; Tajikistan – 19,200.00 USD; Georgia – 357,000 USD; Ukraine – 931,453.96 USD.
Over three years of implementation of SoS_project 2.0 has contributed to significant changes in the financing of HIV services in 14 countries in SEE and EECA regions. The project supported the development of service delivery standards, pricing methodologies, and quality control procedures, which are critical for sustainable financing from the state budget.
The practice of social contracting is applied without interruption in 14 countries.
HSS: Health sector governance and planning
Regulation of service packages for key groups
Progress to date
In the reporting period, the Emergency package of services for key and vulnerable groups of the population in the field of HIV, and TB in the context of military conflicts was finalized, including tariffication. On its basis, in 2023, the process of advocacy and promotion of implementation at the level of countries in the EECA region will be launched.
Strategic Brief on Business Continuity (link) and Strategic Brief on Social contracting (link) were developed. In addition, Analysis of Quality of Services Provided in Azerbaijan was held and is available at the link.
Over three years of implementation of SoS_project 2.0 has contributed to significant changes in the financing of HIV services in 14 countries in SEE and EECA regions. The project supported the development of service delivery standards, pricing methodologies, and quality control procedures, which are critical for sustainable financing from the state budget.
The practice of social contracting is applied without interruption in 14 countries.
Solutions
Implementer:
- Select an implementer
- APH
- Positive Initiative
- APH
Period:
RSSH: Health sector governance and planning
REGIONAL: regional dashboard (with 2 integrated portals) + preliminary results to be reflected on the timeframe / deadlines, at least for this year
Progress to date
ToR for the dashboard is under development; methodologies and approaches to data collection for the social contacting and sustainability and transition portals are being updated.
The concepts and the ToRs for the database, BI analytics module and website to present the information from the dashboard were developed.
RSSH: Health sector governance and planning
Virtual social worker
Progress to date
Concept is developed, scripts are under development, research is being carried out to identify the optimal technical framework.
The first version of the eSW solution (web-based) has been developed – English language solution with the key topics of the knowledge database and tested, plans for further development and adaptation/improvement formulated.
The Virtual (Electronic) Social Worker – TWIIN Digital Assistant solution (co-funded by Gilead) was developed and launched in Ukraine. The solution is accessible through the dedicated website – https://twiin.aph.org.ua/en/ and a mobile app had also been developed that allows for easier direct access to the digital assistant, as well as to the knowledge database in form of a walkthrough menu based library which allows for access to the information in offline mode. The piloting started in September 2024 and by the end of the year, TWIIN had provided over 35000 sessions to over 5000 unique users. We procured three interactive screens, placed in three cities in Ukraine, that have provided access to the tool to potential audiences and throughout 2025 these screens will be functioning in several sites across the cities, increasing coverage and raising awareness. We had utilised a wide variety of approaches to promoting the solution, collected extensive feedback and continue to improve the tool on an ongoing basis, as well as making efforts in order to achieve sustainability and scale up the solution.
Objective Description:
OBjective task:
- Select a objective task
- Removing structural barriers to increase of HIV testing in EECA
- Removing structural barriers to ART in EECA
- Launching critical enabling interventions to improve HIV care cascade
- Implementation of COVID-19 response mechanism
- Select a objective task
- Monitoring situation with human rights of KPs, responding to viloations
- Revision of legisation and other regulations on KPs that pose barriers to accessing HIV services:
- Select a objective task
- IT solutions to improve the efficiency of service delivery within the HIV care cascade and ensure the sustainability of HIV services
- Developing necessary legal framework and technical solutuions for cost-effective care package for KPs in EECA
- Advocacy for domestic resource allocation for KP services in EECA
Solutions
Implementer:
- Select an implementer
- APH
- APH
Period:
Supporting key group populations in a COVID setting
Provision of HIV prevention services with precautions against COVID-19
Progress to date
Work on shelters has expanded – in addition to 5 shelters for working with women who use drugs in conditions of violence (Ukraine, Serbia, North Macedonia, Kazakhstan), support for flexible shelters for representatives of the LGBT community in Kazakhstan, Uzbekistan, Kyrgyzstan and Tajikistan has been added. The program was distinguished by a special programmatic approach to working with clients – about 3,200 clients received material assistance in the form of food packages (Georgia, Kazakhstan). PPE support in Kaz for migrants and KGP (124,000 disposable masks, 1,000 antiseptics); CLM to provide quality services for clients of OST programs in 7 countries.
Supporting key group populations in a COVID setting
National Contingency Planning
Progress to date
Supporting key group populations in a COVID setting “General contingency planning guide developed in the frames of the C19RM is available here.
Guide by APH for Contingency Planning for Key Population HIV Services during COVID-19 and Other Emergencies for North Macedonia, Serbia, Bosnia and Herzegovina, Montenegro, Moldova, Georgia, Kazakhstan, Uzbekistan, Tajikistan and Kyrgyzstan in English is available at the link https://aph.org.ua/en/eeca/ in the folders with the names of each country.
Solutions
Implementer:
- Select an implementer
- EHRA
- EHRA
- ECOM
- EHRA
Period:
Integrated service delivery and HIV service quality improvement
Assessment of OAT sustainability
Progress to date
Assessment of the sustainability of the opioid agonist therapy programme in the context of transition from donor support to domestic funding was conducted in Moldova and Tajikistan. The reports are being finalized and sent for design, they’ll be published by the end of Q1 2023. The assessments in Albania, Kyrgyzstan and Ukraine are ongoing and will be finalized in 2023.
Reassessing the sustainability of the opioid agonist therapy programme within the context of transition from donor support to domestic funding took place in 2022 in Tajikistan and Moldova, reports were published in 2023.
In 2023, the reassessment of the sustainability of the opioid agonist therapy programme within the context of transition from donor support to domestic funding also was finished in Ukraine, the report can be found at the link.
Integrated service delivery and HIV service quality improvement
Community groups conduct community-led assessment of national quality standards in accordance to IDUIT and organize dialogue with service providers and MOH/local authorities
Progress to date
Moldova
PULS Communitar conducted CLM study to evaluate OAT programs in the Republic of Moldova, identify the level of the availability and acceptability of programs, outline achievements, and identify and evaluate difficulties faced by the program participants. Report with findings and conclusions was prepared and presented on the meeting with service providers and decision makers. Next steps and recommendations for CCM were elaborated.
GENDERDOC-M conducted a CLM study to identify the barriers in access to PrEP among MSM/TG. The results were presented to the Key Affected Populations (KAP) committee. After the presentation, it was strongly recommended to showcase these results at the National Dialogue event. The aim is to leverage the platform to advocate for a comprehensive revision of the National Clinical Protocol on Pre-Exposure Prophylaxis (PrEP) in the first quarter of 2024. This strategic move aligns with the commitment to fostering meaningful changes in the national approach to PrEP in response to the insights gained through the CLM survey.
Kazakhstan
Forum of PWUD conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian is prepared. Meeting with CCM is planned to be organized in January 2024.
Georgia
Rubikoni conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Furthermore, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Kyrgyzstan
Equal to equal conducted a study on the client satisfaction with OAT. Report in Russian was prepared. Moreover, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Tajikistan
Intighob (Initiative group based on SPIN PLUS) conducted a study of the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian language was prepared. Moreover, the meetings with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Armenia
“New Generation” conducted Community Based Assessment of HIV Services Provided to MSM Living With HIV In Armenia through a focus group with broad number of experts and MSM community members (including representatives from CCM). The results were included to “Funding Priorities of Civil Society and Communities Most Affected by HIV, Tuberculosis and Malaria” by Global Fund under the number 9 (The funding priorities and minutes from CRG group meeting attached). These priorities are in active use to prepare an application for the Global Fund grant in Armenia. In addition, results are in active use in the National dialogue now.
Integrated service delivery and HIV service quality improvement
Integration of community-led monitoring (CLM) into the health care systems of countries in the EECA region to assure the quality of services for key populations (KPs)
Progress to date
Practical handbook on community-led monitoring tools was developed in English and Russian languages. The checklist with EHRA and other partners for CLM was discussed and agreed upon.
On 2-8 December 2022, specialists from the Eurasian Harm Reduction Association (EHRA) conducted regional online training “Community-Led Monitoring Methods” for the representatives of community organizations in the CEECA region. The training was attended by 38 representatives of organizations from different vulnerable communities in the CEECA region. The aim of the training consisting of three online sessions was to train leaders of self-organizations from different key communities in the CEECA region to understand, which role CLM can play in their advocacy work, how to formulate the proper problem and research question for CLM, and which of the different methodologies can most effectively provide the data needed for advocacy. Video recordings of the training, as well as presentations can be found at the link.
Following the CLM Handbook, developed in 2022, integration of CLM into the healthcare system can be ensured through productive and sustainable participation of community representatives in the decision-making process, mainly within CCM, and through national consultations with CCM and other health sector coordination bodies on key needs for CLM and its findings and recommendations on improving of health services.
CLM has been conducted in all planned countries. Results were presented in 5 countries and protocols were received (Moldova, Georgia, Tajikistan, Kazakhstan and Kyrgyzstan). In Armenia, the results of the CLM are in active use in the National dialogue now. The focus group with broad number of experts and MSM community members (including representatives from CCM) was conducted, and based on the results PrEP was identified as a key priority and included to “Funding Priorities of Civil Society and Communities Most Affected by HIV, Tuberculosis and Malaria” by Global Fund under the number 9 (The funding priorities and minutes from CRG group meeting attached). These priorities are in active use to prepare an application for the Global Fund grant in Armenia.
Following CLM Handbook, developed in 2022, integration of CLM into healthcare system can be ensured through productive and sustainable participation of community representatives in decision-making process, mainly within CCM, and through national consultations with CCM and other health sector coordination bodies on key needs for CLM and its findings and recommendations on improving of health services. Within EHRA activities, CLM results in all countries in Georgia, Moldova, Kyrgyzstan, Kazakhstan and Tajikistan were presented and reviewed in CCMs and/or in other healthcare managing bodies. Protocol/minutes of the CCM meeting or other health authority body, based on the conducted national consultations with CCM and other health sector coordination bodies on key needs for CLM and discussed how results of CLM will help to improve services and integration of them into the healthcare system. What is more, additionally to presentation of CLM results, this year consultants in Georgia, Moldova, Kyrgyzstan and Kazakhstan prepared requests to healthcare managing bodies by asking provide information on how CLM results were being implemented. EHRA prepared a final publication – report, which draws on the three-year SoS 2.0. project of the EHRA to support community-led monitoring (CLM) initiatives for opioid agonist therapy (OAT) and the findings and results of community groups in Georgia, Moldova, Kazakhstan, Kyrgyzstan, and Tajikistan, offering insights into best practices and lessons learnt.
Moldova
PULS Communitar conducted CLM study to evaluate OAT programs in the Republic of Moldova, identify the level of the availability and acceptability of programs, outline achievements, and identify and evaluate difficulties faced by the program participants. Report with findings and conclusions was prepared and presented on the meeting with service providers and decision makers.
GENDERDOC-M conducted a CLM study to identify the barriers in access to PrEP among MSM/TG. The results were presented to the Key Affected Populations (KAP) committee. After the presentation, it was strongly recommended to showcase these results at the National Dialogue event. Following dialogues and agreements with the Protocol revision experts, the recommendations were formally presented on August 23, 2024, during the Round Table on the National Clinical Protocol on PrEP. The updated draft protocol, which includes the proposed recommendations, is currently under review by government authorities. In addition, the approval of new service standards, which will also include CLM, is expected in June 2025.
Kazakhstan
Forum of PWUD conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian is prepared.
Georgia
Rubikoni conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Furthermore, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps. In addition, based on ECOM recommendations, the working group developed CLM mechanisms and a special chapter was included in the Standards for Management of Public Health Interventions (PrEP Protocol). The working group included representatives from the National Centre for Disease Control and Public Health (NCDC), the Research Centre for Infectious Diseases, AIDS and Clinical Immunology, NGOs and MSM representatives, including members of the András team. Letter received from NCDC in support of the modified protocol.
Kyrgyzstan
Equal to equal conducted a study on the client satisfaction with OAT. Report in Russian was prepared. Moreover, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Tajikistan
Intighob (Initiative group based on SPIN PLUS) conducted a study of the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian language was prepared. Moreover, the meetings with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Armenia
“New Generation” conducted Community Based Assessment of HIV Services Provided to MSM Living With HIV In Armenia through a focus group with broad number of experts and MSM community members (including representatives from CCM). The results were included to “Funding Priorities of Civil Society and Communities Most Affected by HIV, Tuberculosis and Malaria” by Global Fund under the number 9 (The funding priorities and minutes from CRG group meeting attached). The National Guidelines on PrEP for HIV infection have been officially approved under Order No. 6241-L by the Minister of Health, dated 13 November 2024. These guidelines are now available on the Ministry of Health’s official website.
Solutions
Implementer:
- Select an implementer
- SEH
- HAC
- HAC
- HAC
- 100% Life
Period:
HSS: Health products management systems
Decentralization of HIV treatment through integration to primary healthcare
Progress to date
Synthesis Report on assessment of health systems to decentralize HIV treatment services in 5 countries of the EECA is developed and can be found at the link.
The road maps were finalized in Armenia, Georgia, Moldova, Kazakhstan, and Kyrgyzstan.
HSS: Health products management systems
Technical support in implementation of long-term contracts for ARV procurement
Progress to date
Advocacy plans were developed for Kazakhstan, Kyrgyzstan and Moldova to further contribute to ARV price reduction. Official letters were sent to pharmaceutical companies and government authorities regarding further price reduction for ARVs, keeping the simplified procedures of registration of medicines and medical devices, etc.
The national experts in Kazakhstan, Kyrgyzstan, and Moldova implemented the activities envisaged by the developed advocacy plans.
The analysis of the existing legislation in the field of procurement of medicines was carried out, and the list of normative acts that prevent the Center for Centralized Public Procurement in the field of Health from procuring medicines and consumables through international procurement platforms was identified. The analysis of the National HIV/AIDS Program Needs for 2024 from the state budget was carried out. Based on this analysis, the changes were made based on the optimization of the treatment schemes for 2024. The prices for procurement of medicines were analyzed.
In Moldova, to identify potential obstacles and opportunities for the introduction of a procurement mechanism through international procurement agencies, a comprehensive review of the current legislation on procurement of medical devices and medicines was conducted. An assessment of the current clinical protocol was conducted to develop recommendations for the inclusion of ART drug resistance monitoring. These recommendations were presented to the CCM HIV Working Group, and efforts are ongoing to advocate for their inclusion in the 2025 revision of the National HIV Protocol.
ECAT meeting was held on December 4–6 in Tbilisi, Georgia.
Reports on procurement monitoring of CD4 and VL tests as well as the rapid tests for HIV implemented in 2023 are published.
HSS: Health products management systems
Technical support in implementation of simplified registration for ARVs
Progress to date
Advocacy plans were developed for Kazakhstan, Kyrgyzstan and Moldova to further contribute to ARV price reduction. Official letters were sent to pharmaceutical companies and government authorities regarding further price reduction for ARVs, keeping the simplified procedures of registration of medicines and medical devices, etc.
The national experts in Kazakhstan, Kyrgyzstan, and Moldova implemented the activities envisaged by the developed advocacy plans.
The analysis of the existing legislation in the field of procurement of medicines was carried out, and the list of normative acts that prevent the Center for Centralized Public Procurement in the field of Health from procuring medicines and consumables through international procurement platforms was identified. The analysis of the National HIV/AIDS Program Needs for 2024 from the state budget was carried out. Based on this analysis, the changes were made based on the optimization of the treatment schemes for 2024. The prices for procurement of medicines were analyzed.
ECAT meeting was held on December 4–6 in Tbilisi, Georgia.
Reports on procurement monitoring of CD4 and VL tests as well as the rapid tests for HIV implemented in 2023 are published.
HSS: Health products management systems
Advocacy for engagement of patient community experts into national working groups to develop and adopt medicine procurement lists and technical procurement documentation
Progress to date
Advocacy plans were developed for Kazakhstan, Kyrgyzstan and Moldova to further contribute to ARV price reduction. Official letters were sent to pharmaceutical companies and government authorities regarding further price reduction for ARVs, keeping the simplified procedures of registration of medicines and medical devices, etc.
The national experts in Kazakhstan, Kyrgyzstan, and Moldova implemented the activities envisaged by the developed advocacy plans.
The workshop was conducted on December 14 to develop comprehensive skills and knowledge of the participants, ensuring their readiness to effectively participate in procurement processes and ensure access to medicines for HIV/TB treatment.
In Kazakhstan, comprehensive justification documents were prepared to demonstrate the benefits and necessity of transferring procurement responsibilities to the Sole Distributor. The legal rationale was presented to a wide range of stakeholders at the working meeting “On expanding access to essential medicines for people living with HIV by amending the legal acts regulating the procurement of medicines” held in Q4 2024.
In Kyrgyzstan, an advocacy strategy was developed based on an analysis of the procurement of ARV tests, HIV diagnostic and treatment monitoring products procured with public funds and humanitarian supplies funded by the Global Fund (GF) and UNDP. Official letters were also sent to the State Enterprise “Kyrgyzpharmacy” and the GF, UNDP outlining potential measures to optimize procurement processes and reduce the cost of ARVs and diagnostic tests. In addition, a number of informal discussions were held with the Kyrgyzpharmacy SE, the Republican Center for HIV/AIDS Control and GF/UNDP on further optimization of procurement strategies, expansion of the range of ARVs and diagnostic tests procured with public funds, and the possibility of reducing the cost of certain ARVs and diagnostic tools. A meeting was also held with experts engaged by the GF and the GF/UNDP to prepare for the transfer of GF grant management to national agencies.
In Moldova, to identify potential obstacles and opportunities for the introduction of a procurement mechanism through international procurement agencies, a comprehensive review of the current legislation on procurement of medical devices and medicines was conducted. An assessment of the current clinical protocol was conducted to develop recommendations for the inclusion of ART drug resistance monitoring. These recommendations were presented to the CCM HIV Working Group, and efforts are ongoing to advocate for their inclusion in the 2025 revision of the National HIV Protocol.
ECAT meeting was held on December 4–6 in Tbilisi, Georgia.
Reports on procurement monitoring of CD4 and VL tests as well as the rapid tests for HIV implemented in 2023 are published.
HSS: Health products management systems
Community-led advocacy of elimination of identified critical discrepancies with the WHO prevention, testing and treatment guidelines
Progress to date
Current testing and treatment protocols analysis is finished in 7 countries (Armenia, Moldova, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan, and Ukraine) and recommendations to align the national protocols with the WHO guidelines are provided. The report is available at the link.
WHO has held the analysis of HIV testing guidelines in 6 countries of EECA – Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Uzbekistan. The report is available at the link.
National HIV testing and ART-optimized strategies based on and aligned with the WHO recommendations were developed for 4 EECA countries – Armenia, Kazakhstan, Kyrgyzstan, Moldova.
In Armenia, Kazakhstan, Kyrgyzstan, and Moldova, all key actions related to the development and implementation of HIV testing and ART optimization strategies, in line with WHO recommendations, have been completed. According to the results of the assessment in 2022, there was a need to replace Georgia with another country to implement activities for 2023 and 2024 since the Georgian testing and treatment protocol is generally in line with the 2021 WHO recommendations for the use of ARV drugs for the prevention and treatment of HIV, and as well as other aspects of the clinical management of HIV. During project meetings different optios were discussed, and the desicion was taken to continue the activities in Armenia instead of Georgia.
Kazakhstan
- Approved – Order of the Ministry of Health of the Republic of Kazakhstan No. 774 dated 08.11.2024. This Оrder amended the Order of the Ministry of Health of the Republic of Kazakhstan dated 16.03.2023 No. 155 in the context of changes and updates in terms of implementation of the items of the Roadmap “On Implementation of Measures for HIV Prevention in the Republic of Kazakhstan for 2025-2026”, in particular:
- Amendments to paragraph 23 of the Order of the Minister of Health of the Republic of Kazakhstan dated November 30, 2020, No. KR DSM-224/2020 “On Approval of the Standard for the Organization of Medical and Social Assistance in the Field of Mental Health to the Population of the Republic of Kazakhstan” (registered in the Register of State Registration of Normative Legal Acts No. 21712) regarding the provision of PTAO services at the hospital level are scheduled for the 3rd quarter of 2026.
- Amendments and additions to the Clinical Protocols: “HIV infection in adults”, ‘HIV infection in children’, ‘HIV/TB co-infection’, taking into account the update of the best international practices, is scheduled for the 4th quarter of 2025.
- Approved – Order of the Minister of Health of the Republic of Kazakhstan dated June 24, 2024 № 29 on amendments to the Order of the Minister of Health of the Republic of Kazakhstan dated December 3, 2020, No. KR DSM-231/2020 “On Approval of the Rules for Investigation of Cases of HIV Infection among the Population”.
- Approved – Order of the Ministry of Health of the Republic of Kazakhstan dated July 11, 2024 No. 55 “On Amendments and Additions to the Order of the Ministry of Health of the Republic of Kazakhstan dated October 19, 2020 No. KR DSM-137/2020 ‘On Approval of the Rules for Conducting Measures for the Prevention of HIV Infection’.
- Drafted – Amendments to the Code of the Republic of Kazakhstan dated July 7, 2020 “On the Health of the People and the Health Care System” on HIV infection”. It is expected that at the beginning of 2025, it will be approved.
Moldova
- Approved – National Clinical Protocol “Treatment of Viral Hepatitis C in Adults” approved by the Order of the Ministry of Health of the Republic of Moldova dated 11.10.2024.
- Drafted – National Clinical Protocol “Pre-exposure prophylaxis of HLV infection (PrEP)”.
Solutions
Implementer:
- Select an implementer
- 100% Life
- SEH
Period:
HSS: Health products management systems
Community-led advocacy of elimination of identified critical discrepancies with the WHO prevention, testing and treatment guidelines
Progress to date
Current testing and treatment protocols analysis is finished in 7 countries (Armenia, Moldova, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan, and Ukraine) and recommendations to align the national protocols with the WHO guidelines are provided. The report is available at the link.
WHO has held the analysis of HIV testing guidelines in 6 countries of EECA – Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Uzbekistan. The report is available at the link.
National HIV testing and ART-optimized strategies based on and aligned with the WHO recommendations were developed for 4 EECA countries – Armenia, Kazakhstan, Kyrgyzstan, Moldova.
In Armenia, Kazakhstan, Kyrgyzstan, and Moldova, all key actions related to the development and implementation of HIV testing and ART optimization strategies, in line with WHO recommendations, have been completed. According to the results of the assessment in 2022, there was a need to replace Georgia with another country to implement activities for 2023 and 2024 since the Georgian testing and treatment protocol is generally in line with the 2021 WHO recommendations for the use of ARV drugs for the prevention and treatment of HIV, and as well as other aspects of the clinical management of HIV. During project meetings different optios were discussed, and the desicion was taken to continue the activities in Armenia instead of Georgia.
Kazakhstan
- Approved – Order of the Ministry of Health of the Republic of Kazakhstan No. 774 dated 08.11.2024. This Оrder amended the Order of the Ministry of Health of the Republic of Kazakhstan dated 16.03.2023 No. 155 in the context of changes and updates in terms of implementation of the items of the Roadmap “On Implementation of Measures for HIV Prevention in the Republic of Kazakhstan for 2025-2026”, in particular:
- Amendments to paragraph 23 of the Order of the Minister of Health of the Republic of Kazakhstan dated November 30, 2020, No. KR DSM-224/2020 “On Approval of the Standard for the Organization of Medical and Social Assistance in the Field of Mental Health to the Population of the Republic of Kazakhstan” (registered in the Register of State Registration of Normative Legal Acts No. 21712) regarding the provision of PTAO services at the hospital level are scheduled for the 3rd quarter of 2026.
- Amendments and additions to the Clinical Protocols: “HIV infection in adults”, ‘HIV infection in children’, ‘HIV/TB co-infection’, taking into account the update of the best international practices, is scheduled for the 4th quarter of 2025.
- Approved – Order of the Minister of Health of the Republic of Kazakhstan dated June 24, 2024 № 29 on amendments to the Order of the Minister of Health of the Republic of Kazakhstan dated December 3, 2020, No. KR DSM-231/2020 “On Approval of the Rules for Investigation of Cases of HIV Infection among the Population”.
- Approved – Order of the Ministry of Health of the Republic of Kazakhstan dated July 11, 2024 No. 55 “On Amendments and Additions to the Order of the Ministry of Health of the Republic of Kazakhstan dated October 19, 2020 No. KR DSM-137/2020 ‘On Approval of the Rules for Conducting Measures for the Prevention of HIV Infection’.
- Drafted – Amendments to the Code of the Republic of Kazakhstan dated July 7, 2020 “On the Health of the People and the Health Care System” on HIV infection”. It is expected that at the beginning of 2025, it will be approved.
Moldova
- Approved – National Clinical Protocol “Treatment of Viral Hepatitis C in Adults” approved by the Order of the Ministry of Health of the Republic of Moldova dated 11.10.2024.
- Drafted – National Clinical Protocol “Pre-exposure prophylaxis of HLV infection (PrEP)”.
HSS: Health products management systems
Decentralization of HIV testing services through integration to primary healthcare
Progress to date
Synthesis Report on assessment of readiness of health systems to decentralize HIV testing services in 5 countries of the EECA region is developed and can be found at the link.
The road maps were finalized in Armenia, Georgia, Moldova, Kazakhstan, and Kyrgyzstan.
Amendments related to HIV testing in Kazakhstan and Georgia were approved at the end of 2023. This, with close collaboration with local and international consultants, enabled in 2024 to focus on implementing normative acts through various measures, such as training sessions, advocacy campaigns, and strengthening cooperation among local CSOs and stakeholders into practice.
Local CSOs/community-based organizations, already involved in HIV testing, will play a key role in the decentralization of HIV treatment, further strengthening access to care at the community level.
1. Georgia
Georgia has completed the process of developing and approving regulations for decentralizing HIV testing and treatment. The HIV strategy for 2023–2025 was approved, and amendments to the national HIV/AIDS program have been made, including the creation of new testing and outpatient treatment points in new regions (Telavi, Akhaltsikhe, Poti, Khashuri). Measures for centralized supply of HIV tests have also been introduced. These changes came into force in January 2024.
Amendments approved by the Government of Georgia, on December 30, 2024. Annex 7 of the program regulates HIV services and indicates that decentralized testing with 2 different test kits will be implemented as a pilot together with sub contractor organizations and NGOs working with high risk groups in 8 cities of country – Tbilisi, Telavi, Khashuri, Akhsltsike, Kutaisi, Zugdidi, Poti and Batumi.
2. Kazakhstan
In Kazakhstan, in 3 cities: Almaty, Pavlodar and Ustkamenogorsk HIV testing is available through CSO, community based organizations: “You are not alone”, “Answer” and “Kemel Arma Foundation”. The document was registered in the Ministry of Justice of the Republic of Kazakhstan on December 4, 2023 № 33715. The adopted and entered into force document approving tariffs for HIV servies. In addition, the Roadmap to prevent HIV infection in the Republic of Kazakhstan for 2023-2026 was approved by Order of the Ministry of Health No. 155 dated March 16, 2023.
Solutions
Implementer:
- Select an implementer
- APH
- ENPUD
- FreeZone
- EWNA
- EKPC
Period:
Reducing human rights-related barriers to HIV/TB services
REAct (https://react-aph.org/): Monitoring of human rights violations and discrimination against PLHIV and KPs. Responding to such cases through provision or referring to legal or social services to victims and through advocacy actions. In Georgia, Kyrgyzstan, Moldova and Tajikistan, REAct system was initiated within SoS_project#1.0 in 2020, and in 2022 is transferred to national funding, meanwhile APH continues to provide technical support to users. In Ukraine, REAct was implemented in 2019 and is functional within national GF grant. REAct system is supported by APH in Uzbekistan for 2022-2023, in 5 Balkan countries – for 2022-2024, and in Armenia and Azerbaijan – for 2023-2024. At the same time, regional networks ECOM and ENPUD started to use REAct program for documentation in several countries of the region and are supported for 2022-2024 within SoS_project#2.0 grant.
Progress to date
Cumulatively, during 2022 there were registered 6700+ cases in 13 countries (Albania, Armenia, Bosnia and Herzegovina, Georgia, North Macedonia, Moldova, Montenegro, Kazakhstan, Kyrgyzstan, Tajikistan, Serbia, Ukraine, Uzbekistan) involving 170+ CBOs, as well as regional networks such as ECOM (in Uzbekistan, Tajikistan, Armenia, Kazakhstan, Kyrgyzstan) and ENPUD (Georgia, Moldova, Ukraine, Kyrgyzstan, Kazakhstan, Tajikistan, Belarus).
The following publications are available:
- Statistic country reports by APH on human rights violations based on REAct data collected in 2021 in Kyrgyzstan, in Georgia, in Moldova, in Tajikistan.
- Protectors or Perpetrators: the impact of unlawful policing on human rights and HIV. Join analytical publication in partnership with Frontline AIDS, Alliance for Public Health (Ukraine, Kyrgyzstan, Tajikistan, Moldova, Georgia, Uzbekistan), AIDS Foundation (South Africa), Gender Dynamix.
- Report on the results of the analysis of the Hotline calls by APH: Domestic and other forms of violence against women living with HIV and women in key populations during the COVID-19 pandemic in Tajikistan.
- REAct Statistical Report for the 1st half of 2022 by APH. Violations of the rights of people living with HIV and representatives of vulnerable groups in Georgia.
Situational Report by APH: Drug policy in Georgia and Challenges. - Series of publications by APH based on REAct data within regional campaign “16 days against gender-based violence”.
REAct system is available and functional at the national level in the following counties. It enables documentation of cases of human rights violations: Albania (45 cases), Armenia (182), Azerbaijan (174), B&H (70), Montenegro (60), Kazakhstan (363), North Macedonia (42), Tajikistan (1155), Serbia (24), Uzbekistan (835). More detailed data of 2023 is available in REAct Regional Digest and REAct website.
Cumulatively in 10 countries, 49,9% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions. During 2023 in 10 countries, there were provided 2162 consultations about human rights, 1022 consultations with professional lawyers. In 168 cases REActors helped to draft simple legal documents, such as complains or statement to police, in 236 cases represented client’s interests in medical facilities, assisted in getting medical services and support, in 336 cases – accompanied the client in the initial appeal to the police. There were at least 20 strategic court cases, and at least 162 cases were used for shadow reports to UN Treaty Bodies.
Cumulatively in 8 countries (Armenia, Azerbaijan, Kazakhstan, Albania, Bosnia and Herzegovina, Montenegro, North Macedonia, Serbia) 56,2% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions (https://drive.google.com/drive/folders/1wtJaecXERatg8cmrAE1mzaoshtdLQY_w). Numerous success stories of cases resolutions are available at REAct website.
Reducing human rights-related barriers to HIV/TB services
Ensure a monitoring system for the implementation of the human right to health in prisons through national preventive mechanisms
Progress to date
An analysis of the current situation regarding the development and implementation of tools to ensure access to harm reduction services with a focus on OST was conducted by FreeZone in Georgia and in Kyrgyzstan.
An analysis of the current functioning of NPMs was carried out by FreeZone in Moldova and Kazakhstan.
For Moldova and Kazakhstan, Information on key indicators of the incidence of socially dangerous diseases in penitentiary institutions was collected, namely data on the total number of convicts held in penitentiary institutions; detailed information on the number of people living with HIV infection; the number of detected cases of tuberculosis; the number of convicts who were provided with treatment for viral hepatitis. The results can be found at the links: Moldova, Kazakhstan.
In Georgia, the Overdose prevention training module was developed for prison staff. The Module is aimed at training the prison employees involved in the release preparation programs. The training module contains both theoretical material, as well as practical exercises. The Module details overdose prevention mechanisms and interventions that are necessary in case to prevent death.
In Kyrgyzstan, meetings were held with the Ministry of Justice, the Ministry of Finance, etc. on the expanding health services, including HIV services in the penitentiary institutions; extended discussions were initiated at the Country Coordination Committee meetings and round tables on issues related to expanding government funding for penitentiary institutions.
In Moldova, temporary accreditation of the training program for the profession of “peer-to-peer consultant” in penal institutions of Moldova was obtained, and activities related to advocating for the inclusion of the position of “peer-to-peer consultant” in the list of positions in penitentiary institutions were provided.
In Kazakhstan, on November 30, 2023, a meeting was organized to discuss the current issues of compulsory social health insurance, the guaranteed volume of free medical care services for representatives of the PWUD community, drug provision, and diagnosis of diseases among prisoners. To intensify community participation in the mechanisms to ensure the implementation of state policy on combating TB and HIV/AIDS, the prisoners and ex-prisoners community member was included in the CLM Working Group during the Country Coordination Committee meeting on November 3rd, 2023.
In Ukraine, communication was ensured with the relevant government bodies (Center for Health Protection of the Ministry of Health of Ukraine, the Health Center of the State Criminal-Executive Service of Ukraine, and others) to advocate for the updated SOP standard. Discussions were initiated for the preliminary approval of the SOP “Diagnostics, treatment and support of PLHIV (and suspected HIV) in medical points of the Health Center of the State Criminal-Executive Service of Ukraine”. An updated SOP was presented and discussed within the Working Group on ensuring the continuity of services in the penitentiary institutions. An order of the Health Center of the State Criminal-Executive Service of Ukraine on the approval of SOP has been prepared, signed, and published.
Moldova
10 training sessions for selected peer-to-peer consultants were held on the basis of the Peer Counselor’s Manual to train consultants among prisoners. Each session lasted 6 hours and included theoretical and practical components of counselor training. As a result of this training, two prisoners from Penitentiary Institution #4 and, Penitentiary Institution #7 were prepared as peer counselors (1 Male, 1 Female) and started provision of services to inmates on a voluntary basis.
Kazakhstan
Cooperation between NGO “Kazakhstan Union of People Living with HIV” and Department of organization of medical care of the Ministry of Health of the Republic of Kazakhstan and Committee of Criminal Executive System of the Ministry of Internal Affairs of the Republic of Kazakhstan was established, that led to improved service provision for prisoners. Increase in the state order for work with people released from prison was advocated.
Kyrgyzstan
In order to increase state funding for health care services in the penitentiary system, negotiations were held with representatives of the State Service of Penitentiary Execution (SSPE). As a result of negotiations and communication, the SSPE increased the planned budget for health services in the penitentiary system in 2025 to 25 million KGS (compared to 13 million KGS in 2024).
Consultant is monitoring the activities related to the Program on HIV and Hemocontact Viral Hepatitis 2024-2027 in the Republic of Kyrgyzstan regarding people who are incarcerated. The work is in place to ensure inclusion of necessary services for prisoners – needle exchange programs, OAT, and conducting advocacy to ensure state funding for HIV, TB, hepatitis diagnostic services in the penitentiary system, and support for released prisoners.
Georgia
Due to the unstable political situation in the country regarding the adoption of the law on foreign agents, the project activities were not implemented.
Reducing human rights-related barriers to HIV/TB services
Women-led research, “Monitoring of violence against women living with HIV”, including factors preventing support/help seeking behaviors for women living with HIV who experience violence
Reducing human rights-related barriers to HIV/TB services
Developing and launching call for “Gender and HIV” small grants with special eligibility focus on Monitoring situation with human rights of Trans* people
Progress to date
Small Grants Programme with 4 selected projects run by grass-root NGOs in 2022 included:
- “National Trans Coalition” NGO with the project titled “HIV prevention in Armenia through gender mainstreaming” (Armenia);
- “The Public Association “Union for Equity and Health” NGO with the project titled “Gender Equality for sex workers” (Moldova);
- “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Check your health – Equality for Trans Roma and Roma women/girls sex workers” (Serbia);
- “NON-GOVERNMENTAL ORGANIZATION «NASHA DOPOMOGA»” with the project titled “RIGHT TO HEALTH!” (Ukraine).
- The project applicant is the organization “Albanian Association of People Living with HIV/AIDS (PLWHA)” with the project titled “New approach on transforming the spiral of exclusion and marginalization, towards the right of recognition before the law, gender-diverse and reduce the violence in health-care settings for trans persons in Albania”.
- The project applicant is the “National Trans Coalition” NGO with the project titled “Strategic pathway to remove structural barriers for trans* communities to PrEP and PEP services in Armenia”. The proposed project has been designed to establish favorable conditions for improving access of Trans* communities to PrEP and PEP services in Armenia.
- The project applicant is the organization “STAR STAR” Skopje with the project titled “Community Mobilization to Mitigate Funding Cuts and Gender Inequality in National HIV Programs for Sex Workers in North Macedonia”. The project is envisioned as a response to the latest developments in North Macedonia related to provision and delivery of HIV prevention services for key populations.
- The project applicant is the organization “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Supporting health wellbeing and safety of Trans and Intersex Roma, sex workers and HIV+”.
In 2024, grants “Gender and HIV” were implemented in Albania, Georgia, Moldova and Ukraine.
Moldova
GENDERDOC-M, alongside a parent support group, aimed to create a safe and inclusive environment for transgender and gender-nonconforming youth. Two formal partnerships with youth clinics expanded access to health services and 24/7 hotline support. Parent education sessions led to increased understanding, school negotiations for name recognition, and medical referrals. As a result, a strategic plan for 2025 includes engaging health and education ministries to address systemic barriers.
Georgia
The Queer Association Temida established an informal network of trans-friendly professionals across three cities, despite restrictive anti-LGBT laws. The network held two meetings to discuss the legal landscape and continued service delivery. A memorandum with Psychea Mental Health Center helped maintain access to gender-affirming care. A peer educator training course was launched, and two trained educators provided online consultations to 32 beneficiaries, offering support on HIV and gender-affirming care.
Ukraine
The “Help Is Near” project by HPLGBT produced a comprehensive report on barriers and solutions in trans health services, especially for intersectional groups like sex workers and those using psychoactive substances. Recommendations for service decentralization were developed and are planned to be presented to the CCM in early 2025. HPLGBT aims to integrate these recommendations into national funding requests to the Global Fund, ensuring sustained support for marginalized trans communities.
Solutions
Implementer:
- Select an implementer
- ECECACD
Period:
Reducing human rights-related barriers to HIV/TB services
Development and promotion of the Guiding principles (recommendations, model legislation etc.) on drug policy for the EECA region with specific advocacy efforts for reforming drug policy and decriminalization of personal drug use
Progress to date
The Guiding Principles document is developed and approved by the ECECACD. The first draft of the document was reviewed and discussed during in-person meeting of Commissioners on November 2, 2022 (the Minutes extract with provided recommendations to the document are available upon request). The document was amended accordingly to the recommendations and sent for the second review by Commissioners. Commissioners provided their recommendations and corrections to the text (the letters and texts with corrections are available upon request). Final amendments was done, the document was completed and finally approved by Commissioners (relevant correspondence is available upon request). The final version of the Guiding principles is under design.
In 2023, the EECA Drug Policy Commission conducted two country visits: to Kyrgyzstan on 19-21 June, 2023, to Moldova on 11-13 September, 2023 to present and promote the ‘Guiding Principles’ during the meetings at the highest political level. Prime Ministers of these countries, Ministers oh Health, Ministers of Internal Affairs, Members of the Parliament, other officials have received a copy of this document. Commissioners provided their expertise and arguments in support of changes to drug legislation based on the pathways described in the document.
In addition, Commissioners participated in several international Conferences to promote Guiding Principles and advocate for a change in drug policy: International Harm Reduction Conference, Melbourne (Australia), European Conference on Law Enforcement and Public Health, Umeå (Sweden), Drug policy discussions in Georgia. August 3, 2023, Public discussion of the state strategy on drugs, December 18, 2023 Kyiv, Ukraine.
Moreover, the recent OHCHR Report Human rights challenges in addressing and countering all aspects of the world drug problem” contains direct referring to Guiding Principles.
Kazakhstan
A high-level meeting in Astana, attended by President Kassym-Jomart Tokayev and ECECACD Commissioners, successfully prevented the closure of opioid agonist therapy (OAT) programs in Kazakhstan. The government secured OAT medicine procurement for 2025, ensuring continued treatment for opioid dependence. https://ececacd.org/high-level-meeting-in-astana-on-drug-policy-and-opioid-agonist-therapy/
Kyrgyzstan
In 2024, Kyrgyzstan replaced the term “registry of people with drug dependency” with “dynamic monitoring,” shifting from a law enforcement focus to a medical record approach. Legislative amendments were made, and a working group drafted seven subordinate legal acts to support this transition, with further government review ongoing into 2025.
https://cbd.minjust.gov.kg/4-5260/edition/1939/ru
https://cbd.minjust.gov.kg/4-5301/edition/3727/ru
Moldova
ECECACD engagement in Moldova throughout 2024 led to discussions on reforming the National Anti-Drug Commission, proposing its transfer to the Cabinet of Ministers. A December 2024 national meeting resulted in a recommendation to develop a new National Drug Strategy in 2025. The National Commission on Drugs officially endorsed this, forming an inter-ministerial working group to oversee its development. https://ececacd.org/planning-drug-policy-reform-in-moldova/
Georgia
In response to Georgia’s rollback towards undemocratic, pro-Russian approaches, we have taken emergency measures to prevent the deterioration of the country’s drug policy situation. A multi-stakeholder dialogue meeting on harm reduction and drug policy was held in May 2024, and “Recommendations to community organizations on risk reduction related to legal acts enacted in 2024” were emergently developed, striving to respond to the crisis. In addition, in December 2024, the Recommendations to community organizations on risk reduction related to some legal acts enacted in 2024, were developed and distributed among key actors and stakeholders to inform Georgian leaders and activists of LGBT community organizations what steps can be taken to reduce the risks appeared after enacting several new laws, particularly the law “On Protection of Family Values and Minors”.
Solutions
Implementer:
- Select an implementer
- SEH
Period:
HSS: Health sector governance and planning
Increasing domestic financing of countries for services to key groups
Progress to date
Targeted activities were held in all project countries to discuss with national and international, governmental and non-governmental stakeholders the changes needed to enable sustainable and uninterrupted funding of HIV-related activities from national resources. Through targeted advocacy, technical support, and an integrated approach to HIV funding, in 2022 the project team managed to allocate approximately 1,7 million USD at the national level to programs for key populations, using social contracting mechanisms: Moldova – 154,126.84 USD; Kazakhstan – 118,529.33 USD; Kyrgyzstan – 61,000 USD; Tajikistan – 19,200.00 USD; Georgia – 357,000 USD; Ukraine – 931,453.96 USD.
Thanks to budget advocacy within the SoS project 2.0, the amount of money allocated from national budgets for HIV services through social contracting mechanisms in EECA project countries amounted to $3 269 959 in 2024. During SoS project 2.0 – $ 6 273 049 were allocated for social contracting in EECA region. The cumulative domestic budget expenditures for servicing key populations in 5 countries of SEE amounted to $1 061 383 in 2024. During SoS project 2.0 – $ 3 236 260 were allocated for social contracting in SEE region.
Solutions
Implementer:
- Select an implementer
- SEH
- SEH
Period:
HSS: Health sector governance and planning
Legal framework for financing HIV services from domestic funds – development and approval
Progress to date
Targeted activities were held in all project countries to discuss with national and international, governmental and non-governmental stakeholders the changes needed to enable sustainable and uninterrupted funding of HIV-related activities from national resources. Through targeted advocacy, technical support, and an integrated approach to HIV funding, in 2022 the project team managed to allocate approximately 1,7 million USD at the national level to programs for key populations, using social contracting mechanisms: Moldova – 154,126.84 USD; Kazakhstan – 118,529.33 USD; Kyrgyzstan – 61,000 USD; Tajikistan – 19,200.00 USD; Georgia – 357,000 USD; Ukraine – 931,453.96 USD.
Over three years of implementation of SoS_project 2.0 has contributed to significant changes in the financing of HIV services in 14 countries in SEE and EECA regions. The project supported the development of service delivery standards, pricing methodologies, and quality control procedures, which are critical for sustainable financing from the state budget.
The practice of social contracting is applied without interruption in 14 countries.
HSS: Health sector governance and planning
Regulation of service packages for key groups
Progress to date
In the reporting period, the Emergency package of services for key and vulnerable groups of the population in the field of HIV, and TB in the context of military conflicts was finalized, including tariffication. On its basis, in 2023, the process of advocacy and promotion of implementation at the level of countries in the EECA region will be launched.
Strategic Brief on Business Continuity (link) and Strategic Brief on Social contracting (link) were developed. In addition, Analysis of Quality of Services Provided in Azerbaijan was held and is available at the link.
Over three years of implementation of SoS_project 2.0 has contributed to significant changes in the financing of HIV services in 14 countries in SEE and EECA regions. The project supported the development of service delivery standards, pricing methodologies, and quality control procedures, which are critical for sustainable financing from the state budget.
The practice of social contracting is applied without interruption in 14 countries.
Solutions
Implementer:
- Select an implementer
- APH
- Positive Initiative
Period:
RSSH: Health sector governance and planning
REGIONAL: regional dashboard (with 2 integrated portals) + preliminary results to be reflected on the timeframe / deadlines, at least for this year
Progress to date
ToR for the dashboard is under development; methodologies and approaches to data collection for the social contacting and sustainability and transition portals are being updated.
The concepts and the ToRs for the database, BI analytics module and website to present the information from the dashboard were developed.
Objective Description:
OBjective task:
- Select a objective task
- Removing structural barriers to increase of HIV testing in EECA
- Removing structural barriers to ART in EECA
- Launching critical enabling interventions to improve HIV care cascade
- Emergency response to support Ukraine refugees from among PLHA and KPs fleeing from russian war on Ukraine
- Implementation of COVID-19 response mechanism
- Select a objective task
- Monitoring situation with human rights of KPs, responding to viloations
- Revision of legisation and other regulations on KPs that pose barriers to accessing HIV services:
- Select a objective task
- IT solutions to improve the efficiency of service delivery within the HIV care cascade and ensure the sustainability of HIV services
Solutions
Implementer:
- Select an implementer
- APH
- APH
Period:
Integrated service delivery and HIV service quality improvement
Organization and support of two shelters (Kyiv and Ivano-Frankivsk regions), one-time support for 4 shelters, material payments to OST clients
Progress to date
60 stationary places for living in shelters in Kyiv and Ivano-Frankivsk regions were organized with support of food, transportation, coverage of a basic package of medicines and household goods, clothing for 405 people from key groups and members of their families. Provided technical support to 4 shelters (Poltava, Cherkasy, Kryvyi Rih and Zhytomyr). 70 payments were made for the payment of rent and provision of proper social and living conditions for the participants of the OST program. 22 payments were made to victims of violence from the Russian occupiers. In total, more than 1,500 people were covered by the program.
This project was supported in 2022.
Integrated service delivery and HIV service quality improvement
Provision of support to refugees among KPs and PLHIV as a part of emergency response: Ensuring better access to services for people who have moved to other countries due to the war (incl communication, navigation, case management): launch and sustaining of an international support service (HelpNow), two HelpNow hubs, a web portal with crucial regularly updated information and online medical consultations solution
Progress to date
Activity currently being funded from alternative sources.
After the GF financial support of the initative ended, in 2023 it was supported by Aidsfonds, which allowed for seamless continuation of work in full scale for 10 months; several more months were focused on finalising the program and establishing a Polish-based Foundation “Help Now Hub” to enable the opportunity to further support refugees and other groups requiring relevant support in Poland and beyond. At the same time, even after the funding had ended, the teams partially continue(d) to provide support and maintain the communication/information resources on a volutarily basis.
Solutions
Implementer:
- Select an implementer
- APH
- CAAPLA
- ECOM
- EHRA
Period:
Supporting key group populations in a COVID setting
REGIONAL: Operational researches on the impact of COVID-19 on HIV service delivery
Progress to date
The following studies have been carried out:
- Operational study to assess the ways/channels/mechanisms used by various key populations from different countries to access services, research and communications in times of COVID-19 (Alliance)
- Domestic and other forms of violence among transgender women, sex workers and women who use drugs during COVID-19 pandemic (in Tajikistan and Uzbekistan)
- Monitoring and Documentation of Rights Violations Faced by Trans* People during COVID-19 Pandemic in EECA (in process) (ECOM)
- Health and social well-being of MSM and trans*people in EECA during COVID-19 pandemic (in process) (ECOM)
- Situation Analysis on the Provision of HIV Health Services for Foreign Migrant Citizens in Kazakhstan (Kaz)
- An overview of best practices based on civil society and medical institutions in the Russian Federation in assisting foreign migrants in the Russian Federation and overcoming barriers for migrants to access HIV services (Kaz)
- Webinar Series on Police Responses to Gender-Based Violence against Women Who Use Drugs: Practices and Opportunities;
- Development of interactive materials for women who use drugs in violent settings (EHRA)
Solutions
Implementer:
- Select an implementer
- ECOM
- WHO
- APH
Period:
Prevention (Pre-exposure prophylaxis – PrEP)
REGIONAL: Contribute to the transformation of the perception and understanding of the importance of PrEP as one of the key HIV prevention approaches at all levels and for all key populations in the countries of the EECA region and SEE sub-region
Progress to date
ECOM in partnership with WHO regional office for Europe analyzed five national PrEP protocols (Armenia, Kazakhstan, Kyrgyzstan, Georgia and Ukraine) and provided Report with recommendations on the steps needed to include PrEP into nationally approved standard package of services.
Promotion and technical support of PrEP programs is one of the main tasks for HIV prevention within the framework of SoS 2.0 project. WHO and ECOM conduct consultations at all levels of stakeholders interested in this process – meetings with representatives of AIDS centers and CCMs, monitoring visits, technical support in the development of Protocols, regional consultations. Based on the analysis of PrEP Protocols and updated WHO recommendations, policy briefs were developed and sent to countries, the purpose of which was to show and not miss the importance of new interventions that can improve PrEP services in countries. The innovative project on LA CAB in Ukraine became the basis for promoting a regional information campaign throughout the EECA region. Results were presented and meetings were held with partners during EACS 2023 in October 2023. On November 21–22, the 1st (Sub) Regional Consultation on PrEP among MSM and trans people in Central Asia was held in Almaty. This is the first consultation of this scale, which brought together all key stakeholders: representatives of the LGBT community of Kazakhstan, Kyrgyzstan, Tajikistan and Turkmenistan, health specialists, international organizations and donors.
In 2024, the 2nd Subregional Consultation on PrEP among MSM and trans* people in Central Asia was held, which was organized by ECOM in partnership with WHO with the support of the SoS project 2.0. This year, the event brought together over 120 stakeholders from 15 different countries and became a platform for an active exchange of experiences and best practices in the field of PrEP among the countries of Central Asia.
Integrated service delivery and HIV service quality improvement
REGIONAL: Targeted online sexual / reproductive and mental health intervention for experimenting youths: online services to be provided in a wider range of the countries of the region, as well as offline in one Balkan country
Progress to date
Policy statement, being finalised, will be launched in March 2023. Implementation guide with case studies under development.
APH together with representatives of International Harm Reduction Professional organizations, developed a Joint Policy Statement: “Emerging priorities for the reduction of harms associated with recreational use of psychoactive substances in Eastern, South Eastern Europe and Central Asia” which presents key principles and methods of harm reduction work. Intervention Development and Implementation Guide “Harm Reduction Services for People who Use Psychoactive Substances in Recreational Contexts” was developed. The featured approaches and interventions will be particularly useful for the development of programs and services for young women, men and transgender people from key populations and other young people who experiment with psychoactive substances and navigate through the complexities of their sexual lives and relationships. Translation and adaptation of A blended training course: community mental health interventions in partnership with Mainline is launched and will be available for EECA.
Translation and adaptation of a blended training course: community mental health interventions in partnership with Mainline was launched and is available for EECA.
Solutions
Implementer:
- Select an implementer
- HAC
- 100% Life
- HAC
- HAC
Period:
HSS: Health products management systems
REGIONAL: Provision of technical assistance to national CSOs to reduce the price of treatment and diagnostics in countries of the EECA region
Progress to date
Draft reports on procurement monitoring of CD4 and VL tests as well as the rapid tests for HIV have been prepared and a session on diagnostics and ARVs price reduction advocacy was organized and held during the National Consultation in Moldova.
According to the project work plan, the annual meeting of the Eurasian Community for Access to Treatment (ECAT) was held in Almaty on September 27–29, 2023. The Eurasian Community for Access to Treatment (ECAT) sent an open letter to the pharmaceutical company ViiV Healthcare with a request to expand the scope of the license agreement for cabotegravir with the Medicines Patent Pool, adding at least Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan and Moldova.
Analysis of the procurement of rapid tests for HIV diagnosis was held in Moldova and Kyrgyzstan and is available at the links (in Russian): Moldova, Kyrgyzstan.
Analysis of the procurement of test systems for monitoring HIV treatment was held in Moldova and Kyrgyzstan and is available at the links (in Russian): Moldova, Kyrgyzstan.
ECAT meeting was held on December 4–6 in Tbilisi, Georgia.
Reports on procurement monitoring of CD4 and VL tests as well as the rapid tests for HIV implemented in 2023 are published.
According to the analyzed data, during 2022-2024, three countries – Kazakhstan, Kyrgyzstan and Moldova – gained an economy of more than 17 mln USD (or 28%) in the procurement of ARVs. Since 2021, Kazakhstan succeeded in decreasing the price for DTG by 58%, Kyrgyzstan decreased the price for TLD by 28-32%, and Moldova also decreased the price for TLD by 27%.
HSS: Health products management systems
REGIONAL: Provide technical support to SEE RCN and national SEE CSOs to advocate for ART procurement price reductions in five (5) countries of SE Europe
Progress to date
According to the project work plan, the annual meeting of the Eurasian Community for Access to Treatment (ECAT) was held in Almaty on September 27–29, 2023. The Eurasian Community for Access to Treatment (ECAT) sent an open letter to the pharmaceutical company ViiV Healthcare with a request to expand the scope of the license agreement for cabotegravir with the Medicines Patent Pool, adding at least Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan and Moldova.
In Kazakhstan, comprehensive justification documents were prepared to demonstrate the benefits and necessity of transferring procurement responsibilities to the Sole Distributor. The legal rationale was presented to a wide range of stakeholders at the working meeting “On expanding access to essential medicines for people living with HIV by amending the legal acts regulating the procurement of medicines” held in Q4 2024.
In Kyrgyzstan, an advocacy strategy was developed based on an analysis of the procurement of ARV tests, HIV diagnostic and treatment monitoring products procured with public funds and humanitarian supplies funded by the Global Fund (GF) and UNDP. Official letters were also sent to the State Enterprise “Kyrgyzpharmacy” and the GF, UNDP outlining potential measures to optimize procurement processes and reduce the cost of ARVs and diagnostic tests. In addition, a number of informal discussions were held with the Kyrgyzpharmacy SE, the Republican Center for HIV/AIDS Control and GF/UNDP on further optimization of procurement strategies, expansion of the range of ARVs and diagnostic tests procured with public funds, and the possibility of reducing the cost of certain ARVs and diagnostic tools. A meeting was also held with experts engaged by the GF and the GF/UNDP to prepare for the transfer of GF grant management to national agencies.
In Moldova, to identify potential obstacles and opportunities for the introduction of a procurement mechanism through international procurement agencies, a comprehensive review of the current legislation on procurement of medical devices and medicines was conducted. An assessment of the current clinical protocol was conducted to develop recommendations for the inclusion of ART drug resistance monitoring. These recommendations were presented to the CCM HIV Working Group, and efforts are ongoing to advocate for their inclusion in the 2025 revision of the National HIV Protocol.
ECAT meeting was held on December 4–6 in Tbilisi, Georgia.
Reports on procurement monitoring of CD4 and VL tests as well as the rapid tests for HIV implemented in 2023 are published.
HSS: Health products management systems
REGIONAL: Support the development and functioning of a regional platform to share experience and best practices that ensure access to quality assured treatment and testing systems
Progress to date
According to the project work plan, the annual meeting of the Eurasian Community for Access to Treatment (ECAT) was held in Almaty on September 27–29, 2023. The Eurasian Community for Access to Treatment (ECAT) sent an open letter to the pharmaceutical company ViiV Healthcare with a request to expand the scope of the license agreement for cabotegravir with the Medicines Patent Pool, adding at least Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan and Moldova.
Analysis of the procurement of rapid tests for HIV diagnosis was held in Moldova and Kyrgyzstan and is available at the links (in Russian): Moldova, Kyrgyzstan.
Analysis of the procurement of test systems for monitoring HIV treatment was held in Moldova and Kyrgyzstan and is available at the links (in Russian): Moldova, Kyrgyzstan.
ECAT meeting was held on December 4–6 in Tbilisi, Georgia. More than 20 activists from countries across the EECA region participated in the meeting. The meeting was visited by representatives of MPP, pharmaceutical companies like ViiV, Gilead. At the meeting there were presentations from countries outlining news in access to treatment and regulatory documents, and presentation of Andrew Hill from the Liverpool University on the issues of treatment with Lenokapavir and Cabotegravir.
Solutions
Implementer:
- Select an implementer
- PAS with WHO involvement
- PAS
- WHO
- PAS
- WHO
Period:
Integrated service delivery and HIV service quality improvement
REGIONAL: Establish and maintain a virtual regional professional network to update testing strategies and simplify testing, diagnostic and linkage to care, and for information dissemination on evidence for HTS policy revisions in countries of the region
Progress to date
Within the sub-regional meeting in Kazakhstan in November 2022, the establishment of the virtual network was initiated. The concept and purpose of the network were presented to the participants. Within the network, participants (members) will be able to exchange experiences, ask questions, take part in discussions, share files, collaborate on documents, exchange and learn from each other on HIV testing.
During 2023, there were three meetings of virtual professional network on testing held – on March 22, June 12, and November 28. Members of the network include specialists from Moldova, Kazakhstan, Ukraine, Georgia, Kyrgyzstan, as well as representatives from ITPC EECA and WHO Centre for Primary Health Care, WHO European Office and PAS Center. At the meetings, the issues of simplified testing approaches and alignment of testing strategies with the WHO recommendations are discussed, as well as progress in the implementation by countries of National Action Plans to achieve the “first 95”.
During 2024, there were three meetings of virtual professional network on testing held – on March 21, on June 18, and on November 20. The network unites representatives of 8 EECA countries involved in testing in healthcare facilities and AIDS centers.
In addition, the Regional-level policy dialogue to showcase the experience of countries that have adopted the new HTS strategies was held on September 10-12, 2024 in Chisinau, Moldova. The main objectives of the event were to share best practices in revising HIV testing strategies and discuss ways to further improve HIV testing services in line with WHO recommendations in EECA countries. The event was attended by coordinators of the National HIV Programs and specialists responsible for laboratory diagnosis of HIV infection, monitoring and testing quality at the national level from the following countries: Moldova, Ukraine, Kazakhstan, Armenia, Azerbaijan, Kyrgyzstan, Uzbekistan, Tajikistan, Georgia, representatives of the WHO Regional Office and Alliance for Public Health, Ukraine, representatives of WHO country office, UNAIDS, PCIMU, NAPH. During the event, the achievements and challenges of the participating countries regarding the simplification of the HIV testing algorithm and its decentralization were presented. Moldova’s experience in using rapid tests and establishing the diagnosis during one day with the initiation of ARV treatment was shared
Integrated service delivery and HIV service quality improvement
REGIONAL: Conduct an initial sub-regional meeting in Kazakhstan given the WHO Geographically Dispersed Office (GDO) on primary care is based in Almaty, involving Georgia, Kazakhstan, Kyrgyzstan, Moldova and Uzbekistan.
Progress to date
On 28-30 November 2022, in Almaty, Kazakhstan the sub regional meeting on the decentralization of HIV testing services and the simplification of HIV algorithms was organized by WHO Regional Office for Europe in partnership with PAS.
The main aims of the meeting were to discuss ways to improve HIV testing services in line with WHO recommendations and to exchange countries’ best experiences of revising their HIV testing strategies. The event was attended by: representatives of the ministries of health responsible for HIV testing services, HIV programme managers, technical-level specialists from the health institutions responsible for the national HIV testing services from Kazakhstan, Kyrgyzstan, Moldova, Georgia and Uzbekistan and SoS project implementers and partners.
During the meeting, were presented and discussed: The Regional Action plans for ending AIDS and eliminating viral hepatitis and STIs 2022-2030 and HIV testing related Actions, the experience of the countries in simplifying the HIV testing algorithm and its decentralization, the main gaps, challenges and opportunities for the expansion of HIV testing services especially for key and vulnerable populations etc. Also, the representatives of the countries had the opportunity to elaborate the country plans for implementing WHO guidance on HIV testing services
Integrated service delivery and HIV service quality improvement
REGIONAL: Develop regional operational guidance on decentralization and rapid initiation of HIV testing and treatment based on country experience
Progress to date
Terms of Reference is under development to hire the consultant who will develop regional operational guidance based on country experience from Moldova and Kyrgyzstan.
WHO has held the analysis of HIV testing guidelines in 6 countries of EECA – Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Uzbekistan.
The operational guidelines based on experience of Moldova and Kyrgyzstan were translated into English and sent to WHO Euro for revision. The final versions will be presented during the Regional level policy dialogue to showcase experience of countries that have adopted the new HTS strategies, that will be organized during the Q2_Q3 2024.
Regional operational guidance on decentralization and rapid initiation of HIV testing and treatment based on country experience from Moldova and Kyrgyzstan was developed, translated into English and presented during the Regional level policy dialogue to showcase experience of countries that have adopted the new HTS strategies, which took place in September 2024 in Chisinau, Moldova.
Solutions
Implementer:
- Select an implementer
- ECOM
- ECOM
- ECOM
- EWNA
- ECOM
- EKPC
- ENPUD
- EWNA
Period:
Reducing human rights-related barriers to HIV/TB services
REGIONAL: Develop regional annual summary reports on rights violations faced by MSM and transgender people in the EECA region
Progress to date
National summary reports for 2022 are developed for five EECA countries: Armenia, Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan. They are under design and will be available by the end of January 2023. Regional summary report for 2022 will be finalized in Q1 2023.
Legal environment assessments on MSM and trans people are prepared and published in Kazakhstan, Tajikistan, Kyrgyzstan, Armenia, Uzbekistan. In addition, regional report was published Invisible Voices: Regional report on violations of the right to health of LGBT people in the region of Eastern Europe and Central Asia in 2022.
ECOM has prepared annual national summary reports of human rights violations in 5 countries. The reports consist of three main chapters:
- Legislation;
- Access to human rights;
- Conclusion and recommendations.
All reports are based on the ECOM’s REact monitoring of human rights violations based on SOGI or HIV status.
- National Report on Violations of the Rights of LGBT People in Uzbekistan;
- National Report on Violations of the Rights of LGBT People in Tajikistan;
- National Report on Violations of the Rights of LGBT People in Armenia;
- National Report on Violations of the Rights of LGBT People in Kyrgyzstan;
- National Report on Violations of the Rights of LGBT People in Kazakhstan.
Reducing human rights-related barriers to HIV/TB services
REGIONAL: Support high-level review of legislation for MSM and trans people
Progress to date
ECOM is supporting strategic litigations on human rights abuses among gay men, other MSM and trans people in Armenia. Apart from that, a number of webinars for gay men, other MSM and trans people on meaningful involvement with UN Treaty Bodies, UPR and UN Special Procedures were held, namely: “Universal Periodic Review: Advocacy within a process” on October 20, 2022, “The right to health for LGBT people: submission of alternative reports to UN treaty bodies” on November 18, 2022.
In 2023, ECOM submitted several shadow reports: Kazakhstan to CAT, Tajikistan to CEDAW, Kyrgyzstan to Follow-up procedure CAT, Moldova to UN Human Rights Committee in Advance of its Adoption of the List of Issues, UPR: Uzbekistan, Armenia to the CESCR.
ECOM has prepared annual national summary reports of human rights violations in 5 countries. The reports consist of three main chapters:
- Legislation;
- Access to human rights;
- Conclusion and recommendations.
All reports are based on the ECOM’s REact monitoring of human rights violations based on SOGI or HIV status.
- National Report on Violations of the Rights of LGBT People in Uzbekistan;
- National Report on Violations of the Rights of LGBT People in Tajikistan;
- National Report on Violations of the Rights of LGBT People in Armenia;
- National Report on Violations of the Rights of LGBT People in Kyrgyzstan;
- National Report on Violations of the Rights of LGBT People in Kazakhstan.
Reducing human rights-related barriers to HIV/TB services
REGIONAL: Rapid gender assessment of barriers faced by key populations in access to HIV services using secondary and available data
Progress to date
Gender barriers assessment is under finalization, the report will be published in Q1 2023.
The summary report on Women-led gender assessment: How countries address barriers to HIV services for women living with HIV, sex workers and women who use drugs was published (the assessment took place in 2022 and country reports were available) and can be found in English and in Russian.
Reducing human rights-related barriers to HIV/TB services
REGIONAL: Build the capacity, and raise awareness, of gender equality and rights of key populations in the region
Progress to date
On October 11, 2022, EWNA held a Regional consultation for the EECA countries “Expanding access to mental health services for women living with HIV and women from key populations” in order to identify priority measures for the integration of community-led HIV-related mental and physical health prevention, care and support services for women living with HIV and women from key populations. Based on the findings of the Regional consultation on mental health for women living with HIV and women from key populations in EECA, the EWNA developed the statement “Integration of women’s community-led mental health services into the HIV response in the EECA region”.
EHRA held online training for social workers, outreach workers, psychologists and other experts, providing counselling to people who use drugs (6 modules, 153 people trained from Armenia, Georgia, Ukraine, Moldova, Kyrgyzstan, Uzbekistan, Kazakhstan, Tajikistan and other countries), developed recommendations for organizing and providing harm reduction online.
In 2024, ECOM hold two webinars:
- Presentation of an analysis of national legislation related to LGBT rights and HIV in 12 CEECA countries: key trends;
- Information Campaigns for Promoting LGBTQ+ Rights.
ECOM has prepared the design of the Guide on Monitoring, Documenting, and Responding to Cases of Violations of the Rights of LGBT People. The link is https://ecom.ngo/library/rukovodstvo-monitoring.
Solutions
Implementer:
- Select an implementer
- EHRA
- ENPUD
- ECOM
- EHRA
- EWNA
- ECECACD
Period:
Reducing human rights-related barriers to HIV/TB services
REGIONAL: Build the capacity of the community of people who use drugs in the EECA region
Progress to date
For 4 countries (Georgia, Kyrgyzstan, Moldova and Ukraine) in December 2022, EHRA announced RFP – Subgrants: Capacity building in promotion of drug policy reform in Georgia, Kyrgyzstan, Moldova and Ukraine. The winners will be selected in early 2023.
ENPUD Expert Council on Treatment was established: prevention of interruptions in access to treatment, and monitoring the availability of stocks of OST drugs in case of force majeure. ENPUD Expert Council on Rights and Drug Policy was established: direct dialogue with decision-makers in the countries of the region. The Emergency Assistance Fund for the Protection of Human Rights Defenders (ENPUD) was established: organization of departure, starting with the preparation of visas, exit corridor; work with shelters for departure.
On December, 2024 a a pre-conference “Public Health Policing, Drug Policy Reform and Human Rights: Role of Law Enforcement in Access to Health and Harm Reduction in CEECA Countries” in Warsaw, where we brought human rights, law enforcement experts to train/educate CEECA region law enforcement peers.
Reducing human rights-related barriers to HIV/TB services
REGIONAL: Development and submission of reports to UN Treaty Bodies, UN Special Procedures or UPR on human rights violations among KPs (countries TBD)
Progress to date
ECOM in this reporting period has submitted a number of reports to the UN institutions, among which:
- an alternative report on rights violations of trans people in Kyrgyzstan to the UN Committee against Torture (CAT), for the follow up procedure. The report includes cases collected by the ECOM Reactors in Kyrgyzstan.
- an alternative report on behalf of the community of Tajikistan to the UN Special Rapporteur on the rights of Human Rights Defenders, with the data on rights violations based on sexual orientation and gender identity faced by LGBT HRDs, with a particular focus on the right to health. Report was presented at the online meeting with the UN Special Rapporteur and the relevant recommendations were made by the mandate holder in its final communique.
- an alternative report on Rights Violations based on Sexual Orientation and Gender Identity in Kyrgyzstan to the UN Human Rights Committee (HRCtee), for the Country Review.
- an alternative report on rights violations of trans people in Armenia to the UN Committee on the Elimination of Discrimination against Women (CEDAW), for the country review.
Matrix for analysing trends in human rights violations against people who use drugs is prepared and published by EHRA. The purpose of this Matrix is to facilitate the analysis of documented human right violations by grouping violations into strategic blocks that are easy to use for the subsequent reporting to human rights treaty bodies and/or as part of follow-up advocacy at national level; and to equip human rights activists with knowledge/skills in how to prepare/ write reports for a human right body. The Matrix aligns the analysis with the environment in which human rights treaty bodies and national governments develop human rights practices, surrounded and mediated by community-led monitoring.
Committee on Economic, Social and Cultural Rights Parallel Submission for 74 Session with respect to Armenia concerning the access of individuals who use drugs to health services was also published at
Analysis of measures to implement the recommendations of the United Nations human rights treaty bodies to the Republic of Kazakhstan () and Ukraine () were developed.
In 2024, EHRA prepared submissions about Kyrgyzstan and Albania to CESCR.
EHRA also made a submission about the situation in Central and Eastern Europe and Central Asia to inform the Special Rapporteur’s thematic report “Harm reduction for sustainable peace and development”
In 2024, ECOM prepared a report for the Universal Periodic Review (UPR) on the human rights situation in Kazakhstan, Kyrgyzstan, Armenia. The report “Ill-Treatment of LGBT People in Kyrgyzstan” has been submitted jointly with LGBT NGOs. ECOM, joint with national partners, submitted alternative reports on the implementation of the Sustainable Development Goals (SDGs) in Georgia and Armenia with an analysis of LGBTI inclusion in the 2030 Agenda. The report “Hate Crimes and Torture Concerning LGBT People in Kazakhstan” has been jointly submitted with a partner organisation from Kazakhstan. Submission was made within the Follow-up procedure on Concluding Observations of the UN Committee against Torture (CAT) on the Fourth Periodic Report of Kazakhstan. The ODIHR Hate Crime Report 2023 was submitted.
Reducing human rights-related barriers to HIV/TB services
REGIONAL: Coordination, support in development and submission of the CEDAW alternative/shadow reports prepared by the coalition of women’s communities (HIV-positive women, women who use drugs, sex-workers, LBT women) countries TBD
Progress to date
A shadow report on Uzbekistan was submitted to the CEDAW committee in January 2022. Recommendations to decriminalize HIV were received.
Alternative report on the implementation of the CEDAW concerning women living with HIV in Georgia for the 84th session of the UN Committee on the Elimination of Discrimination against Women was developed in 2022 and submitted in 2023, available at the link.
Reducing human rights-related barriers to HIV/TB services
REGIONAL: Engage with the EECA Commission on Drug Policy to initiate and facilitate public discourse at a high political level in the region and to raise awareness among the general public and professional groups in order to get the public to demand changes and prepare the ground for reforms
Progress to date
In 2022 there were two meetings of the ECECECAD Commissioners: on May 31, 2022 (online) and on November 2, 2022 (in person). During the meetings, Commissioners discussed the current situation and war implications to the region as well as have made decisions and plans for the work.
Commissioners represented the ECECACD at different global and regional events. President Kwasniewski and Professor Kazatchkine represented the Commission at the EuroScience Open Forum ‘Why Europe Must Lead Drug Policy Reform & Decriminalization’, July 14, 2022, Leiden, The Netherlands (online) and at the media-event in Montreal (within the International AIDS Conference), July 31 2022, Montreal, Canada. It was a good media coverage in international media after that. Mr. Andriukaitis represented the Commission at the Bloomberg CityLab 2022 Session: Drug Legalization: What Works? October 11, 2022, Amsterdam, The Netherlands (in person). Professor Kazatchkine and Olena Kucheruk contributed to producing a JIED podcast on drug policies and the war in Ukraine from 2014, October 27, 2022.
Country visit to Vilnius was conducted on November 2-4, 2022. The main advocacy target was the draft law on decriminalization of possession of small amounts of cannabis. On 23 November, the Seimas Committee on Legal Affairs approved amendments to the Administrative and Criminal Code that propose to decriminalize possession of small amounts of cannabis without intent to distribute it. With this decision, the Committee puts the bill to a vote in the Seimas. It is worth mentioning that during its official visit to Lithuania on November 2-4, a delegation of the ECECACD had a number of meetings to discuss the draft law with members of the Seimas, the Speaker of the Seimas, the President of Lithuania and representatives of key ministries and institutions responsible for drug policy. Commissioners provided scientific evidences and arguments in favor of decriminalization, held a press conference, gave a series of interviews and had a series of working meetings to support the draft law in Lithuania.
The web-site of the ECECACD is developed and updated: ececacd.org. Brief video with speeches of all Commissioners is developed and placed to the web-site.
In 2022, there were Guiding principles towards effective and humane drug policies in Eastern and Central Europe and Central Asia developed. They were published in 2923 and are available at the link.
In addition, the visit of ECECACD comissioners to Moldova took place, some documented summary with feedback is available at the link.
Kazakhstan
A high-level meeting in Astana, attended by President Kassym-Jomart Tokayev and ECECACD Commissioners, successfully prevented the closure of opioid agonist therapy (OAT) programs in Kazakhstan. The government secured OAT medicine procurement for 2025, ensuring continued treatment for opioid dependence. https://ececacd.org/high-level-meeting-in-astana-on-drug-policy-and-opioid-agonist-therapy/
Kyrgyzstan
In 2024, Kyrgyzstan replaced the term “registry of people with drug dependency” with “dynamic monitoring,” shifting from a law enforcement focus to a medical record approach. Legislative amendments were made, and a working group drafted seven subordinate legal acts to support this transition, with further government review ongoing into 2025.
https://cbd.minjust.gov.kg/4-5260/edition/1939/ru
https://cbd.minjust.gov.kg/4-5301/edition/3727/ru
Moldova
ECECACD engagement in Moldova throughout 2024 led to discussions on reforming the National Anti-Drug Commission, proposing its transfer to the Cabinet of Ministers. A December 2024 national meeting resulted in a recommendation to develop a new National Drug Strategy in 2025. The National Commission on Drugs officially endorsed this, forming an inter-ministerial working group to oversee its development. https://ececacd.org/planning-drug-policy-reform-in-moldova/
Solutions
Implementer:
- Select an implementer
- APH
- Positive Initiative
Period:
RSSH: Health sector governance and planning
REGIONAL: regional dashboard (with 2 integrated portals) + preliminary results to be reflected on the timeframe / deadlines, at least for this year
Progress to date
ToR for the dashboard is under development; methodologies and approaches to data collection for the social contacting and sustainability and transition portals are being updated.
The Regional HIV data dashboard – https://eecadata.hiv – was developed, including the components for the database, BI analytics module and the website. The database/data warehouse includes data from GAM reports, national systems on prevention, sustainability and transition and social contracting data that were previously collected and presented on separate dedicated portals. The technology allows for integration with DHIS2 national prevention systems that were developed within the grant and there are agreements in place with corresponding country stakeholders to make the data from those systems available on the dashboard once it is entered in reasonable volumes. In early 2025, the dashboard will be finalised to reflect feedback received from stakeholders and experts engaged in evaluating the first version of the tool and presented to the global community.
Objective Description:
OBjective task:
- Select a objective task
- Removing structural barriers to increase of HIV testing in EECA
- Removing structural barriers to ART in EECA
- Launching critical enabling interventions to improve HIV care cascade
- Implementation of COVID-19 response mechanism
- Select a objective task
- Monitoring situation with human rights of KPs, responding to viloations
- Select a objective task
- Developing necessary legal framework and technical solutuions for cost-effective care package for KPs in EECA
- Advocacy for domestic resource allocation for KP services in EECA
Solutions
Implementer:
- Select an implementer
- APH
Period:
Supporting key group populations in a COVID setting
Provision of HIV prevention services with precautions against COVID-19
Progress to date
Work on shelters has expanded – in addition to 5 shelters for working with women who use drugs in conditions of violence (Ukraine, Serbia, North Macedonia, Kazakhstan), support for flexible shelters for representatives of the LGBT community in Kazakhstan, Uzbekistan, Kyrgyzstan and Tajikistan has been added. The program was distinguished by a special programmatic approach to working with clients – about 3,200 clients received material assistance in the form of food packages (Georgia, Kazakhstan). PPE support in Kaz for migrants and KGP (124,000 disposable masks, 1,000 antiseptics); CLM to provide quality services for clients of OST programs in 7 countries.
Solutions
Implementer:
- Select an implementer
- ECOM
- EHRA
- ECOM
- EHRA
Period:
Prevention (Pre-exposure prophylaxis – PrEP)
Inclusion of PrEP into nationally approved service packages for MSM and/or other key populations
Progress to date
ECOM in partnership with WHO regional office for Europe analyzed five national PrEP protocols (Armenia, Kazakhstan, Kyrgyzstan, Georgia and Ukraine) and provided Report with recommendations on the steps needed to include PrEP into nationally approved standard package of servises. The report is under design and will be published by the end of February.
Much work was done in 2023 to present recommendations based on analyzes of PrEP Protocols in 5 countries. Online and offline meetings with stakeholders, monitoring visits (Kazakhstan, Kyrgyzstan) were held, the results were presented at various meetings, conferences, and technical consultations. Based on the analysis of PrEP Protocols and updated WHO recommendations, policy briefs were developed and sent to countries, the purpose of which was to show and not miss the importance of new interventions that can improve PrEP services in countries.
PrEP is available and integrated into the healthcare system as part of the standard service package funded by the government in 5 countries: Armenia, Georgia, Kazakhstan, Kyrgyzstan, and Ukraine.
1. Armenia
PrEP is available as part of the national HIV prevention program and partly funded by the governmentand. PrEP has been officially included in the national HIV prevention guidelines approved by the Ministry of Health of Armenia.
2. Georgia
PrEP is available as part of the national HIV prevention program and partly funded by the governmentand.
3. Kazakhstan
PrEP is available as part of the national HIV prevention program and fully funded by the governmentand.
4. Kyrgyzstan
PrEP is included in the healthcare system and fully funded by the governmentandand.
5. Ukraine
PrEP is available and included in national clinical protocols.
Continued state support is confirmed to ensure the availability of PrEP for key populations.
Measures have been taken to strengthen the position of PrEP within healthcare.
Integrated service delivery and HIV service quality improvement
Community groups conduct community-led assessment of national quality standards in accordance to IDUIT and organize dialogue with service providers and MOH/local authorities
Progress to date
Moldova
PULS Communitar conducted CLM study to evaluate OAT programs in the Republic of Moldova, identify the level of the availability and acceptability of programs, outline achievements, and identify and evaluate difficulties faced by the program participants. Report with findings and conclusions was prepared and presented on the meeting with service providers and decision makers. Next steps and recommendations for CCM were elaborated.
GENDERDOC-M conducted a CLM study to identify the barriers in access to PrEP among MSM/TG. The results were presented to the Key Affected Populations (KAP) committee. After the presentation, it was strongly recommended to showcase these results at the National Dialogue event. The aim is to leverage the platform to advocate for a comprehensive revision of the National Clinical Protocol on Pre-Exposure Prophylaxis (PrEP) in the first quarter of 2024. This strategic move aligns with the commitment to fostering meaningful changes in the national approach to PrEP in response to the insights gained through the CLM survey.
Kazakhstan
Forum of PWUD conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian is prepared. Meeting with CCM is planned to be organized in January 2024.
Georgia
Rubikoni conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Furthermore, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Kyrgyzstan
Equal to equal conducted a study on the client satisfaction with OAT. Report in Russian was prepared. Moreover, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Tajikistan
Intighob (Initiative group based on SPIN PLUS) conducted a study of the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian language was prepared. Moreover, the meetings with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Armenia
“New Generation” conducted Community Based Assessment of HIV Services Provided to MSM Living With HIV In Armenia through a focus group with broad number of experts and MSM community members (including representatives from CCM). The results were included to “Funding Priorities of Civil Society and Communities Most Affected by HIV, Tuberculosis and Malaria” by Global Fund under the number 9 (The funding priorities and minutes from CRG group meeting attached). These priorities are in active use to prepare an application for the Global Fund grant in Armenia. In addition, results are in active use in the National dialogue now.
Integrated service delivery and HIV service quality improvement
Integration of community-led monitoring (CLM) into the health care systems of countries in the EECA region to assure the quality of services for key populations (KPs)
Progress to date
Practical handbook on community-led monitoring tools was developed in English and Russian languages. The checklist with EHRA and other partners for CLM was discussed and agreed upon.
On 2-8 December 2022, specialists from the Eurasian Harm Reduction Association (EHRA) conducted regional online training “Community-Led Monitoring Methods” for the representatives of community organizations in the CEECA region. The training was attended by 38 representatives of organizations from different vulnerable communities in the CEECA region. The aim of the training consisting of three online sessions was to train leaders of self-organizations from different key communities in the CEECA region to understand, which role CLM can play in their advocacy work, how to formulate the proper problem and research question for CLM, and which of the different methodologies can most effectively provide the data needed for advocacy. Video recordings of the training, as well as presentations can be found at the link.
Following the CLM Handbook, developed in 2022, integration of CLM into the healthcare system can be ensured through productive and sustainable participation of community representatives in the decision-making process, mainly within CCM, and through national consultations with CCM and other health sector coordination bodies on key needs for CLM and its findings and recommendations on improving of health services.
CLM has been conducted in all planned countries. Results were presented in 5 countries and protocols were received (Moldova, Georgia, Tajikistan, Kazakhstan and Kyrgyzstan). In Armenia, the results of the CLM are in active use in the National dialogue now. The focus group with broad number of experts and MSM community members (including representatives from CCM) was conducted, and based on the results PrEP was identified as a key priority and included to “Funding Priorities of Civil Society and Communities Most Affected by HIV, Tuberculosis and Malaria” by Global Fund under the number 9 (The funding priorities and minutes from CRG group meeting attached). These priorities are in active use to prepare an application for the Global Fund grant in Armenia.
Following CLM Handbook, developed in 2022, integration of CLM into healthcare system can be ensured through productive and sustainable participation of community representatives in decision-making process, mainly within CCM, and through national consultations with CCM and other health sector coordination bodies on key needs for CLM and its findings and recommendations on improving of health services. Within EHRA activities, CLM results in all countries in Georgia, Moldova, Kyrgyzstan, Kazakhstan and Tajikistan were presented and reviewed in CCMs and/or in other healthcare managing bodies. Protocol/minutes of the CCM meeting or other health authority body, based on the conducted national consultations with CCM and other health sector coordination bodies on key needs for CLM and discussed how results of CLM will help to improve services and integration of them into the healthcare system. What is more, additionally to presentation of CLM results, this year consultants in Georgia, Moldova, Kyrgyzstan and Kazakhstan prepared requests to healthcare managing bodies by asking provide information on how CLM results were being implemented. EHRA prepared a final publication – report, which draws on the three-year SoS 2.0. project of the EHRA to support community-led monitoring (CLM) initiatives for opioid agonist therapy (OAT) and the findings and results of community groups in Georgia, Moldova, Kazakhstan, Kyrgyzstan, and Tajikistan, offering insights into best practices and lessons learnt.
Moldova
PULS Communitar conducted CLM study to evaluate OAT programs in the Republic of Moldova, identify the level of the availability and acceptability of programs, outline achievements, and identify and evaluate difficulties faced by the program participants. Report with findings and conclusions was prepared and presented on the meeting with service providers and decision makers.
GENDERDOC-M conducted a CLM study to identify the barriers in access to PrEP among MSM/TG. The results were presented to the Key Affected Populations (KAP) committee. After the presentation, it was strongly recommended to showcase these results at the National Dialogue event. Following dialogues and agreements with the Protocol revision experts, the recommendations were formally presented on August 23, 2024, during the Round Table on the National Clinical Protocol on PrEP. The updated draft protocol, which includes the proposed recommendations, is currently under review by government authorities. In addition, the approval of new service standards, which will also include CLM, is expected in June 2025.
Kazakhstan
Forum of PWUD conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian is prepared.
Georgia
Rubikoni conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Furthermore, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps. In addition, based on ECOM recommendations, the working group developed CLM mechanisms and a special chapter was included in the Standards for Management of Public Health Interventions (PrEP Protocol). The working group included representatives from the National Centre for Disease Control and Public Health (NCDC), the Research Centre for Infectious Diseases, AIDS and Clinical Immunology, NGOs and MSM representatives, including members of the András team. Letter received from NCDC in support of the modified protocol.
Kyrgyzstan
Equal to equal conducted a study on the client satisfaction with OAT. Report in Russian was prepared. Moreover, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Tajikistan
Intighob (Initiative group based on SPIN PLUS) conducted a study of the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian language was prepared. Moreover, the meetings with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Armenia
“New Generation” conducted Community Based Assessment of HIV Services Provided to MSM Living With HIV In Armenia through a focus group with broad number of experts and MSM community members (including representatives from CCM). The results were included to “Funding Priorities of Civil Society and Communities Most Affected by HIV, Tuberculosis and Malaria” by Global Fund under the number 9 (The funding priorities and minutes from CRG group meeting attached). The National Guidelines on PrEP for HIV infection have been officially approved under Order No. 6241-L by the Minister of Health, dated 13 November 2024. These guidelines are now available on the Ministry of Health’s official website.
Solutions
Implementer:
- Select an implementer
- 100% Life
- SEH
- 100% Life
Period:
HSS: Health products management systems
Technical support in optimization of medicine procurement cycles
Progress to date
Priorities for improvements of PSM systems in Armenia, Georgia and Kazakhstan were discussed and agreed for further activities in 2023-2024. In Kazakhstan, MOH provided a list of its activities aimed to preserve state registration procedure and expressed the need to develop relevant legislation. In Georgia, access to the Global Fund procurement mechanism is of the highest priority. In Armenia, long-term agreements for ARVs and streamlining procurement practices from bottom to the top level in terms of centralization/decentralization and improvement of medicines registration procedure are of importance.
Georgia developed legally binding draft Drug Agency letter with supporting technical analysis allowing to significantly simplify receiving waivers for medicines import for Georgia.
Kazakhstan developed draft MoH order to mitigate some risks for medicines tendering procedures for Kazakhstan.
Armenia developed draft Law and draft Governmental decree enabling launching a medicines reimbursement reform for Armenia.
In Kazakhstan, comprehensive justification documents were prepared to demonstrate the benefits and necessity of transferring procurement responsibilities to the Sole Distributor. The legal rationale was presented to a wide range of stakeholders at the working meeting “On expanding access to essential medicines for people living with HIV by amending the legal acts regulating the procurement of medicines” held in Q4 2024.
In Kyrgyzstan, an advocacy strategy was developed based on an analysis of the procurement of ARV tests, HIV diagnostic and treatment monitoring products procured with public funds and humanitarian supplies funded by the Global Fund (GF) and UNDP. Official letters were also sent to the State Enterprise “Kyrgyzpharmacy” and the GF, UNDP outlining potential measures to optimize procurement processes and reduce the cost of ARVs and diagnostic tests. In addition, a number of informal discussions were held with the Kyrgyzpharmacy SE, the Republican Center for HIV/AIDS Control and GF/UNDP on further optimization of procurement strategies, expansion of the range of ARVs and diagnostic tests procured with public funds, and the possibility of reducing the cost of certain ARVs and diagnostic tools. A meeting was also held with experts engaged by the GF and the GF/UNDP to prepare for the transfer of GF grant management to national agencies.
In Moldova, to identify potential obstacles and opportunities for the introduction of a procurement mechanism through international procurement agencies, a comprehensive review of the current legislation on procurement of medical devices and medicines was conducted. An assessment of the current clinical protocol was conducted to develop recommendations for the inclusion of ART drug resistance monitoring. These recommendations were presented to the CCM HIV Working Group, and efforts are ongoing to advocate for their inclusion in the 2025 revision of the National HIV Protocol.
ECAT meeting was held on December 4–6 in Tbilisi, Georgia.
Reports on procurement monitoring of CD4 and VL tests as well as the rapid tests for HIV implemented in 2023 are published.
Armenia
The draft legal framework for the national supply chain system in Armenia (available at the link https://www.e-draft.am/en/projects/7783), according to Samvel Kharazyan, Head of State Health Agency of the Ministry of Health Armenia, was successfully approved by the relevant authorities within the ordinary national bureaucracy regulations. This includes the adoption of necessary regulations needed to launch a reform starting from April 1, 2025.
Georgia
The legal framework for the national supply chain system in Georgia has been reviewed and the document with relevant suggestions has been submitted to the MOH of Georgia for approval.
Kazakhstan
Kazakhstan has made significant progress in improving the legal framework for the national supply chain system, having drafted and submitted suggestions to the MOH for approval. Additionally, changes to our relevant Order No. 110 have been published for public discussion in Kazakhstan.
HSS: Health products management systems
Decentralization of HIV treatment through integration to primary healthcare
Progress to date
Synthesis Report on assessment of health systems to decentralize HIV treatment services in 5 countries of the EECA is developed and can be found at the link.
The road maps were finalized in Armenia, Georgia, Moldova, Kazakhstan, and Kyrgyzstan.
HSS: Health products management systems
Community-led advocacy of elimination of identified critical discrepancies with the WHO prevention, testing and treatment guidelines
Progress to date
Current testing and treatment protocols analysis is finished in 7 countries (Armenia, Moldova, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan, and Ukraine) and recommendations to align the national protocols with the WHO guidelines are provided. The report is available at the link.
WHO has held the analysis of HIV testing guidelines in 6 countries of EECA – Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Uzbekistan. The report is available at the link.
National HIV testing and ART-optimized strategies based on and aligned with the WHO recommendations were developed for 4 EECA countries – Armenia, Kazakhstan, Kyrgyzstan, Moldova.
In Armenia, Kazakhstan, Kyrgyzstan, and Moldova, all key actions related to the development and implementation of HIV testing and ART optimization strategies, in line with WHO recommendations, have been completed. According to the results of the assessment in 2022, there was a need to replace Georgia with another country to implement activities for 2023 and 2024 since the Georgian testing and treatment protocol is generally in line with the 2021 WHO recommendations for the use of ARV drugs for the prevention and treatment of HIV, and as well as other aspects of the clinical management of HIV. During project meetings different optios were discussed, and the desicion was taken to continue the activities in Armenia instead of Georgia.
Armenia
- Approved – Order of the Ministry of Health of Armenia No. 6241-L dated 11/13/2024 on implementation of the clinical protocol “Pre-Exposure Prophylaxis of HIV Infection” in Armenia. The Order entered into force on November 13, 2024.
- Approved – Clinical protocol “Pre-Exposure Prophylaxis of HIV Infection”.
An official letter-response from the Ministry of Health of Armenia dated on November 26, 2024 confirms the approval of the PrEP protocol and contains the information on other legal acts that are developed and will be approved in 2025 is also attached.
Solutions
Implementer:
- Select an implementer
- SEH
- 100% Life
Period:
HSS: Health products management systems
Decentralization of HIV testing services through integration to primary healthcare
Progress to date
Synthesis Report on assessment of readiness of health systems to decentralize HIV testing services in 5 countries of the EECA region is developed and can be found at the link.
The road maps were finalized in Armenia, Georgia, Moldova, Kazakhstan, and Kyrgyzstan.
Amendments related to HIV testing in Kazakhstan and Georgia were approved at the end of 2023. This, with close collaboration with local and international consultants, enabled in 2024 to focus on implementing normative acts through various measures, such as training sessions, advocacy campaigns, and strengthening cooperation among local CSOs and stakeholders into practice.
Local CSOs/community-based organizations, already involved in HIV testing, will play a key role in the decentralization of HIV treatment, further strengthening access to care at the community level.
1. Georgia
Georgia has completed the process of developing and approving regulations for decentralizing HIV testing and treatment. The HIV strategy for 2023–2025 was approved, and amendments to the national HIV/AIDS program have been made, including the creation of new testing and outpatient treatment points in new regions (Telavi, Akhaltsikhe, Poti, Khashuri). Measures for centralized supply of HIV tests have also been introduced. These changes came into force in January 2024.
Amendments approved by the Government of Georgia, on December 30, 2024. Annex 7 of the program regulates HIV services and indicates that decentralized testing with 2 different test kits will be implemented as a pilot together with sub contractor organizations and NGOs working with high risk groups in 8 cities of country – Tbilisi, Telavi, Khashuri, Akhsltsike, Kutaisi, Zugdidi, Poti and Batumi.
2. Kazakhstan
In Kazakhstan, in 3 cities: Almaty, Pavlodar and Ustkamenogorsk HIV testing is available through CSO, community based organizations: “You are not alone”, “Answer” and “Kemel Arma Foundation”. The document was registered in the Ministry of Justice of the Republic of Kazakhstan on December 4, 2023 № 33715. The adopted and entered into force document approving tariffs for HIV servies. In addition, the Roadmap to prevent HIV infection in the Republic of Kazakhstan for 2023-2026 was approved by Order of the Ministry of Health No. 155 dated March 16, 2023.
HSS: Health products management systems
Community-led advocacy of elimination of identified critical discrepancies with the WHO prevention, testing and treatment guidelines
Progress to date
Current testing and treatment protocols analysis is finished in 7 countries (Armenia, Moldova, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan, and Ukraine) and recommendations to align the national protocols with the WHO guidelines are provided. The report is available at the link.
WHO has held the analysis of HIV testing guidelines in 6 countries of EECA – Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Uzbekistan. The report is available at the link.
National HIV testing and ART-optimized strategies based on and aligned with the WHO recommendations were developed for 4 EECA countries – Armenia, Kazakhstan, Kyrgyzstan, Moldova.
In Armenia, Kazakhstan, Kyrgyzstan, and Moldova, all key actions related to the development and implementation of HIV testing and ART optimization strategies, in line with WHO recommendations, have been completed. According to the results of the assessment in 2022, there was a need to replace Georgia with another country to implement activities for 2023 and 2024 since the Georgian testing and treatment protocol is generally in line with the 2021 WHO recommendations for the use of ARV drugs for the prevention and treatment of HIV, and as well as other aspects of the clinical management of HIV. During project meetings different optios were discussed, and the desicion was taken to continue the activities in Armenia instead of Georgia.
Armenia
- Approved – Order of the Ministry of Health of Armenia No. 6241-L dated 11/13/2024 on implementation of the clinical protocol “Pre-Exposure Prophylaxis of HIV Infection” in Armenia. The Order entered into force on November 13, 2024.
- Approved – Clinical protocol “Pre-Exposure Prophylaxis of HIV Infection”.
An official letter-response from the Ministry of Health of Armenia dated on November 26, 2024 confirms the approval of the PrEP protocol and contains the information on other legal acts that are developed and will be approved in 2025.
Solutions
Implementer:
- Select an implementer
- CAAPLA
- EKPC
- APH
- ECOM
- ENPUD
- REGMH
- ECOM
Period:
Reducing human rights-related barriers to HIV/TB services
Through the use of the Stigma Index 2.0 , measure HIV-related stigma and discrimination experienced by PLHIV in countries of the EECA region by delivering training for interviewers and researchers to familiarize them with the methodology and survey instrument, and in conducting interviews and entering data into the RedСap database system, as well as to develop and disseminate the survey report
Progress to date
Protocols for Stigma Index Research are developed in Armenia and Georgia. The filed phase will start in 2023.
In all three countries the Protocols are approved. Moreover, the Stigma Index Researches are fully completed in Armenia and Georgia.
The reports has been approved by the Global Partnership and presented to all stakeholders. In Kazakhstan, the protocol is approved and the field stage of the research is successfully completed with a final sample of over 1430 surveyed respondents. Currently, within the project, the Research Team has commenced the analysis of the collected data and is preparing the initial draft of the Research Report.
Stigma Index Researches are fully completed in Armenia, Georgia and in Kazakhstan.
Reducing human rights-related barriers to HIV/TB services
Developing and launching call for “Gender and HIV” small grants with special eligibility focus on Monitoring situation with human rights of Trans* people
Progress to date
Small Grants Programme with 4 selected projects run by grass-root NGOs in 2022 included:
- “National Trans Coalition” NGO with the project titled “HIV prevention in Armenia through gender mainstreaming” (Armenia);
- “The Public Association “Union for Equity and Health” NGO with the project titled “Gender Equality for sex workers” (Moldova);
- “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Check your health – Equality for Trans Roma and Roma women/girls sex workers” (Serbia);
- “NON-GOVERNMENTAL ORGANIZATION «NASHA DOPOMOGA»” with the project titled “RIGHT TO HEALTH!” (Ukraine).
- The project applicant is the organization “Albanian Association of People Living with HIV/AIDS (PLWHA)” with the project titled “New approach on transforming the spiral of exclusion and marginalization, towards the right of recognition before the law, gender-diverse and reduce the violence in health-care settings for trans persons in Albania”.
- The project applicant is the “National Trans Coalition” NGO with the project titled “Strategic pathway to remove structural barriers for trans* communities to PrEP and PEP services in Armenia”. The proposed project has been designed to establish favorable conditions for improving access of Trans* communities to PrEP and PEP services in Armenia.
- The project applicant is the organization “STAR STAR” Skopje with the project titled “Community Mobilization to Mitigate Funding Cuts and Gender Inequality in National HIV Programs for Sex Workers in North Macedonia”. The project is envisioned as a response to the latest developments in North Macedonia related to provision and delivery of HIV prevention services for key populations.
- The project applicant is the organization “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Supporting health wellbeing and safety of Trans and Intersex Roma, sex workers and HIV+”.
In 2024, grants “Gender and HIV” were implemented in Albania, Georgia, Moldova and Ukraine.
Moldova
GENDERDOC-M, alongside a parent support group, aimed to create a safe and inclusive environment for transgender and gender-nonconforming youth. Two formal partnerships with youth clinics expanded access to health services and 24/7 hotline support. Parent education sessions led to increased understanding, school negotiations for name recognition, and medical referrals. As a result, a strategic plan for 2025 includes engaging health and education ministries to address systemic barriers.
Georgia
The Queer Association Temida established an informal network of trans-friendly professionals across three cities, despite restrictive anti-LGBT laws. The network held two meetings to discuss the legal landscape and continued service delivery. A memorandum with Psychea Mental Health Center helped maintain access to gender-affirming care. A peer educator training course was launched, and two trained educators provided online consultations to 32 beneficiaries, offering support on HIV and gender-affirming care.
Ukraine
The “Help Is Near” project by HPLGBT produced a comprehensive report on barriers and solutions in trans health services, especially for intersectional groups like sex workers and those using psychoactive substances. Recommendations for service decentralization were developed and are planned to be presented to the CCM in early 2025. HPLGBT aims to integrate these recommendations into national funding requests to the Global Fund, ensuring sustained support for marginalized trans communities.
Reducing human rights-related barriers to HIV/TB services
REAct (https://react-aph.org/): Monitoring of human rights violations and discrimination against PLHIV and KPs. Responding to such cases through provision or referring to legal or social services to victims and through advocacy actions. In Georgia, Kyrgyzstan, Moldova and Tajikistan, REAct system was initiated within SoS_project#1.0 in 2020, and in 2022 is transferred to national funding, meanwhile APH continues to provide technical support to users. In Ukraine, REAct was implemented in 2019 and is functional within national GF grant. REAct system is supported by APH in Uzbekistan for 2022-2023, in 5 Balkan countries – for 2022-2024, and in Armenia and Azerbaijan – for 2023-2024. At the same time, regional networks ECOM and ENPUD started to use REAct program for documentation in several countries of the region and are supported for 2022-2024 within SoS_project#2.0 grant.
Progress to date
Cumulatively, during 2022 there were registered 6700+ cases in 13 countries (Albania, Armenia, Bosnia and Herzegovina, Georgia, North Macedonia, Moldova, Montenegro, Kazakhstan, Kyrgyzstan, Tajikistan, Serbia, Ukraine, Uzbekistan) involving 170+ CBOs, as well as regional networks such as ECOM (in Uzbekistan, Tajikistan, Armenia, Kazakhstan, Kyrgyzstan) and ENPUD (Georgia, Moldova, Ukraine, Kyrgyzstan, Kazakhstan, Tajikistan, Belarus).
The following publications are available:
- Statistic country reports by APH on human rights violations based on REAct data collected in 2021 in Kyrgyzstan, in Georgia, in Moldova, in Tajikistan.
- Protectors or Perpetrators: the impact of unlawful policing on human rights and HIV. Join analytical publication in partnership with Frontline AIDS, Alliance for Public Health (Ukraine, Kyrgyzstan, Tajikistan, Moldova, Georgia, Uzbekistan), AIDS Foundation (South Africa), Gender Dynamix.
- Report on the results of the analysis of the Hotline calls by APH: Domestic and other forms of violence against women living with HIV and women in key populations during the COVID-19 pandemic in Tajikistan.
- REAct Statistical Report for the 1st half of 2022 by APH. Violations of the rights of people living with HIV and representatives of vulnerable groups in Georgia.
Situational Report by APH: Drug policy in Georgia and Challenges. - Series of publications by APH based on REAct data within regional campaign “16 days against gender-based violence”.
REAct system is available and functional at the national level in the following counties. It enables documentation of cases of human rights violations: Albania (45 cases), Armenia (182), Azerbaijan (174), B&H (70), Montenegro (60), Kazakhstan (363), North Macedonia (42), Tajikistan (1155), Serbia (24), Uzbekistan (835). More detailed data of 2023 is available in REAct Regional Digest and REAct website.
Cumulatively in 10 countries, 49,9% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions. During 2023 in 10 countries, there were provided 2162 consultations about human rights, 1022 consultations with professional lawyers. In 168 cases REActors helped to draft simple legal documents, such as complains or statement to police, in 236 cases represented client’s interests in medical facilities, assisted in getting medical services and support, in 336 cases – accompanied the client in the initial appeal to the police. There were at least 20 strategic court cases, and at least 162 cases were used for shadow reports to UN Treaty Bodies.
Cumulatively in 8 countries (Armenia, Azerbaijan, Kazakhstan, Albania, Bosnia and Herzegovina, Montenegro, North Macedonia, Serbia) 56,2% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions (https://drive.google.com/drive/folders/1wtJaecXERatg8cmrAE1mzaoshtdLQY_w). Numerous success stories of cases resolutions are available at REAct website.
Reducing human rights-related barriers to HIV/TB services
Legal environment and situation analysis as well as mapping of civil society partners in the area of access by migrants to HIV and TB services
Progress to date
“On December 9, the REGMH with the assistance of the NCC Secretariat held in Dushanbe a Roundtable “Protection of health of migrants from Tajikistan”. The event was timed to presentation of a new study conducted by the REGMH: “Situation and Economic analysis of HIV-related health services in the field of migration in Tajikistan”.
On December 13, 2022, the Regional Expert Group on Migration and Health together with Central Asian Association of People Living with HIV held a Roundtable in Almaty “Health of HIV positive migrants in Kazakhstan”. The aim of the Round Table was to promote effective and timely treatment of international migrants living with HIV. During the meeting, the Situational and Economic analysis on the provision of HIV-related health services for international migrants in Kazakhstan was presented and discussed.
On December 19, REG together with local NGO “Real World. Real People” held a Roundtable in Armenia, Yerevan aimed to buster a discussion and exchange of experience on the provision of services for international HIV-positive migrants between heads of health authorities of the Republic of Armenia, government departments responsible for migration and civil society organizations. At the meeting, a study “Analysis of legal and institutional barriers to accessing HIV services among migrants in the Republic of Armenia” (developed by REG in 2021) was presented.
Also, in Q4 REG has launched a study is Kyrgyzstan.
On October 11, REG held an online meeting “Migrants’ access to HIV services in Central Asia and Caucasus” that gathered representatives of UNAIDS, Central Asian Association of PLHIV (Kazakhstan), TB People (Georgia), NGO “Real World, Real People” (Armenia), IFRC Central Asia, WHO Europe, Elton John AIDS Foundation, NGO Equality Movement (Georgia), AFEW (Kyrgyzstan), IFRC South Caucasus, Global Fund, WHO, and MSF. The goal of the meeting was to initiate a discussion and work out possible solutions to provide access to HIV services for those who urgently left the countries following the political situation.”
Reducing human rights-related barriers to HIV/TB services
Legal environment assessment on MSM and trans people in 4 countries
Progress to date
The goal of this comparative analysis of legislative barriers preventing LGBT people from fully realizing their rights in 12 CEECA countries is to show progress or, on the contrary, regression in terms of the development of legislation and law enforcement practice, enabling or preventing LGBT people from realizing their human rights.
An updated analysis of activities from the end of 2021 to the beginning of 2023 shows the main changes and provides a list of key advocacy recommendations on where the attention of national teams and international organizations is needed to improve the human rights situation in 12 countries of the region.
In 2024, ECOM conducted a legal Environment Assessment in 4 countries of EECA. This comparative country analysis aimed to identify legal barriers and issues in areas where the necessary legislation already exists, but does not fully ensure the implementation of rights and freedoms for gay men, other MSM and trans people.
All reports consist of these chapters:
- International obligations of the country and their implementation;
- Table: Compliance of Domestic legislation with international standards;
- Analysis of legal regulations related to SOGI and HIV and their application;
- Recommendations.
All reports were published on ECOM’s website.
- Legal Environment Assessment in Armenia;
- Legal Environment Assessment in Georgia;
- Legal Environment Assessment in Kazakhstan;
- Legal Environment Assessment in Moldova.
Solutions
Implementer:
- Select an implementer
- SEH
Period:
HSS: Health sector governance and planning
Increasing domestic financing of countries for services to key groups
Progress to date
Targeted activities were held in all project countries to discuss with national and international, governmental and non-governmental stakeholders the changes needed to enable sustainable and uninterrupted funding of HIV-related activities from national resources. Through targeted advocacy, technical support, and an integrated approach to HIV funding, in 2022 the project team managed to allocate approximately 1,7 million USD at the national level to programs for key populations, using social contracting mechanisms: Moldova – 154,126.84 USD; Kazakhstan – 118,529.33 USD; Kyrgyzstan – 61,000 USD; Tajikistan – 19,200.00 USD; Georgia – 357,000 USD; Ukraine – 931,453.96 USD.
Thanks to budget advocacy within the SoS project 2.0, the amount of money allocated from national budgets for HIV services through social contracting mechanisms in EECA project countries amounted to $3 269 959 in 2024. During SoS project 2.0 – $ 6 273 049 were allocated for social contracting in EECA region. The cumulative domestic budget expenditures for servicing key populations in 5 countries of SEE amounted to $1 061 383 in 2024. During SoS project 2.0 – $ 3 236 260 were allocated for social contracting in SEE region.
Solutions
Implementer:
- Select an implementer
- SEH
- SEH
Period:
HSS: Health sector governance and planning
Legal framework for financing HIV services from domestic funds – development and approval
Progress to date
Targeted activities were held in all project countries to discuss with national and international, governmental and non-governmental stakeholders the changes needed to enable sustainable and uninterrupted funding of HIV-related activities from national resources. Through targeted advocacy, technical support, and an integrated approach to HIV funding, in 2022 the project team managed to allocate approximately 1,7 million USD at the national level to programs for key populations, using social contracting mechanisms: Moldova – 154,126.84 USD; Kazakhstan – 118,529.33 USD; Kyrgyzstan – 61,000 USD; Tajikistan – 19,200.00 USD; Georgia – 357,000 USD; Ukraine – 931,453.96 USD.
Over three years of implementation of SoS_project 2.0 has contributed to significant changes in the financing of HIV services in 14 countries in SEE and EECA regions. The project supported the development of service delivery standards, pricing methodologies, and quality control procedures, which are critical for sustainable financing from the state budget.
The practice of social contracting is applied without interruption in 14 countries.
HSS: Health sector governance and planning
Regulation of service packages for key groups
Progress to date
In the reporting period, the Emergency package of services for key and vulnerable groups of the population in the field of HIV, and TB in the context of military conflicts was finalized, including tariffication. On its basis, in 2023, the process of advocacy and promotion of implementation at the level of countries in the EECA region will be launched.
Strategic Brief on Business Continuity (link) and Strategic Brief on Social contracting (link) were developed. In addition, Analysis of Quality of Services Provided in Azerbaijan was held and is available at the link.
Over three years of implementation of SoS_project 2.0 has contributed to significant changes in the financing of HIV services in 14 countries in SEE and EECA regions. The project supported the development of service delivery standards, pricing methodologies, and quality control procedures, which are critical for sustainable financing from the state budget.
The practice of social contracting is applied without interruption in 14 countries.
Objective Description:
OBjective task:
- Select a objective task
- Removing structural barriers to increase of HIV testing in EECA
- Removing structural barriers to ART in EECA
- Launching critical enabling interventions to improve HIV care cascade
- Implementation of COVID-19 response mechanism
- Select a objective task
- Monitoring situation with human rights of KPs, responding to viloations
- Select a objective task
- Developing necessary legal framework and technical solutuions for cost-effective care package for KPs in EECA
- Advocacy for domestic resource allocation for KP services in EECA
Solutions
Implementer:
- Select an implementer
- APH
- APH
- APH
Period:
Supporting key group populations in a COVID setting
Provision of HIV prevention services with precautions against COVID-19
Progress to date
Work on shelters has expanded – in addition to 5 shelters for working with women who use drugs in conditions of violence (Ukraine, Serbia, North Macedonia, Kazakhstan), support for flexible shelters for representatives of the LGBT community in Kazakhstan, Uzbekistan, Kyrgyzstan and Tajikistan has been added. The program was distinguished by a special programmatic approach to working with clients – about 3,200 clients received material assistance in the form of food packages (Georgia, Kazakhstan). PPE support in Kaz for migrants and KGP (124,000 disposable masks, 1,000 antiseptics); CLM to provide quality services for clients of OST programs in 7 countries.
Supporting key group populations in a COVID setting
Procurement of condom vending machines to reduce contacts during COVID-19
Progress to date
2 countries (Moldova, Montenegro) were supported in purchasing vending machines. 13 machines were purchased to reduce contacts during COVID-19.
Supporting key group populations in a COVID setting
National Contingency Planning
Progress to date
Supporting key group populations in a COVID setting “General contingency planning guide developed in the frames of the C19RM is available here.
Guide by APH for Contingency Planning for Key Population HIV Services during COVID-19 and Other Emergencies for North Macedonia, Serbia, Bosnia and Herzegovina, Montenegro, Moldova, Georgia, Kazakhstan, Uzbekistan, Tajikistan and Kyrgyzstan in English is available at the link https://aph.org.ua/en/eeca/ in the folders with the names of each country.
Solutions
Implementer:
- Select an implementer
- SEE RCN
- EHRA
- EHRA
Period:
Prevention (Pre-exposure prophylaxis – PrEP)
Introduction of the piloted PrEP models to the healthcare systems and advocate to revise and update national policy documents
Progress to date
Bosnia and Herzegovina and Montenegro are awaiting the launch of the PrEP pilot project between MCM (Protocols have been developed, client waiting lists are available, study-visits have been carried out for the project staff). The first clients are expected to receive PrEP in Q1 2023.
Bosnia and Herzegovina and Montenegro successfully launched a pilot PREP project among MSM (as of January 1, 2024, number of clients: BiH – 28, Montenegro – 51). Thanks to the coordinated work of the CSoS 2.0 project and partners in Balkans, a pre-exposure prophylaxis drug was purchased for both countries at 10 times cheaper than the commercial drug used in the countries for ART regimens. Our partners SEE Network, with technical support from WHO, developed Protocols and prepared PREP sites to launch the project.
The successful completion of the pilot projects in Bosnia and Herzegovina (65 clients) and Montenegro (81 clients) led to the inclusion of PrEP in national funding schemes. In Bosnia and Herzegovina, an indication for PrEP was officially registered during the reporting period. Since these drugs are also used to treat HIV and are included in the list of essential medicines, they are available free of charge, ensuring uninterrupted access to PrEP. Montenegro is in the final stages of including PrEP in the positive list of medicines, which will allow the state to procure PrEP. The project is successfully expanding in North Macedonia (153 clients). By the end of 2024, a total of 300 clients in the three countries have become participants in the PrEP program.
Integrated service delivery and HIV service quality improvement
Assessment of OAT sustainability
Progress to date
Quality of harm reduction – mapping of the main challenges and barriers in the modernization of principles, values, and approaches in the work of harm reduction programs in Montenegro was held the report is available at the link.
Integrated service delivery and HIV service quality improvement
Community groups conduct community-led assessment of national quality standards in accordance to IDUIT and organize dialogue with service providers and MOH/local authorities
Progress to date
Quality of harm reduction – mapping of the main challenges and barriers in the modernization of principles, values, and approaches in the work of harm reduction programs in Montenegro was held the report is available at the link
Solutions
Implementer:
- Select an implementer
- SEE RCN
Period:
Prevention (Pre-exposure prophylaxis – PrEP)
Advocacy for PrEP financial costs to be covered by national funding schemes (including health insurance)
Progress to date
The second main activity regarding of PrEP was advocacy for PrEP financial costs to be covered by national funding schemes. Our focus in 2022 was preparation of set of recommendations for institutionalization of PrEP in Bosnia and Herzegovina and Montenegro and by the end of the year we finalized first drafts which is distributed to the stakeholders.
This activity is planned for 2024. But remarkable progress was achieved in Bosnia and Herzegovina, where funding for PrEP-related expenses was already included in national schemes.
BiH
PrEP-related expenses is included into national funding scheme. PrEP drugs are included on the essential medicines list, they are available free of charge, ensuring uninterrupted access to PrEP in the Federation of BiH.
Montenegro For the including PrEP into national funding schemes two main steps should be done: approval PrEP drugs by Ministry of health to be distributed towards KPs and to be on Positive list of drugs.
List of approved drugs by Agency of drugs in which Gilestra duo is registered for PrEP use: https://cinmed.me/humani-lijekovi/humani-lijek/?id=3217
The Initiative to include pre-exposure prophylaxis (PrEP) as a new indication on the List of Medicines to the Commission at MoH has been submitted.
Solutions
Implementer:
- Select an implementer
- SEE RCN
- SEE RCN
Period:
Integrated service delivery and HIV service quality improvement
Country level support to adoption and implementation of HTS guidelines and introduction of self-testing, community-based testing and decentralized testing into national policy documents and clinical guidelines, and harmonized testing policies and processes with new WHO recommendations in four (4) countries of the SEE sub-region (Albania, Montenegro, North Macedonia and Serbia)
Progress to date
In 2022, the project conducted an assessment on policies, regulations, and practice of HIV Rapid Testing/Self-testing in 4 SEE countries and developed a report on findings and recommendations. The purpose of this assessment was to evaluate country-specific policies, regulations, and practical factors that are currently facilitating or affecting community-level access to rapid diagnostic tests, including self-testing of HIV.
The SoS project has been instrumental in advancing self-testing and community-based HIV testing in SEE through persistent advocacy, strategic meetings, and expert consultations. Our partners have actively engaged with ministries and public health institutes to push for the integration of self-testing into national HIV strategies and the expansion of community-based testing services.
The advocacy work of SoS partners in 4 countries with stakeholders culminated in the incorporation of self-testing into updated guidelines and HIV testing protocols, namely:
- In North Macedonia, a significant milestone was reached within SoS in 2023 with the inclusion of community-based testing and self-testing initiatives under the National HIV Program. Both community-based HIV testing and self-testing are part of the annual National HIV Program and both are delivered by civil society organisations. The evidence for community based testing and self-testing in 2024 is present in HIV report.
- In Albania, legislative and regulatory revisions have been made, including HIV self-testing, community-based testing, and decentralised testing with the approval in 2022 of the National Guidelines for HIV testing and prevention – on page 16 and in PrEP protocol. As evidence of availability of self testing please see on the page 14 in National 2023 HIV report from the IPH marked with yellow.
- In Montenegro, self-testing, community-based testing and decentralized testing were included in Voluntary Counselling and Testing protocol. Community based testing and new Protocol for HIV testing in Montenegro is modified on WHO guidelines for HIV testing. Community testing is done by CAZAS and community organizations in mobile vans and was integrated through cooperation with IPH during 2024. Several actions have been conducted and as evidence you can find public announcements of some of community testing activities organized in 2024 in Montenegro in supporting docs. Decentralized testing is done in 8 VCT centres in Montenegro.
- In Serbia, within SoS project new VCT protocol that integrate self and community based testing as a regular component of healthcare protocols was developed and approved by the Ministry of Health and the Health Institute. Information on self and community based testing is available. In 2024 community based testing was carried out exclusively through drop-in centers and mobile vehicles. Self-testing for HIV is recognized in the new guidelines and will be piloted for HIV and HCV through community-based services within the new national Global Fund program in Serbia in 2025.
HSS: Health products management systems
Introduction of self-testing, community-based testing and decentralized testing into national policy documents and clinical guidelines, and harmonized testing policies and processes with new WHO recommendations, including with TA provided by the WHO Regional Office, Europe
Progress to date
In 2022, the project conducted an assessment on policies, regulations, and practice of HIV Rapid Testing/Self-testing in 4 SEE countries and developed a report on findings and recommendations. The assessment was conducted in North Macedonia, Albania, Montenegro, and Serbia. The purpose of this assessment was to evaluate country-specific policies, regulations, and practical factors that are currently facilitating or affecting community-level access to rapid diagnostic tests, including self-testing of HIV. Some of the key recomendations which are suggested: to update National Guidelines/Protocols for HIV testing, outlining clear HIV testing algorithm in line with WHO recommendation including community based testing and HIV self-testing; update the existing internal protocol on HIVST; develop policy and advocacy recommendations for reducing HIV-related stigma and discrimination; integrate HIV self-testing into existing HIV service delivery models including OST programs. The report can be found at the link.
The advocacy work of SoS partners in 4 countries with stakeholders culminated in the incorporation of self-testing into updated guidelines and HIV testing protocols, namely:
- In North Macedonia, a significant milestone was reached within SoS in 2023 with the inclusion of community-based testing and self-testing initiatives under the National HIV Program. Both community-based HIV testing and self-testing are part of the annual National HIV Program and both are delivered by civil society organizations. The evidence for community based testing and self-testing in 2024 is present in HIV report.
- In Albania, legislative and regulatory revisions have been made, including HIV self-testing, community-based testing, and decentralized testing with the approval in 2022 of the National Guidelines for HIV testing and prevention – on page 16 and in PrEP protocol. As evidence of availability of self testing please see on the page 14 in National 2023 HIV report from the IPH marked with yellow. In Montenegro, self-testing, community-based testing and decentralized testing were included in Voluntary Counselling and Testing protocol. Community based testing and new Protocol for HIV testing in Montenegro is modified on WHO guidelines for HIV testing.
- Community testing is done by CAZAS and community organizations in mobile vans and was integrated through cooperation with IPH during 2024. Several actions have been conducted and as evidence you can find public announcements of some of community testing activities organized in 2024 in Montenegro in supporting docs. Decentralized testing is done in 8 VCT centres in Montenegro.
- In Serbia, within SoS project new VCT protocol that integrate self and community based testing as a regular component of healthcare protocols was developed and approved by the Ministry of Health and the Health Institute. Information on self and community based testing is available. In 2024 community based testing was carried out exclusively through drop-in centers and mobile vehicles. Self-testing for HIV is recognized in the new guidelines and will be piloted for HIV and HCV through community-based services within the new national Global Fund program in Serbia in 2025.
Solutions
Implementer:
- Select an implementer
- EKPC
- APH
- SEE RCN
Period:
Reducing human rights-related barriers to HIV/TB services
Developing and launching call for “Gender and HIV” small grants with special eligibility focus on Monitoring situation with human rights of Trans* people
Progress to date
Small Grants Programme with 4 selected projects run by grass-root NGOs in 2022 included:
- “National Trans Coalition” NGO with the project titled “HIV prevention in Armenia through gender mainstreaming” (Armenia);
- “The Public Association “Union for Equity and Health” NGO with the project titled “Gender Equality for sex workers” (Moldova);
- “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Check your health – Equality for Trans Roma and Roma women/girls sex workers” (Serbia);
- “NON-GOVERNMENTAL ORGANIZATION «NASHA DOPOMOGA»” with the project titled “RIGHT TO HEALTH!” (Ukraine).
- The project applicant is the organization “Albanian Association of People Living with HIV/AIDS (PLWHA)” with the project titled “New approach on transforming the spiral of exclusion and marginalization, towards the right of recognition before the law, gender-diverse and reduce the violence in health-care settings for trans persons in Albania”.
- The project applicant is the “National Trans Coalition” NGO with the project titled “Strategic pathway to remove structural barriers for trans* communities to PrEP and PEP services in Armenia”. The proposed project has been designed to establish favorable conditions for improving access of Trans* communities to PrEP and PEP services in Armenia.
- The project applicant is the organization “STAR STAR” Skopje with the project titled “Community Mobilization to Mitigate Funding Cuts and Gender Inequality in National HIV Programs for Sex Workers in North Macedonia”. The project is envisioned as a response to the latest developments in North Macedonia related to provision and delivery of HIV prevention services for key populations.
- The project applicant is the organization “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Supporting health wellbeing and safety of Trans and Intersex Roma, sex workers and HIV+”.
In 2024, grants “Gender and HIV” were implemented in Albania, Georgia, Moldova and Ukraine.
Moldova
GENDERDOC-M, alongside a parent support group, aimed to create a safe and inclusive environment for transgender and gender-nonconforming youth. Two formal partnerships with youth clinics expanded access to health services and 24/7 hotline support. Parent education sessions led to increased understanding, school negotiations for name recognition, and medical referrals. As a result, a strategic plan for 2025 includes engaging health and education ministries to address systemic barriers.
Georgia
The Queer Association Temida established an informal network of trans-friendly professionals across three cities, despite restrictive anti-LGBT laws. The network held two meetings to discuss the legal landscape and continued service delivery. A memorandum with Psychea Mental Health Center helped maintain access to gender-affirming care. A peer educator training course was launched, and two trained educators provided online consultations to 32 beneficiaries, offering support on HIV and gender-affirming care.
Ukraine
The “Help Is Near” project by HPLGBT produced a comprehensive report on barriers and solutions in trans health services, especially for intersectional groups like sex workers and those using psychoactive substances. Recommendations for service decentralization were developed and are planned to be presented to the CCM in early 2025. HPLGBT aims to integrate these recommendations into national funding requests to the Global Fund, ensuring sustained support for marginalized trans communities.
Reducing human rights-related barriers to HIV/TB services
REAct (https://react-aph.org/): Monitoring of human rights violations and discrimination against PLHIV and KPs. Responding to such cases through provision or referring to legal or social services to victims and through advocacy actions. In Georgia, Kyrgyzstan, Moldova and Tajikistan, REAct system was initiated within SoS_project#1.0 in 2020, and in 2022 is transferred to national funding, meanwhile APH continues to provide technical support to users. In Ukraine, REAct was implemented in 2019 and is functional within national GF grant. REAct system is supported by APH in Uzbekistan for 2022-2023, in 5 Balkan countries – for 2022-2024, and in Armenia and Azerbaijan – for 2023-2024. At the same time, regional networks ECOM and ENPUD started to use REAct program for documentation in several countries of the region and are supported for 2022-2024 within SoS_project#2.0 grant.
Progress to date
Cumulatively, during 2022 there were registered 6700+ cases in 13 countries (Albania, Armenia, Bosnia and Herzegovina, Georgia, North Macedonia, Moldova, Montenegro, Kazakhstan, Kyrgyzstan, Tajikistan, Serbia, Ukraine, Uzbekistan) involving 170+ CBOs, as well as regional networks such as ECOM (in Uzbekistan, Tajikistan, Armenia, Kazakhstan, Kyrgyzstan) and ENPUD (Georgia, Moldova, Ukraine, Kyrgyzstan, Kazakhstan, Tajikistan, Belarus).
The following publications are available:
- Statistic country reports by APH on human rights violations based on REAct data collected in 2021 in Kyrgyzstan, in Georgia, in Moldova, in Tajikistan.
- Protectors or Perpetrators: the impact of unlawful policing on human rights and HIV. Join analytical publication in partnership with Frontline AIDS, Alliance for Public Health (Ukraine, Kyrgyzstan, Tajikistan, Moldova, Georgia, Uzbekistan), AIDS Foundation (South Africa), Gender Dynamix.
- Report on the results of the analysis of the Hotline calls by APH: Domestic and other forms of violence against women living with HIV and women in key populations during the COVID-19 pandemic in Tajikistan.
- REAct Statistical Report for the 1st half of 2022 by APH. Violations of the rights of people living with HIV and representatives of vulnerable groups in Georgia.
Situational Report by APH: Drug policy in Georgia and Challenges. - Series of publications by APH based on REAct data within regional campaign “16 days against gender-based violence”.
REAct system is available and functional at the national level in the following counties. It enables documentation of cases of human rights violations: Albania (45 cases), Armenia (182), Azerbaijan (174), B&H (70), Montenegro (60), Kazakhstan (363), North Macedonia (42), Tajikistan (1155), Serbia (24), Uzbekistan (835). More detailed data of 2023 is available in REAct Regional Digest and REAct website.
Cumulatively in 10 countries, 49,9% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions. During 2023 in 10 countries, there were provided 2162 consultations about human rights, 1022 consultations with professional lawyers. In 168 cases REActors helped to draft simple legal documents, such as complains or statement to police, in 236 cases represented client’s interests in medical facilities, assisted in getting medical services and support, in 336 cases – accompanied the client in the initial appeal to the police. There were at least 20 strategic court cases, and at least 162 cases were used for shadow reports to UN Treaty Bodies.
Cumulatively in 8 countries (Armenia, Azerbaijan, Kazakhstan, Albania, Bosnia and Herzegovina, Montenegro, North Macedonia, Serbia) 56,2% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions (https://drive.google.com/drive/folders/1wtJaecXERatg8cmrAE1mzaoshtdLQY_w). Numerous success stories of cases resolutions are available at REAct website.
Solutions
Implementer:
- Select an implementer
- SEE RCN
Period:
HSS: Health sector governance and planning
Municipal budget advocacy for cities that chose the Fast Track approach: Podgorica, Bar, Bijelo-Polje cities in the Balkan region
Progress to date
As the result of budget advocacy the city administrations in Dushanbe ($130 000), Podgorica ($43 000), Skopje ($35 000), Tirana (USD 32,000), Novi Sad (USD 9,000), Sabac ($7 500) and Zvezdara ($4 000) allocated funds for the implementation of activities that would achieve the goals of the Paris Declaration.
Solutions
Implementer:
- Select an implementer
- SEE RCN
- SEE RCN
Period:
RSSH: Health sector governance and planning
Assessment of the legal framework to fund HIV services with domestic funds: sustainability planning; advocacy campaign on change of laws and regulations; establishment of Parliamentary group for HIV,TB, Hepatitis and STIs
Progress to date
Preliminary consultations were held in 2022and assessment was planned in 2023.Domestic funding for HIV services is increased. The funding of Tirana municipality for NGOs offer HIV services was $32,000. The level of funding for HIV-related activities from the City of Skopje remained approximately the same as is in 2021 –approximately 35,000 USD. MoH from Montenegro allocated 100.000 EUR for funding NGO HIV programs in 2022. In Bosnia and Herzegovina for increase services for key populations and PLWHA. was two grants. One grant was from Ministry of Civil affairs, Department for Health and it was about 26 000 Euro for nine CSOs, Partnerships in Health was one of them but also our partners from the Project, Victoria and Ruka Ruci. The second grant was from Federal Ministry of Health, and it was for HIV testing and counselling on HIV, education for KAP and youth. It was about 13 500 Euro and it was granted to the Partnerships in Health. In Serbia there was 19214 USD in total from municipality funding for HIV services in Serbia.
Until now there is Parliamentary group for HIV, TB Hepatitis and STIs established in Bosnia and Herzegovina.
The main achievements of the project were the removal of legislative barriers, approval of standards and tariffs for services, adoption of regulatory acts that allow the implementation of social contracting mechanisms, as well as expansion of financing from state budgets. The cumulative domestic budget expenditures for servicing key populations and People Living with HIV/AIDS in 5 countries of Southeastern Europe (SEE) amounted to $1 061 383 in 2024. During SoS project 2.0 – $ 3 236 260 were allocated for social contracting in SEE region.
HSS: Health sector governance and planning
Regulation of service packages for key groups
Progress to date
Strategic Brief on Business Continuity (link) and Strategic Brief on Social contracting (link) were developed. In addition, Analysis of Quality of Services Provided in Azerbaijan was held and is available at the link.
Objective Description:
OBjective task:
- Select a objective task
- Launching critical enabling interventions to improve HIV care cascade
- Implementation of COVID-19 response mechanism
- Select a objective task
- Monitoring situation with human rights of KPs, responding to viloations
- Select a objective task
- IT solutions to improve the efficiency of service delivery within the HIV care cascade and ensure the sustainability of HIV services
- Developing necessary legal framework and technical solutuions for cost-effective care package for KPs in EECA
- Advocacy for domestic resource allocation for KP services in EECA
Solutions
Implementer:
- Select an implementer
- APH
- APH
- APH
- APH
Period:
Supporting key group populations in a COVID setting
Provision of HIV prevention services with precautions against COVID-19
Progress to date
Work on shelters has expanded – in addition to 5 shelters for working with women who use drugs in conditions of violence (Ukraine, Serbia, North Macedonia, Kazakhstan), support for flexible shelters for representatives of the LGBT community in Kazakhstan, Uzbekistan, Kyrgyzstan and Tajikistan has been added. The program was distinguished by a special programmatic approach to working with clients – about 3,200 clients received material assistance in the form of food packages (Georgia, Kazakhstan). PPE support in Kaz for migrants and KGP (124,000 disposable masks, 1,000 antiseptics); CLM to provide quality services for clients of OST programs in 7 countries.
Supporting key group populations in a COVID setting
Procurement and distribution of Ag-RDTs
Progress to date
Purchased 120 thousand rapid antigen tests for COVID (Bosnia and Herzegovina, Serbia, Tajikistan, Ukraine) and 4,000 PCR tests for Ukraine to test key population groups and their close contacts.
Supporting key group populations in a COVID setting
REAct monitoring system implementation to capture COVID-19 related rights violations
Progress to date
Support of the hotline / phone services within REAct monitoring system implementation in order to provide distant support and legal consultations to women from groups at risk suffering domestic violence and experiencing human rights violations (in Tajikistan and Uzbekistan) – Distant legal consulting to avoid face-to-face meetings between client and REActors. With the help of crisis and instant assistance, it was possible to expand the coverage of clients with services (38% of all services in Tajikistan and 45% in Uzbekistan) and reduce barriers to accessing REAct services.
Supporting key group populations in a COVID setting
National Contingency Planning
Progress to date
Supporting key group populations in a COVID setting “General contingency planning guide developed in the frames of the C19RM is available here.
Guide by APH for Contingency Planning for Key Population HIV Services during COVID-19 and Other Emergencies for North Macedonia, Serbia, Bosnia and Herzegovina, Montenegro, Moldova, Georgia, Kazakhstan, Uzbekistan, Tajikistan and Kyrgyzstan in English is available at the link https://aph.org.ua/en/eeca/ in the folders with the names of each country.
Solutions
Implementer:
- Select an implementer
- SPIN Plus
- EHRA
Period:
Integrated service delivery and HIV service quality improvement
Improve HIV care cascade for key populations specific and targeted interventions in Dushanbe, Kulyab and Khorog of Tajikistan
Progress to date
Starting July 2022, Fast Track Cities initiative is being implemented in Dushanbe, Kulyab and Khorog. As the result of budget advocacy the city administrations in Dushanbe allocated $130 000 for HIV programs in 2022.
In Tajikistan – the Municipalities of Kulyab and Khorog established local working groups that developed local HIV plans that were approved in January 2024 in Kulyab and in May 2024 in Khorog. Key successes in 3 cities of Tajikistan: increased testing for HIV among KPs, initiated allocation of funds from city budgets for testing migrants in Dushanbe and Kulyab, improved cascade monitoring system to track the results of treatment from the moment of testing to a decrease in the viral load.
Integrated service delivery and HIV service quality improvement
Assessment of OAT sustainability
Progress to date
Assessment of the sustainability of the opioid agonist therapy programme in the context of transition from donor support to domestic funding was conducted in Moldova and Tajikistan. The reports are being finalized and sent for design, they’ll be published by the end of Q1 2023. The assessments in Albania, Kyrgyzstan and Ukraine are ongoing and will be finalized in 2023.
Reassessing the sustainability of the opioid agonist therapy programme within the context of transition from donor support to domestic funding took place in 2022 in Tajikistan and Moldova, reports were published in 2023.
In 2023, the reassessment of the sustainability of the opioid agonist therapy programme within the context of transition from donor support to domestic funding also was finished in Ukraine, the report can be found at the link.
Solutions
Implementer:
- Select an implementer
- APH
- ECOM
- REGMH
Period:
Reducing human rights-related barriers to HIV/TB services
REAct (https://react-aph.org/): Monitoring of human rights violations and discrimination against PLHIV and KPs. Responding to such cases through provision or referring to legal or social services to victims and through advocacy actions. In Georgia, Kyrgyzstan, Moldova and Tajikistan, REAct system was initiated within SoS_project#1.0 in 2020, and in 2022 is transferred to national funding, meanwhile APH continues to provide technical support to users. In Ukraine, REAct was implemented in 2019 and is functional within national GF grant. REAct system is supported by APH in Uzbekistan for 2022-2023, in 5 Balkan countries – for 2022-2024, and in Armenia and Azerbaijan – for 2023-2024. At the same time, regional networks ECOM and ENPUD started to use REAct program for documentation in several countries of the region and are supported for 2022-2024 within SoS_project#2.0 grant.
Progress to date
Cumulatively, during 2022 there were registered 6700+ cases in 13 countries (Albania, Armenia, Bosnia and Herzegovina, Georgia, North Macedonia, Moldova, Montenegro, Kazakhstan, Kyrgyzstan, Tajikistan, Serbia, Ukraine, Uzbekistan) involving 170+ CBOs, as well as regional networks such as ECOM (in Uzbekistan, Tajikistan, Armenia, Kazakhstan, Kyrgyzstan) and ENPUD (Georgia, Moldova, Ukraine, Kyrgyzstan, Kazakhstan, Tajikistan, Belarus).
The following publications are available:
- Statistic country reports by APH on human rights violations based on REAct data collected in 2021 in Kyrgyzstan, in Georgia, in Moldova, in Tajikistan.
- Protectors or Perpetrators: the impact of unlawful policing on human rights and HIV. Join analytical publication in partnership with Frontline AIDS, Alliance for Public Health (Ukraine, Kyrgyzstan, Tajikistan, Moldova, Georgia, Uzbekistan), AIDS Foundation (South Africa), Gender Dynamix.
- Report on the results of the analysis of the Hotline calls by APH: Domestic and other forms of violence against women living with HIV and women in key populations during the COVID-19 pandemic in Tajikistan.
- REAct Statistical Report for the 1st half of 2022 by APH. Violations of the rights of people living with HIV and representatives of vulnerable groups in Georgia.
Situational Report by APH: Drug policy in Georgia and Challenges. - Series of publications by APH based on REAct data within regional campaign “16 days against gender-based violence”.
REAct system is available and functional at the national level in the following counties. It enables documentation of cases of human rights violations: Albania (45 cases), Armenia (182), Azerbaijan (174), B&H (70), Montenegro (60), Kazakhstan (363), North Macedonia (42), Tajikistan (1155), Serbia (24), Uzbekistan (835). More detailed data of 2023 is available in REAct Regional Digest and REAct website.
Cumulatively in 10 countries, 49,9% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions. During 2023 in 10 countries, there were provided 2162 consultations about human rights, 1022 consultations with professional lawyers. In 168 cases REActors helped to draft simple legal documents, such as complains or statement to police, in 236 cases represented client’s interests in medical facilities, assisted in getting medical services and support, in 336 cases – accompanied the client in the initial appeal to the police. There were at least 20 strategic court cases, and at least 162 cases were used for shadow reports to UN Treaty Bodies.
Cumulatively in 8 countries (Armenia, Azerbaijan, Kazakhstan, Albania, Bosnia and Herzegovina, Montenegro, North Macedonia, Serbia) 56,2% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions (https://drive.google.com/drive/folders/1wtJaecXERatg8cmrAE1mzaoshtdLQY_w). Numerous success stories of cases resolutions are available at REAct website.
Reducing human rights-related barriers to HIV/TB services
Legal environment and situation analysis as well as mapping of civil society partners in the area of access by migrants to HIV and TB services
Progress to date
“On December 9, the REGMH with the assistance of the NCC Secretariat held in Dushanbe a Roundtable “Protection of health of migrants from Tajikistan”. The event was timed to presentation of a new study conducted by the REGMH: “Situation and Economic analysis of HIV-related health services in the field of migration in Tajikistan”.
On December 13, 2022, the Regional Expert Group on Migration and Health together with Central Asian Association of People Living with HIV held a Roundtable in Almaty “Health of HIV positive migrants in Kazakhstan”. The aim of the Round Table was to promote effective and timely treatment of international migrants living with HIV. During the meeting, the Situational and Economic analysis on the provision of HIV-related health services for international migrants in Kazakhstan was presented and discussed.
On December 19, REG together with local NGO “Real World. Real People” held a Roundtable in Armenia, Yerevan aimed to buster a discussion and exchange of experience on the provision of services for international HIV-positive migrants between heads of health authorities of the Republic of Armenia, government departments responsible for migration and civil society organizations. At the meeting, a study “Analysis of legal and institutional barriers to accessing HIV services among migrants in the Republic of Armenia” (developed by REG in 2021) was presented.
Also, in Q4 REG has launched a study is Kyrgyzstan.
On October 11, REG held an online meeting “Migrants’ access to HIV services in Central Asia and Caucasus” that gathered representatives of UNAIDS, Central Asian Association of PLHIV (Kazakhstan), TB People (Georgia), NGO “Real World, Real People” (Armenia), IFRC Central Asia, WHO Europe, Elton John AIDS Foundation, NGO Equality Movement (Georgia), AFEW (Kyrgyzstan), IFRC South Caucasus, Global Fund, WHO, and MSF. The goal of the meeting was to initiate a discussion and work out possible solutions to provide access to HIV services for those who urgently left the countries following the political situation.”
Solutions
Implementer:
- Select an implementer
- SEH
- SPIN Plus
Period:
HSS: Health sector governance and planning
Increasing domestic financing of countries for services to key groups
Progress to date
Targeted activities were held in all project countries to discuss with national and international, governmental and non-governmental stakeholders the changes needed to enable sustainable and uninterrupted funding of HIV-related activities from national resources. Through targeted advocacy, technical support, and an integrated approach to HIV funding, in 2022 the project team managed to allocate approximately 1,7 million USD at the national level to programs for key populations, using social contracting mechanisms: Moldova – 154,126.84 USD; Kazakhstan – 118,529.33 USD; Kyrgyzstan – 61,000 USD; Tajikistan – 19,200.00 USD; Georgia – 357,000 USD; Ukraine – 931,453.96 USD.
Thanks to budget advocacy within the SoS project 2.0, the amount of money allocated from national budgets for HIV services through social contracting mechanisms in EECA project countries amounted to $3 269 959 in 2024. During SoS project 2.0 – $ 6 273 049 were allocated for social contracting in EECA region. The cumulative domestic budget expenditures for servicing key populations in 5 countries of SEE amounted to $1 061 383 in 2024. During SoS project 2.0 – $ 3 236 260 were allocated for social contracting in SEE region.
HSS: Health sector governance and planning
Municipal budget advocacy for cities that chose the Fast Track approach: in Dushanbe, Kulyab and Khorog cities of Tajikistan
Progress to date
As the result of budget advocacy the city administrations in Dushanbe ($130 000), Podgorica ($43 000), Skopje ($35 000), Tirana (USD 32,000), Novi Sad (USD 9,000), Sabac ($7 500) and Zvezdara ($4 000) allocated funds for the implementation of activities that would achieve the goals of the Paris Declaration.
In Tajikistan, the cities allocated municipal funds for HIV programs or KPs during 2022-2024: Dushanbe -$331k, for the first time Kulyab allocated – $11k and Khorog -$2k.
The cumulative domestic budget expenditures for servicing key populations in 5 countries of SEE amounted to $1 061 383 in 2024. During SoS project 2.0 – $3 236 260 were allocated for social contracting in SEE region.
Solutions
Implementer:
- Select an implementer
- SEH
- SEH
Period:
HSS: Health sector governance and planning
Legal framework for financing HIV services from domestic funds – development and approval
Progress to date
Targeted activities were held in all project countries to discuss with national and international, governmental and non-governmental stakeholders the changes needed to enable sustainable and uninterrupted funding of HIV-related activities from national resources. Through targeted advocacy, technical support, and an integrated approach to HIV funding, in 2022 the project team managed to allocate approximately 1,7 million USD at the national level to programs for key populations, using social contracting mechanisms: Moldova – 154,126.84 USD; Kazakhstan – 118,529.33 USD; Kyrgyzstan – 61,000 USD; Tajikistan – 19,200.00 USD; Georgia – 357,000 USD; Ukraine – 931,453.96 USD.
Over three years of implementation of SoS_project 2.0 has contributed to significant changes in the financing of HIV services in 14 countries in SEE and EECA regions. The project supported the development of service delivery standards, pricing methodologies, and quality control procedures, which are critical for sustainable financing from the state budget.
The practice of social contracting is applied without interruption in 14 countries.
HSS: Health sector governance and planning
Regulation of service packages for key groups
Progress to date
In the reporting period, the Emergency package of services for key and vulnerable groups of the population in the field of HIV, and TB in the context of military conflicts was finalized, including tariffication. On its basis, in 2023, the process of advocacy and promotion of implementation at the level of countries in the EECA region will be launched.
Strategic Brief on Business Continuity (link) and Strategic Brief on Social contracting (link) were developed. In addition, Analysis of Quality of Services Provided in Azerbaijan was held and is available at the link.
Over three years of implementation of SoS_project 2.0 has contributed to significant changes in the financing of HIV services in 14 countries in SEE and EECA regions. The project supported the development of service delivery standards, pricing methodologies, and quality control procedures, which are critical for sustainable financing from the state budget.
The practice of social contracting is applied without interruption in 14 countries.
Solutions
Implementer:
- Select an implementer
- APH
Period:
RSSH: Health sector governance and planning
National info system with database, service provider app, and client app
Progress to date
ToR is developed, specifications are being developed, team is being trained, development is due to start in April 2023.
The APH National HIV prevention care and support information system was finalised for and piloted in Kyrgyzstan in close collaboration with the UNDP and the AIDS Centre. The pilot focused on two NGOs, sub recipients of the national Global Fund grant. The pilot utilised desktop and mobile data entry options; allowed to test out the newly developed batch/journal entry application and mode.
The System version was developed for Tajikistan and launched country-wide in collaboration with the AIDS Centre and the UNDP as the prime Global Fund grant recipient in the country. Up to 60 NGOs and trust cabinets (AIDS Centre service points) have started using the system, entering data for several quarters of the year, based on existing sources, as well as ongoing program implementation. The teams are using both desktop and mobile data entry options and are being supported by the APH team as they become more familiar with the system and/or identify additional changes or improvements required.
Objective Description:
OBjective task:
- Select a objective task
- Removing structural barriers to increase of HIV testing in EECA
- Implementation of COVID-19 response mechanism
- Select a objective task
- Monitoring situation with human rights of KPs, responding to viloations
- Select a objective task
- Developing necessary legal framework and technical solutuions for cost-effective care package for KPs in EECA
- Advocacy for domestic resource allocation for KP services in EECA
Solutions
Implementer:
- Select an implementer
- APH
- APH
- APH
Period:
Supporting key group populations in a COVID setting
Provision of HIV prevention services with precautions against COVID-19
Progress to date
Work on shelters has expanded – in addition to 5 shelters for working with women who use drugs in conditions of violence (Ukraine, Serbia, North Macedonia, Kazakhstan), support for flexible shelters for representatives of the LGBT community in Kazakhstan, Uzbekistan, Kyrgyzstan and Tajikistan has been added. The program was distinguished by a special programmatic approach to working with clients – about 3,200 clients received material assistance in the form of food packages (Georgia, Kazakhstan). PPE support in Kaz for migrants and KGP (124,000 disposable masks, 1,000 antiseptics); CLM to provide quality services for clients of OST programs in 7 countries.
Supporting key group populations in a COVID setting
Procurement and distribution of Ag-RDTs
Progress to date
Purchased 120 thousand rapid antigen tests for COVID (Bosnia and Herzegovina, Serbia, Tajikistan, Ukraine) and 4,000 PCR tests for Ukraine to test key population groups and their close contacts.
Supporting key group populations in a COVID setting
National Contingency Planning
Progress to date
Supporting key group populations in a COVID setting “General contingency planning guide developed in the frames of the C19RM is available here.
Guide by APH for Contingency Planning for Key Population HIV Services during COVID-19 and Other Emergencies for North Macedonia, Serbia, Bosnia and Herzegovina, Montenegro, Moldova, Georgia, Kazakhstan, Uzbekistan, Tajikistan and Kyrgyzstan in English is available at the link https://aph.org.ua/en/eeca/ in the folders with the names of each country.
Solutions
Implementer:
- Select an implementer
- SEE RCN
- SEE RCN
Period:
Integrated service delivery and HIV service quality improvement
Country level support to adoption and implementation of HTS guidelines and introduction of self-testing, community-based testing and decentralized testing into national policy documents and clinical guidelines, and harmonized testing policies and processes with new WHO recommendations in four (4) countries of the SEE sub-region (Albania, Montenegro, North Macedonia and Serbia)
Progress to date
In 2022, the project conducted an assessment on policies, regulations, and practice of HIV Rapid Testing/Self-testing in 4 SEE countries and developed a report on findings and recommendations. The purpose of this assessment was to evaluate country-specific policies, regulations, and practical factors that are currently facilitating or affecting community-level access to rapid diagnostic tests, including self-testing of HIV.
The SoS project has been instrumental in advancing self-testing and community-based HIV testing in SEE through persistent advocacy, strategic meetings, and expert consultations. Our partners have actively engaged with ministries and public health institutes to push for the integration of self-testing into national HIV strategies and the expansion of community-based testing services.
The advocacy work of SoS partners in 4 countries with stakeholders culminated in the incorporation of self-testing into updated guidelines and HIV testing protocols, namely:
- In North Macedonia, a significant milestone was reached within SoS in 2023 with the inclusion of community-based testing and self-testing initiatives under the National HIV Program. Both community-based HIV testing and self-testing are part of the annual National HIV Program and both are delivered by civil society organisations. The evidence for community based testing and self-testing in 2024 is present in HIV report.
- In Albania, legislative and regulatory revisions have been made, including HIV self-testing, community-based testing, and decentralised testing with the approval in 2022 of the National Guidelines for HIV testing and prevention – on page 16 and in PrEP protocol. As evidence of availability of self testing please see on the page 14 in National 2023 HIV report from the IPH marked with yellow.
- In Montenegro, self-testing, community-based testing and decentralized testing were included in Voluntary Counselling and Testing protocol. Community based testing and new Protocol for HIV testing in Montenegro is modified on WHO guidelines for HIV testing. Community testing is done by CAZAS and community organizations in mobile vans and was integrated through cooperation with IPH during 2024. Several actions have been conducted and as evidence you can find public announcements of some of community testing activities organized in 2024 in Montenegro in supporting docs. Decentralized testing is done in 8 VCT centres in Montenegro.
- In Serbia, within SoS project new VCT protocol that integrate self and community based testing as a regular component of healthcare protocols was developed and approved by the Ministry of Health and the Health Institute. Information on self and community based testing is available. In 2024 community based testing was carried out exclusively through drop-in centers and mobile vehicles. Self-testing for HIV is recognized in the new guidelines and will be piloted for HIV and HCV through community-based services within the new national Global Fund program in Serbia in 2025.
HSS: Health products management systems
Introduction of self-testing, community-based testing and decentralized testing into national policy documents and clinical guidelines, and harmonized testing policies and processes with new WHO recommendations, including with TA provided by the WHO Regional Office, Europe
Progress to date
In 2022, the project conducted an assessment on policies, regulations, and practice of HIV Rapid Testing/Self-testing in 4 SEE countries and developed a report on findings and recommendations. The assessment was conducted in North Macedonia, Albania, Montenegro, and Serbia. The purpose of this assessment was to evaluate country-specific policies, regulations, and practical factors that are currently facilitating or affecting community-level access to rapid diagnostic tests, including self-testing of HIV. Some of the key recomendations which are suggested: to update National Guidelines/Protocols for HIV testing, outlining clear HIV testing algorithm in line with WHO recommendation including community based testing and HIV self-testing; update the existing internal protocol on HIVST; develop policy and advocacy recommendations for reducing HIV-related stigma and discrimination; integrate HIV self-testing into existing HIV service delivery models including OST programs. The report can be found at the link.
The advocacy work of SoS partners in 4 countries with stakeholders culminated in the incorporation of self-testing into updated guidelines and HIV testing protocols, namely:
- In North Macedonia, a significant milestone was reached within SoS in 2023 with the inclusion of community-based testing and self-testing initiatives under the National HIV Program. Both community-based HIV testing and self-testing are part of the annual National HIV Program and both are delivered by civil society organizations. The evidence for community based testing and self-testing in 2024 is present in HIV report.
- In Albania, legislative and regulatory revisions have been made, including HIV self-testing, community-based testing, and decentralized testing with the approval in 2022 of the National Guidelines for HIV testing and prevention – on page 16 and in PrEP protocol. As evidence of availability of self testing please see on the page 14 in National 2023 HIV report from the IPH marked with yellow. In Montenegro, self-testing, community-based testing and decentralized testing were included in Voluntary Counselling and Testing protocol. Community based testing and new Protocol for HIV testing in Montenegro is modified on WHO guidelines for HIV testing.
- Community testing is done by CAZAS and community organizations in mobile vans and was integrated through cooperation with IPH during 2024. Several actions have been conducted and as evidence you can find public announcements of some of community testing activities organized in 2024 in Montenegro in supporting docs. Decentralized testing is done in 8 VCT centres in Montenegro.
- In Serbia, within SoS project new VCT protocol that integrate self and community based testing as a regular component of healthcare protocols was developed and approved by the Ministry of Health and the Health Institute. Information on self and community based testing is available. In 2024 community based testing was carried out exclusively through drop-in centers and mobile vehicles. Self-testing for HIV is recognized in the new guidelines and will be piloted for HIV and HCV through community-based services within the new national Global Fund program in Serbia in 2025.
Solutions
Implementer:
- Select an implementer
- EWNA
- EKPC
- APH
- SEE RCN
Period:
Reducing human rights-related barriers to HIV/TB services
Women-led research, “Sexual and reproductive health and rights (SRHR) of women living with HIV”
Reducing human rights-related barriers to HIV/TB services
Developing and launching call for “Gender and HIV” small grants with special eligibility focus on Monitoring situation with human rights of Trans* people
Progress to date
Small Grants Programme with 4 selected projects run by grass-root NGOs in 2022 included:
- “National Trans Coalition” NGO with the project titled “HIV prevention in Armenia through gender mainstreaming” (Armenia);
- “The Public Association “Union for Equity and Health” NGO with the project titled “Gender Equality for sex workers” (Moldova);
- “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Check your health – Equality for Trans Roma and Roma women/girls sex workers” (Serbia);
- “NON-GOVERNMENTAL ORGANIZATION «NASHA DOPOMOGA»” with the project titled “RIGHT TO HEALTH!” (Ukraine).
- The project applicant is the organization “Albanian Association of People Living with HIV/AIDS (PLWHA)” with the project titled “New approach on transforming the spiral of exclusion and marginalization, towards the right of recognition before the law, gender-diverse and reduce the violence in health-care settings for trans persons in Albania”.
- The project applicant is the “National Trans Coalition” NGO with the project titled “Strategic pathway to remove structural barriers for trans* communities to PrEP and PEP services in Armenia”. The proposed project has been designed to establish favorable conditions for improving access of Trans* communities to PrEP and PEP services in Armenia.
- The project applicant is the organization “STAR STAR” Skopje with the project titled “Community Mobilization to Mitigate Funding Cuts and Gender Inequality in National HIV Programs for Sex Workers in North Macedonia”. The project is envisioned as a response to the latest developments in North Macedonia related to provision and delivery of HIV prevention services for key populations.
- The project applicant is the organization “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Supporting health wellbeing and safety of Trans and Intersex Roma, sex workers and HIV+”.
In 2024, grants “Gender and HIV” were implemented in Albania, Georgia, Moldova and Ukraine.
Moldova
GENDERDOC-M, alongside a parent support group, aimed to create a safe and inclusive environment for transgender and gender-nonconforming youth. Two formal partnerships with youth clinics expanded access to health services and 24/7 hotline support. Parent education sessions led to increased understanding, school negotiations for name recognition, and medical referrals. As a result, a strategic plan for 2025 includes engaging health and education ministries to address systemic barriers.
Georgia
The Queer Association Temida established an informal network of trans-friendly professionals across three cities, despite restrictive anti-LGBT laws. The network held two meetings to discuss the legal landscape and continued service delivery. A memorandum with Psychea Mental Health Center helped maintain access to gender-affirming care. A peer educator training course was launched, and two trained educators provided online consultations to 32 beneficiaries, offering support on HIV and gender-affirming care.
Ukraine
The “Help Is Near” project by HPLGBT produced a comprehensive report on barriers and solutions in trans health services, especially for intersectional groups like sex workers and those using psychoactive substances. Recommendations for service decentralization were developed and are planned to be presented to the CCM in early 2025. HPLGBT aims to integrate these recommendations into national funding requests to the Global Fund, ensuring sustained support for marginalized trans communities.
Reducing human rights-related barriers to HIV/TB services
REAct (https://react-aph.org/): Monitoring of human rights violations and discrimination against PLHIV and KPs. Responding to such cases through provision or referring to legal or social services to victims and through advocacy actions. In Georgia, Kyrgyzstan, Moldova and Tajikistan, REAct system was initiated within SoS_project#1.0 in 2020, and in 2022 is transferred to national funding, meanwhile APH continues to provide technical support to users. In Ukraine, REAct was implemented in 2019 and is functional within national GF grant. REAct system is supported by APH in Uzbekistan for 2022-2023, in 5 Balkan countries – for 2022-2024, and in Armenia and Azerbaijan – for 2023-2024. At the same time, regional networks ECOM and ENPUD started to use REAct program for documentation in several countries of the region and are supported for 2022-2024 within SoS_project#2.0 grant.
Progress to date
Cumulatively, during 2022 there were registered 6700+ cases in 13 countries (Albania, Armenia, Bosnia and Herzegovina, Georgia, North Macedonia, Moldova, Montenegro, Kazakhstan, Kyrgyzstan, Tajikistan, Serbia, Ukraine, Uzbekistan) involving 170+ CBOs, as well as regional networks such as ECOM (in Uzbekistan, Tajikistan, Armenia, Kazakhstan, Kyrgyzstan) and ENPUD (Georgia, Moldova, Ukraine, Kyrgyzstan, Kazakhstan, Tajikistan, Belarus).
The following publications are available:
- Statistic country reports by APH on human rights violations based on REAct data collected in 2021 in Kyrgyzstan, in Georgia, in Moldova, in Tajikistan.
- Protectors or Perpetrators: the impact of unlawful policing on human rights and HIV. Join analytical publication in partnership with Frontline AIDS, Alliance for Public Health (Ukraine, Kyrgyzstan, Tajikistan, Moldova, Georgia, Uzbekistan), AIDS Foundation (South Africa), Gender Dynamix.
- Report on the results of the analysis of the Hotline calls by APH: Domestic and other forms of violence against women living with HIV and women in key populations during the COVID-19 pandemic in Tajikistan.
- REAct Statistical Report for the 1st half of 2022 by APH. Violations of the rights of people living with HIV and representatives of vulnerable groups in Georgia.
Situational Report by APH: Drug policy in Georgia and Challenges. - Series of publications by APH based on REAct data within regional campaign “16 days against gender-based violence”.
REAct system is available and functional at the national level in the following counties. It enables documentation of cases of human rights violations: Albania (45 cases), Armenia (182), Azerbaijan (174), B&H (70), Montenegro (60), Kazakhstan (363), North Macedonia (42), Tajikistan (1155), Serbia (24), Uzbekistan (835). More detailed data of 2023 is available in REAct Regional Digest and REAct website.
Cumulatively in 10 countries, 49,9% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions. During 2023 in 10 countries, there were provided 2162 consultations about human rights, 1022 consultations with professional lawyers. In 168 cases REActors helped to draft simple legal documents, such as complains or statement to police, in 236 cases represented client’s interests in medical facilities, assisted in getting medical services and support, in 336 cases – accompanied the client in the initial appeal to the police. There were at least 20 strategic court cases, and at least 162 cases were used for shadow reports to UN Treaty Bodies.
Cumulatively in 8 countries (Armenia, Azerbaijan, Kazakhstan, Albania, Bosnia and Herzegovina, Montenegro, North Macedonia, Serbia) 56,2% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions (https://drive.google.com/drive/folders/1wtJaecXERatg8cmrAE1mzaoshtdLQY_w). Numerous success stories of cases resolutions are available at REAct website.
Solutions
Implementer:
- Select an implementer
- SEE RCN
Period:
HSS: Health sector governance and planning
Municipal budget advocacy for cities that chose the Fast Track approach: Sombor, Kragujevac, Zvezdara, Subotica, Novi Sad, Sabac, Stari Grad, Zajecar, Novi Pazar and Nis cities in the Balkan region
Progress to date
As the result of budget advocacy the city administrations in Dushanbe ($130 000), Podgorica ($43 000), Skopje ($35 000), Tirana (USD 32,000), Novi Sad (USD 9,000), Sabac ($7 500) and Zvezdara ($4 000) allocated funds for the implementation of activities that would achieve the goals of the Paris Declaration.
Solutions
Implementer:
- Select an implementer
- SEE RCN
- SEE RCN
Period:
RSSH: Health sector governance and planning
Assessment of the legal framework to fund HIV services with domestic funds: sustainability planning; advocacy campaign on change of laws and regulations; establishment of Parliamentary group for HIV,TB, Hepatitis and STIs
Progress to date
Preliminary consultations were held in 2022and assessment was planned in 2023.Domestic funding for HIV services is increased. The funding of Tirana municipality for NGOs offer HIV services was $32,000. The level of funding for HIV-related activities from the City of Skopje remained approximately the same as is in 2021 –approximately 35,000 USD. MoH from Montenegro allocated 100.000 EUR for funding NGO HIV programs in 2022. In Bosnia and Herzegovina for increase services for key populations and PLWHA. was two grants. One grant was from Ministry of Civil affairs, Department for Health and it was about 26 000 Euro for nine CSOs, Partnerships in Health was one of them but also our partners from the Project, Victoria and Ruka Ruci. The second grant was from Federal Ministry of Health, and it was for HIV testing and counselling on HIV, education for KAP and youth. It was about 13 500 Euro and it was granted to the Partnerships in Health. In Serbia there was 19214 USD in total from municipality funding for HIV services in Serbia.
Until now there is Parliamentary group for HIV, TB Hepatitis and STIs established in Bosnia and Herzegovina.
The main achievements of the project were the removal of legislative barriers, approval of standards and tariffs for services, adoption of regulatory acts that allow the implementation of social contracting mechanisms, as well as expansion of financing from state budgets. The cumulative domestic budget expenditures for servicing key populations and People Living with HIV/AIDS in 5 countries of Southeastern Europe (SEE) amounted to $1 061 383 in 2024. During SoS project 2.0 – $ 3 236 260 were allocated for social contracting in SEE region.
HSS: Health sector governance and planning
Regulation of service packages for key groups
Progress to date
Strategic Brief on Business Continuity (link) and Strategic Brief on Social contracting (link) were developed. In addition, Analysis of Quality of Services Provided in Azerbaijan was held and is available at the link.
Objective Description:
OBjective task:
- Select a objective task
- Removing structural barriers to increase of HIV testing in EECA
- Removing structural barriers to ART in EECA
- Implementation of COVID-19 response mechanism
- Select a objective task
- Monitoring situation with human rights of KPs, responding to viloations
- Revision of legisation and other regulations on KPs that pose barriers to accessing HIV services:
- Select a objective task
- Developing necessary legal framework and technical solutuions for cost-effective care package for KPs in EECA
- Advocacy for domestic resource allocation for KP services in EECA
Solutions
Implementer:
- Select an implementer
- APH
- APH
Period:
Supporting key group populations in a COVID setting
REAct monitoring system implementation to capture COVID-19 related rights violations
Progress to date
Support of the hotline / phone services within REAct monitoring system implementation in order to provide distant support and legal consultations to women from groups at risk suffering domestic violence and experiencing human rights violations (in Tajikistan and Uzbekistan) – Distant legal consulting to avoid face-to-face meetings between client and REActors. With the help of crisis and instant assistance, it was possible to expand the coverage of clients with services (38% of all services in Tajikistan and 45% in Uzbekistan) and reduce barriers to accessing REAct services.
Supporting key group populations in a COVID setting
National Contingency Planning
Progress to date
Supporting key group populations in a COVID setting “General contingency planning guide developed in the frames of the C19RM is available here.
Guide by APH for Contingency Planning for Key Population HIV Services during COVID-19 and Other Emergencies for North Macedonia, Serbia, Bosnia and Herzegovina, Montenegro, Moldova, Georgia, Kazakhstan, Uzbekistan, Tajikistan and Kyrgyzstan in English is available at the link https://aph.org.ua/en/eeca/ in the folders with the names of each country.
Solutions
Implementer:
- Select an implementer
- 100% Life
Period:
HSS: Health products management systems
Community-led advocacy of elimination of identified critical discrepancies with the WHO prevention, testing and treatment guidelines
Progress to date
Current testing and treatment protocols analysis is finished in 7 countries (Armenia, Moldova, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan, and Ukraine) and recommendations to align the national protocols with the WHO guidelines are provided. The report is available at the link.
WHO has held the analysis of HIV testing guidelines in 6 countries of EECA – Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Uzbekistan. The report is available at the link.
National HIV testing and ART-optimized strategies based on and aligned with the WHO recommendations were developed for 4 EECA countries – Armenia, Kazakhstan, Kyrgyzstan, Moldova.
In Armenia, Kazakhstan, Kyrgyzstan, and Moldova, all key actions related to the development and implementation of HIV testing and ART optimization strategies, in line with WHO recommendations, have been completed. According to the results of the assessment in 2022, there was a need to replace Georgia with another country to implement activities for 2023 and 2024 since the Georgian testing and treatment protocol is generally in line with the 2021 WHO recommendations for the use of ARV drugs for the prevention and treatment of HIV, and as well as other aspects of the clinical management of HIV. During project meetings different optios were discussed, and the desicion was taken to continue the activities in Armenia instead of Georgia.
Armenia
- Approved – Order of the Ministry of Health of Armenia No. 6241-L dated 11/13/2024 on implementation of the clinical protocol “Pre-Exposure Prophylaxis of HIV Infection” in Armenia. The Order entered into force on November 13, 2024.
- Approved – Clinical protocol “Pre-Exposure Prophylaxis of HIV Infection”.
An official letter-response from the Ministry of Health of Armenia dated on November 26, 2024 confirms the approval of the PrEP protocol and contains the information on other legal acts that are developed and will be approved in 2025 is also attached.
Solutions
Implementer:
- Select an implementer
- 100% Life
Period:
HSS: Health products management systems
Community-led advocacy of elimination of identified critical discrepancies with the WHO prevention, testing and treatment guidelines
Progress to date
Current testing and treatment protocols analysis is finished in 7 countries (Armenia, Moldova, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan, and Ukraine) and recommendations to align the national protocols with the WHO guidelines are provided. The report is available at the link.
WHO has held the analysis of HIV testing guidelines in 6 countries of EECA – Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Uzbekistan. The report is available at the link.
National HIV testing and ART-optimized strategies based on and aligned with the WHO recommendations were developed for 4 EECA countries – Armenia, Kazakhstan, Kyrgyzstan, Moldova.
In Armenia, Kazakhstan, Kyrgyzstan, and Moldova, all key actions related to the development and implementation of HIV testing and ART optimization strategies, in line with WHO recommendations, have been completed. According to the results of the assessment in 2022, there was a need to replace Georgia with another country to implement activities for 2023 and 2024 since the Georgian testing and treatment protocol is generally in line with the 2021 WHO recommendations for the use of ARV drugs for the prevention and treatment of HIV, and as well as other aspects of the clinical management of HIV. During project meetings different optios were discussed, and the desicion was taken to continue the activities in Armenia instead of Georgia.
Armenia
- Approved – Order of the Ministry of Health of Armenia No. 6241-L dated 11/13/2024 on implementation of the clinical protocol “Pre-Exposure Prophylaxis of HIV Infection” in Armenia. The Order entered into force on November 13, 2024.
- Approved – Clinical protocol “Pre-Exposure Prophylaxis of HIV Infection”.
An official letter-response from the Ministry of Health of Armenia dated on November 26, 2024 confirms the approval of the PrEP protocol and contains the information on other legal acts that are developed and will be approved in 2025.
Solutions
Implementer:
- Select an implementer
- ECOM
- EKPC
- APH
- CAAPLA
- Ishonch va Hayot
Period:
Reducing human rights-related barriers to HIV/TB services
Legal environment assessment on MSM and trans people in 4 countries
Progress to date
Legal environment assessments for Kyrgyzstan and for Uzbekistan were published.
In 2024, ECOM conducted a legal Environment Assessment in 4 countries of EECA. This comparative country analysis aimed to identify legal barriers and issues in areas where the necessary legislation already exists, but does not fully ensure the implementation of rights and freedoms for gay men, other MSM and trans people.
All reports consist of these chapters:
- International obligations of the country and their implementation;
- Table: Compliance of Domestic legislation with international standards;
- Analysis of legal regulations related to SOGI and HIV and their application;
- Recommendations.
All reports were published on ECOM’s website.
- Legal Environment Assessment in Armenia;
- Legal Environment Assessment in Georgia;
- Legal Environment Assessment in Kazakhstan;
- Legal Environment Assessment in Moldova.
Reducing human rights-related barriers to HIV/TB services
Developing and launching call for “Gender and HIV” small grants with special eligibility focus on Monitoring situation with human rights of Trans* people
Progress to date
Small Grants Programme with 4 selected projects run by grass-root NGOs in 2022 included:
- “National Trans Coalition” NGO with the project titled “HIV prevention in Armenia through gender mainstreaming” (Armenia);
- “The Public Association “Union for Equity and Health” NGO with the project titled “Gender Equality for sex workers” (Moldova);
- “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Check your health – Equality for Trans Roma and Roma women/girls sex workers” (Serbia);
- “NON-GOVERNMENTAL ORGANIZATION «NASHA DOPOMOGA»” with the project titled “RIGHT TO HEALTH!” (Ukraine).
- The project applicant is the organization “Albanian Association of People Living with HIV/AIDS (PLWHA)” with the project titled “New approach on transforming the spiral of exclusion and marginalization, towards the right of recognition before the law, gender-diverse and reduce the violence in health-care settings for trans persons in Albania”.
- The project applicant is the “National Trans Coalition” NGO with the project titled “Strategic pathway to remove structural barriers for trans* communities to PrEP and PEP services in Armenia”. The proposed project has been designed to establish favorable conditions for improving access of Trans* communities to PrEP and PEP services in Armenia.
- The project applicant is the organization “STAR STAR” Skopje with the project titled “Community Mobilization to Mitigate Funding Cuts and Gender Inequality in National HIV Programs for Sex Workers in North Macedonia”. The project is envisioned as a response to the latest developments in North Macedonia related to provision and delivery of HIV prevention services for key populations.
- The project applicant is the organization “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Supporting health wellbeing and safety of Trans and Intersex Roma, sex workers and HIV+”.
In 2024, grants “Gender and HIV” were implemented in Albania, Georgia, Moldova and Ukraine.
Moldova
GENDERDOC-M, alongside a parent support group, aimed to create a safe and inclusive environment for transgender and gender-nonconforming youth. Two formal partnerships with youth clinics expanded access to health services and 24/7 hotline support. Parent education sessions led to increased understanding, school negotiations for name recognition, and medical referrals. As a result, a strategic plan for 2025 includes engaging health and education ministries to address systemic barriers.
Georgia
The Queer Association Temida established an informal network of trans-friendly professionals across three cities, despite restrictive anti-LGBT laws. The network held two meetings to discuss the legal landscape and continued service delivery. A memorandum with Psychea Mental Health Center helped maintain access to gender-affirming care. A peer educator training course was launched, and two trained educators provided online consultations to 32 beneficiaries, offering support on HIV and gender-affirming care.
Ukraine
The “Help Is Near” project by HPLGBT produced a comprehensive report on barriers and solutions in trans health services, especially for intersectional groups like sex workers and those using psychoactive substances. Recommendations for service decentralization were developed and are planned to be presented to the CCM in early 2025. HPLGBT aims to integrate these recommendations into national funding requests to the Global Fund, ensuring sustained support for marginalized trans communities.
Reducing human rights-related barriers to HIV/TB services
REAct (https://react-aph.org/): Monitoring of human rights violations and discrimination against PLHIV and KPs. Responding to such cases through provision or referring to legal or social services to victims and through advocacy actions. In Georgia, Kyrgyzstan, Moldova and Tajikistan, REAct system was initiated within SoS_project#1.0 in 2020, and in 2022 is transferred to national funding, meanwhile APH continues to provide technical support to users. In Ukraine, REAct was implemented in 2019 and is functional within national GF grant. REAct system is supported by APH in Uzbekistan for 2022-2023, in 5 Balkan countries – for 2022-2024, and in Armenia and Azerbaijan – for 2023-2024. At the same time, regional networks ECOM and ENPUD started to use REAct program for documentation in several countries of the region and are supported for 2022-2024 within SoS_project#2.0 grant.
Progress to date
Cumulatively, during 2022 there were registered 6700+ cases in 13 countries (Albania, Armenia, Bosnia and Herzegovina, Georgia, North Macedonia, Moldova, Montenegro, Kazakhstan, Kyrgyzstan, Tajikistan, Serbia, Ukraine, Uzbekistan) involving 170+ CBOs, as well as regional networks such as ECOM (in Uzbekistan, Tajikistan, Armenia, Kazakhstan, Kyrgyzstan) and ENPUD (Georgia, Moldova, Ukraine, Kyrgyzstan, Kazakhstan, Tajikistan, Belarus).
The following publications are available:
- Statistic country reports by APH on human rights violations based on REAct data collected in 2021 in Kyrgyzstan, in Georgia, in Moldova, in Tajikistan.
- Protectors or Perpetrators: the impact of unlawful policing on human rights and HIV. Join analytical publication in partnership with Frontline AIDS, Alliance for Public Health (Ukraine, Kyrgyzstan, Tajikistan, Moldova, Georgia, Uzbekistan), AIDS Foundation (South Africa), Gender Dynamix.
- Report on the results of the analysis of the Hotline calls by APH: Domestic and other forms of violence against women living with HIV and women in key populations during the COVID-19 pandemic in Tajikistan.
- REAct Statistical Report for the 1st half of 2022 by APH. Violations of the rights of people living with HIV and representatives of vulnerable groups in Georgia.
Situational Report by APH: Drug policy in Georgia and Challenges. - Series of publications by APH based on REAct data within regional campaign “16 days against gender-based violence”.
REAct system is available and functional at the national level in the following counties. It enables documentation of cases of human rights violations: Albania (45 cases), Armenia (182), Azerbaijan (174), B&H (70), Montenegro (60), Kazakhstan (363), North Macedonia (42), Tajikistan (1155), Serbia (24), Uzbekistan (835). More detailed data of 2023 is available in REAct Regional Digest and REAct website.
Cumulatively in 10 countries, 49,9% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions. During 2023 in 10 countries, there were provided 2162 consultations about human rights, 1022 consultations with professional lawyers. In 168 cases REActors helped to draft simple legal documents, such as complains or statement to police, in 236 cases represented client’s interests in medical facilities, assisted in getting medical services and support, in 336 cases – accompanied the client in the initial appeal to the police. There were at least 20 strategic court cases, and at least 162 cases were used for shadow reports to UN Treaty Bodies.
Cumulatively in 8 countries (Armenia, Azerbaijan, Kazakhstan, Albania, Bosnia and Herzegovina, Montenegro, North Macedonia, Serbia) 56,2% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions (https://drive.google.com/drive/folders/1wtJaecXERatg8cmrAE1mzaoshtdLQY_w). Numerous success stories of cases resolutions are available at REAct website.
Solutions
Implementer:
- Select an implementer
- 100% Life
Period:
Reducing human rights-related barriers to HIV/TB services
Decriminalization of HIV and unintended HIV transmission
Progress to date
100% Life conducted an analysis of the legal environment in Georgia, Kyrgyz Republic and the Republic of Uzbekistan in order to identify regulatory legal acts that need to be amended to reduce the criminalization of people living with HIV.
During 2023, draft legislative amendments to the regulations in the context of the legal and legislative acts that contribute to the criminalization of HIV in Georgia, Kyrgyzstan, Kazakhstan, and Uzbekistan were developed. These amendments concern both general and specialized norms.
- Draft Law “On amendments and additions to the Criminal Code of the Republic of Uzbekistan with regard to liability for human infection with the immunodeficiency virus (HIV)”
- Legal justification for amending the requirements to the list of professions prohibited for people living with HIV infection. By Order of the Minister of Health of the Republic of Uzbekistan (registered by the Ministry of Justice on 7.05.2014 No. 2581) and In accordance with Article 21 of the Law “On counteracting the spread of the disease caused by human immunodeficiency virus (HIV infection)” (dated 23.09.2013 No. ZRU-353) it is not allowed to terminate the employment contract, refuse an employment (except for certain types of professional activities provided by the list established by the Ministry of Health of the Republic of Uzbekistan).
Extensive advocacy efforts were made to decriminalize HIV in Uzbekistan, focusing on amending Article 113 of the Criminal Code. A working group comprising state representatives, NGOs, and experts developed a Draft Law “On amendments and additions to the Criminal Code of the Republic of Uzbekistan about liability for human infection with the immunodeficiency virus (HIV)” and discussed it during a Stakeholders meeting in May 2024. The finalized Draft Law with Recommendations was officially submitted to the Committee of the Legislative Chamber of the Oliy Majlis of the Republic of Uzbekistan on Public Health Issues in September 2024 and was accepted for consideration, marking a crucial step toward HIV law reform. Moreover, the List of Jobs and Types of Professions Prohibited for PLHIV (Reg. No. 881 dated January 25, 2000) was amended and now excludes professions of diagnostics and medical-preventive procedures, nursing, services rendered to the public (care for newborns, critically ill patients, work with preschool children and their education), massage procedures, and contact sports.
Solutions
Implementer:
- Select an implementer
- SEH
Period:
HSS: Health sector governance and planning
Increasing domestic financing of countries for services to key groups
Progress to date
Targeted activities were held in all project countries to discuss with national and international, governmental and non-governmental stakeholders the changes needed to enable sustainable and uninterrupted funding of HIV-related activities from national resources. Through targeted advocacy, technical support, and an integrated approach to HIV funding, in 2022 the project team managed to allocate approximately 1,7 million USD at the national level to programs for key populations, using social contracting mechanisms: Moldova – 154,126.84 USD; Kazakhstan – 118,529.33 USD; Kyrgyzstan – 61,000 USD; Tajikistan – 19,200.00 USD; Georgia – 357,000 USD; Ukraine – 931,453.96 USD.
Thanks to budget advocacy within the SoS project 2.0, the amount of money allocated from national budgets for HIV services through social contracting mechanisms in EECA project countries amounted to $3 269 959 in 2024. During SoS project 2.0 – $ 6 273 049 were allocated for social contracting in EECA region. The cumulative domestic budget expenditures for servicing key populations in 5 countries of SEE amounted to $1 061 383 in 2024. During SoS project 2.0 – $ 3 236 260 were allocated for social contracting in SEE region.
Solutions
Implementer:
- Select an implementer
- SEH
- SEH
Period:
HSS: Health sector governance and planning
Legal framework for financing HIV services from domestic funds – development and approval
Progress to date
Targeted activities were held in all project countries to discuss with national and international, governmental and non-governmental stakeholders the changes needed to enable sustainable and uninterrupted funding of HIV-related activities from national resources. Through targeted advocacy, technical support, and an integrated approach to HIV funding, in 2022 the project team managed to allocate approximately 1,7 million USD at the national level to programs for key populations, using social contracting mechanisms: Moldova – 154,126.84 USD; Kazakhstan – 118,529.33 USD; Kyrgyzstan – 61,000 USD; Tajikistan – 19,200.00 USD; Georgia – 357,000 USD; Ukraine – 931,453.96 USD.
Over three years of implementation of SoS_project 2.0 has contributed to significant changes in the financing of HIV services in 14 countries in SEE and EECA regions. The project supported the development of service delivery standards, pricing methodologies, and quality control procedures, which are critical for sustainable financing from the state budget.
The practice of social contracting is applied without interruption in 14 countries.
HSS: Health sector governance and planning
Regulation of service packages for key groups
Progress to date
In the reporting period, the Emergency package of services for key and vulnerable groups of the population in the field of HIV, and TB in the context of military conflicts was finalized, including tariffication. On its basis, in 2023, the process of advocacy and promotion of implementation at the level of countries in the EECA region will be launched.
Strategic Brief on Business Continuity (link) and Strategic Brief on Social contracting (link) were developed. In addition, Analysis of Quality of Services Provided in Azerbaijan was held and is available at the link.
Over three years of implementation of SoS_project 2.0 has contributed to significant changes in the financing of HIV services in 14 countries in SEE and EECA regions. The project supported the development of service delivery standards, pricing methodologies, and quality control procedures, which are critical for sustainable financing from the state budget.
The practice of social contracting is applied without interruption in 14 countries.
Objective Description:
OBjective task:
- Select a objective task
- Removing structural barriers to ART in EECA
- Launching critical enabling interventions to improve HIV care cascade
- Implementation of COVID-19 response mechanism
- Select a objective task
- Monitoring situation with human rights of KPs, responding to viloations
- Select a objective task
- Developing necessary legal framework and technical solutuions for cost-effective care package for KPs in EECA
- Advocacy for domestic resource allocation for KP services in EECA
Solutions
Implementer:
- Select an implementer
- APH
- APH
- APH
Period:
Supporting key group populations in a COVID setting
Provision of HIV prevention services with precautions against COVID-19
Progress to date
Work on shelters has expanded – in addition to 5 shelters for working with women who use drugs in conditions of violence (Ukraine, Serbia, North Macedonia, Kazakhstan), support for flexible shelters for representatives of the LGBT community in Kazakhstan, Uzbekistan, Kyrgyzstan and Tajikistan has been added. The program was distinguished by a special programmatic approach to working with clients – about 3,200 clients received material assistance in the form of food packages (Georgia, Kazakhstan). PPE support in Kaz for migrants and KGP (124,000 disposable masks, 1,000 antiseptics); CLM to provide quality services for clients of OST programs in 7 countries.
Supporting key group populations in a COVID setting
Procurement and distribution of Ag-RDTs
Progress to date
Purchased 120 thousand rapid antigen tests for COVID (Bosnia and Herzegovina, Serbia, Tajikistan, Ukraine) and 4,000 PCR tests for Ukraine to test key population groups and their close contacts.
Supporting key group populations in a COVID setting
National Contingency Planning
Progress to date
Supporting key group populations in a COVID setting “General contingency planning guide developed in the frames of the C19RM is available here.
Guide by APH for Contingency Planning for Key Population HIV Services during COVID-19 and Other Emergencies for North Macedonia, Serbia, Bosnia and Herzegovina, Montenegro, Moldova, Georgia, Kazakhstan, Uzbekistan, Tajikistan and Kyrgyzstan in English is available at the link https://aph.org.ua/en/eeca/ in the folders with the names of each country.
Solutions
Implementer:
- Select an implementer
- SEE RCN
Period:
Prevention (Pre-exposure prophylaxis – PrEP)
Introduction of the piloted PrEP models to the healthcare systems and advocate to revise and update national policy documents
Progress to date
Bosnia and Herzegovina and Montenegro are awaiting the launch of the PrEP pilot project between MCM (Protocols have been developed, client waiting lists are available, study-visits have been carried out for the project staff). The first clients are expected to receive PrEP in Q1 2023.
Bosnia and Herzegovina and Montenegro successfully launched a pilot PREP project among MSM (as of January 1, 2024, number of clients: BiH – 28, Montenegro – 51). Thanks to the coordinated work of the CSoS 2.0 project and partners in Balkans, a pre-exposure prophylaxis drug was purchased for both countries at 10 times cheaper than the commercial drug used in the countries for ART regimens. Our partners SEE Network, with technical support from WHO, developed Protocols and prepared PREP sites to launch the project.
The successful completion of the pilot projects in Bosnia and Herzegovina (65 clients) and Montenegro (81 clients) led to the inclusion of PrEP in national funding schemes. In Bosnia and Herzegovina, an indication for PrEP was officially registered during the reporting period. Since these drugs are also used to treat HIV and are included in the list of essential medicines, they are available free of charge, ensuring uninterrupted access to PrEP. Montenegro is in the final stages of including PrEP in the positive list of medicines, which will allow the state to procure PrEP. The project is successfully expanding in North Macedonia (153 clients). By the end of 2024, a total of 300 clients in the three countries have become participants in the PrEP program.
Solutions
Implementer:
- Select an implementer
- SEE RCN
Period:
Prevention (Pre-exposure prophylaxis – PrEP)
Advocacy for PrEP financial costs to be covered by national funding schemes (including health insurance)
Progress to date
The second main activity regarding of PrEP was advocacy for PrEP financial costs to be covered by national funding schemes. Our focus in 2022 was preparation of set of recommendations for institutionalization of PrEP in Bosnia and Herzegovina and Montenegro and by the end of the year we finalized first drafts which is distributed to the stakeholders.
This activity is planned for 2024. But remarkable progress was achieved in Bosnia and Herzegovina, where funding for PrEP-related expenses was already included in national schemes.
BiH
PrEP-related expenses is included into national funding scheme. PrEP drugs are included on the essential medicines list, they are available free of charge, ensuring uninterrupted access to PrEP in the Federation of BiH.
Montenegro For the including PrEP into national funding schemes two main steps should be done: approval PrEP drugs by Ministry of health to be distributed towards KPs and to be on Positive list of drugs.
List of approved drugs by Agency of drugs in which Gilestra duo is registered for PrEP use: https://cinmed.me/humani-lijekovi/humani-lijek/?id=3217
The Initiative to include pre-exposure prophylaxis (PrEP) as a new indication on the List of Medicines to the Commission at MoH has been submitted.
Solutions
Implementer:
- Select an implementer
- EKPC
- APH
- SEE RCN
Period:
Reducing human rights-related barriers to HIV/TB services
Developing and launching call for “Gender and HIV” small grants with special eligibility focus on Monitoring situation with human rights of Trans* people
Progress to date
Small Grants Programme with 4 selected projects run by grass-root NGOs in 2022 included:
- “National Trans Coalition” NGO with the project titled “HIV prevention in Armenia through gender mainstreaming” (Armenia);
- “The Public Association “Union for Equity and Health” NGO with the project titled “Gender Equality for sex workers” (Moldova);
- “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Check your health – Equality for Trans Roma and Roma women/girls sex workers” (Serbia);
- “NON-GOVERNMENTAL ORGANIZATION «NASHA DOPOMOGA»” with the project titled “RIGHT TO HEALTH!” (Ukraine).
- The project applicant is the organization “Albanian Association of People Living with HIV/AIDS (PLWHA)” with the project titled “New approach on transforming the spiral of exclusion and marginalization, towards the right of recognition before the law, gender-diverse and reduce the violence in health-care settings for trans persons in Albania”.
- The project applicant is the “National Trans Coalition” NGO with the project titled “Strategic pathway to remove structural barriers for trans* communities to PrEP and PEP services in Armenia”. The proposed project has been designed to establish favorable conditions for improving access of Trans* communities to PrEP and PEP services in Armenia.
- The project applicant is the organization “STAR STAR” Skopje with the project titled “Community Mobilization to Mitigate Funding Cuts and Gender Inequality in National HIV Programs for Sex Workers in North Macedonia”. The project is envisioned as a response to the latest developments in North Macedonia related to provision and delivery of HIV prevention services for key populations.
- The project applicant is the organization “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Supporting health wellbeing and safety of Trans and Intersex Roma, sex workers and HIV+”.
In 2024, grants “Gender and HIV” were implemented in Albania, Georgia, Moldova and Ukraine.
Moldova
GENDERDOC-M, alongside a parent support group, aimed to create a safe and inclusive environment for transgender and gender-nonconforming youth. Two formal partnerships with youth clinics expanded access to health services and 24/7 hotline support. Parent education sessions led to increased understanding, school negotiations for name recognition, and medical referrals. As a result, a strategic plan for 2025 includes engaging health and education ministries to address systemic barriers.
Georgia
The Queer Association Temida established an informal network of trans-friendly professionals across three cities, despite restrictive anti-LGBT laws. The network held two meetings to discuss the legal landscape and continued service delivery. A memorandum with Psychea Mental Health Center helped maintain access to gender-affirming care. A peer educator training course was launched, and two trained educators provided online consultations to 32 beneficiaries, offering support on HIV and gender-affirming care.
Ukraine
The “Help Is Near” project by HPLGBT produced a comprehensive report on barriers and solutions in trans health services, especially for intersectional groups like sex workers and those using psychoactive substances. Recommendations for service decentralization were developed and are planned to be presented to the CCM in early 2025. HPLGBT aims to integrate these recommendations into national funding requests to the Global Fund, ensuring sustained support for marginalized trans communities.
Reducing human rights-related barriers to HIV/TB services
REAct (https://react-aph.org/): Monitoring of human rights violations and discrimination against PLHIV and KPs. Responding to such cases through provision or referring to legal or social services to victims and through advocacy actions. In Georgia, Kyrgyzstan, Moldova and Tajikistan, REAct system was initiated within SoS_project#1.0 in 2020, and in 2022 is transferred to national funding, meanwhile APH continues to provide technical support to users. In Ukraine, REAct was implemented in 2019 and is functional within national GF grant. REAct system is supported by APH in Uzbekistan for 2022-2023, in 5 Balkan countries – for 2022-2024, and in Armenia and Azerbaijan – for 2023-2024. At the same time, regional networks ECOM and ENPUD started to use REAct program for documentation in several countries of the region and are supported for 2022-2024 within SoS_project#2.0 grant.
Progress to date
Cumulatively, during 2022 there were registered 6700+ cases in 13 countries (Albania, Armenia, Bosnia and Herzegovina, Georgia, North Macedonia, Moldova, Montenegro, Kazakhstan, Kyrgyzstan, Tajikistan, Serbia, Ukraine, Uzbekistan) involving 170+ CBOs, as well as regional networks such as ECOM (in Uzbekistan, Tajikistan, Armenia, Kazakhstan, Kyrgyzstan) and ENPUD (Georgia, Moldova, Ukraine, Kyrgyzstan, Kazakhstan, Tajikistan, Belarus).
The following publications are available:
- Statistic country reports by APH on human rights violations based on REAct data collected in 2021 in Kyrgyzstan, in Georgia, in Moldova, in Tajikistan.
- Protectors or Perpetrators: the impact of unlawful policing on human rights and HIV. Join analytical publication in partnership with Frontline AIDS, Alliance for Public Health (Ukraine, Kyrgyzstan, Tajikistan, Moldova, Georgia, Uzbekistan), AIDS Foundation (South Africa), Gender Dynamix.
- Report on the results of the analysis of the Hotline calls by APH: Domestic and other forms of violence against women living with HIV and women in key populations during the COVID-19 pandemic in Tajikistan.
- REAct Statistical Report for the 1st half of 2022 by APH. Violations of the rights of people living with HIV and representatives of vulnerable groups in Georgia.
Situational Report by APH: Drug policy in Georgia and Challenges. - Series of publications by APH based on REAct data within regional campaign “16 days against gender-based violence”.
REAct system is available and functional at the national level in the following counties. It enables documentation of cases of human rights violations: Albania (45 cases), Armenia (182), Azerbaijan (174), B&H (70), Montenegro (60), Kazakhstan (363), North Macedonia (42), Tajikistan (1155), Serbia (24), Uzbekistan (835). More detailed data of 2023 is available in REAct Regional Digest and REAct website.
Cumulatively in 10 countries, 49,9% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions. During 2023 in 10 countries, there were provided 2162 consultations about human rights, 1022 consultations with professional lawyers. In 168 cases REActors helped to draft simple legal documents, such as complains or statement to police, in 236 cases represented client’s interests in medical facilities, assisted in getting medical services and support, in 336 cases – accompanied the client in the initial appeal to the police. There were at least 20 strategic court cases, and at least 162 cases were used for shadow reports to UN Treaty Bodies.
Cumulatively in 8 countries (Armenia, Azerbaijan, Kazakhstan, Albania, Bosnia and Herzegovina, Montenegro, North Macedonia, Serbia) 56,2% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions (https://drive.google.com/drive/folders/1wtJaecXERatg8cmrAE1mzaoshtdLQY_w). Numerous success stories of cases resolutions are available at REAct website.
Solutions
Implementer:
- Select an implementer
- SEE RCN
Period:
HSS: Health sector governance and planning
Municipal budget advocacy for cities that chose the Fast Track approach: Sarajevo, Mostar, Bijelina cities in the Balkan region
Progress to date
As the result of budget advocacy the city administrations in Dushanbe ($130 000), Podgorica ($43 000), Skopje ($35 000), Tirana (USD 32,000), Novi Sad (USD 9,000), Sabac ($7 500) and Zvezdara ($4 000) allocated funds for the implementation of activities that would achieve the goals of the Paris Declaration.
Solutions
Implementer:
- Select an implementer
- SEE RCN
- SEE RCN
Period:
RSSH: Health sector governance and planning
Assessment of the legal framework to fund HIV services with domestic funds: sustainability planning; advocacy campaign on change of laws and regulations; establishment of Parliamentary group for HIV,TB, Hepatitis and STIs
Progress to date
Preliminary consultations were held in 2022and assessment was planned in 2023.Domestic funding for HIV services is increased. The funding of Tirana municipality for NGOs offer HIV services was $32,000. The level of funding for HIV-related activities from the City of Skopje remained approximately the same as is in 2021 –approximately 35,000 USD. MoH from Montenegro allocated 100.000 EUR for funding NGO HIV programs in 2022. In Bosnia and Herzegovina for increase services for key populations and PLWHA. was two grants. One grant was from Ministry of Civil affairs, Department for Health and it was about 26 000 Euro for nine CSOs, Partnerships in Health was one of them but also our partners from the Project, Victoria and Ruka Ruci. The second grant was from Federal Ministry of Health, and it was for HIV testing and counselling on HIV, education for KAP and youth. It was about 13 500 Euro and it was granted to the Partnerships in Health. In Serbia there was 19214 USD in total from municipality funding for HIV services in Serbia.
Until now there is Parliamentary group for HIV, TB Hepatitis and STIs established in Bosnia and Herzegovina.
The main achievements of the project were the removal of legislative barriers, approval of standards and tariffs for services, adoption of regulatory acts that allow the implementation of social contracting mechanisms, as well as expansion of financing from state budgets. The cumulative domestic budget expenditures for servicing key populations and People Living with HIV/AIDS in 5 countries of Southeastern Europe (SEE) amounted to $1 061 383 in 2024. During SoS project 2.0 – $ 3 236 260 were allocated for social contracting in SEE region.
HSS: Health sector governance and planning
Regulation of service packages for key groups
Progress to date
Strategic Brief on Business Continuity (link) and Strategic Brief on Social contracting (link) were developed. In addition, Analysis of Quality of Services Provided in Azerbaijan was held and is available at the link.
Objective Description:
OBjective task:
- Select a objective task
- Removing structural barriers to increase of HIV testing in EECA
- Implementation of COVID-19 response mechanism
- Select a objective task
- Monitoring situation with human rights of KPs, responding to viloations
- Select a objective task
- Developing necessary legal framework and technical solutuions for cost-effective care package for KPs in EECA
- Advocacy for domestic resource allocation for KP services in EECA
Solutions
Implementer:
- Select an implementer
- APH
- APH
Period:
Supporting key group populations in a COVID setting
Provision of HIV prevention services with precautions against COVID-19
Progress to date
Work on shelters has expanded – in addition to 5 shelters for working with women who use drugs in conditions of violence (Ukraine, Serbia, North Macedonia, Kazakhstan), support for flexible shelters for representatives of the LGBT community in Kazakhstan, Uzbekistan, Kyrgyzstan and Tajikistan has been added. The program was distinguished by a special programmatic approach to working with clients – about 3,200 clients received material assistance in the form of food packages (Georgia, Kazakhstan). PPE support in Kaz for migrants and KGP (124,000 disposable masks, 1,000 antiseptics); CLM to provide quality services for clients of OST programs in 7 countries.
Supporting key group populations in a COVID setting
National Contingency Planning
Progress to date
Supporting key group populations in a COVID setting “General contingency planning guide developed in the frames of the C19RM is available here.
Guide by APH for Contingency Planning for Key Population HIV Services during COVID-19 and Other Emergencies for North Macedonia, Serbia, Bosnia and Herzegovina, Montenegro, Moldova, Georgia, Kazakhstan, Uzbekistan, Tajikistan and Kyrgyzstan in English is available at the link https://aph.org.ua/en/eeca/ in the folders with the names of each country.
Solutions
Implementer:
- Select an implementer
- SEE RCN
- SEE RCN
Period:
Integrated service delivery and HIV service quality improvement
Country level support to adoption and implementation of HTS guidelines and introduction of self-testing, community-based testing and decentralized testing into national policy documents and clinical guidelines, and harmonized testing policies and processes with new WHO recommendations in four (4) countries of the SEE sub-region (Albania, Montenegro, North Macedonia and Serbia)
Progress to date
In 2022, the project conducted an assessment on policies, regulations, and practice of HIV Rapid Testing/Self-testing in 4 SEE countries and developed a report on findings and recommendations. The purpose of this assessment was to evaluate country-specific policies, regulations, and practical factors that are currently facilitating or affecting community-level access to rapid diagnostic tests, including self-testing of HIV.
The SoS project has been instrumental in advancing self-testing and community-based HIV testing in SEE through persistent advocacy, strategic meetings, and expert consultations. Our partners have actively engaged with ministries and public health institutes to push for the integration of self-testing into national HIV strategies and the expansion of community-based testing services.
The advocacy work of SoS partners in 4 countries with stakeholders culminated in the incorporation of self-testing into updated guidelines and HIV testing protocols, namely:
- In North Macedonia, a significant milestone was reached within SoS in 2023 with the inclusion of community-based testing and self-testing initiatives under the National HIV Program. Both community-based HIV testing and self-testing are part of the annual National HIV Program and both are delivered by civil society organisations. The evidence for community based testing and self-testing in 2024 is present in HIV report.
- In Albania, legislative and regulatory revisions have been made, including HIV self-testing, community-based testing, and decentralised testing with the approval in 2022 of the National Guidelines for HIV testing and prevention – on page 16 and in PrEP protocol. As evidence of availability of self testing please see on the page 14 in National 2023 HIV report from the IPH marked with yellow.
- In Montenegro, self-testing, community-based testing and decentralized testing were included in Voluntary Counselling and Testing protocol. Community based testing and new Protocol for HIV testing in Montenegro is modified on WHO guidelines for HIV testing. Community testing is done by CAZAS and community organizations in mobile vans and was integrated through cooperation with IPH during 2024. Several actions have been conducted and as evidence you can find public announcements of some of community testing activities organized in 2024 in Montenegro in supporting docs. Decentralized testing is done in 8 VCT centres in Montenegro.
- In Serbia, within SoS project new VCT protocol that integrate self and community based testing as a regular component of healthcare protocols was developed and approved by the Ministry of Health and the Health Institute. Information on self and community based testing is available. In 2024 community based testing was carried out exclusively through drop-in centers and mobile vehicles. Self-testing for HIV is recognized in the new guidelines and will be piloted for HIV and HCV through community-based services within the new national Global Fund program in Serbia in 2025.
HSS: Health products management systems
Introduction of self-testing, community-based testing and decentralized testing into national policy documents and clinical guidelines, and harmonized testing policies and processes with new WHO recommendations, including with TA provided by the WHO Regional Office, Europe
Progress to date
In 2022, the project conducted an assessment on policies, regulations, and practice of HIV Rapid Testing/Self-testing in 4 SEE countries and developed a report on findings and recommendations. The assessment was conducted in North Macedonia, Albania, Montenegro, and Serbia. The purpose of this assessment was to evaluate country-specific policies, regulations, and practical factors that are currently facilitating or affecting community-level access to rapid diagnostic tests, including self-testing of HIV. Some of the key recomendations which are suggested: to update National Guidelines/Protocols for HIV testing, outlining clear HIV testing algorithm in line with WHO recommendation including community based testing and HIV self-testing; update the existing internal protocol on HIVST; develop policy and advocacy recommendations for reducing HIV-related stigma and discrimination; integrate HIV self-testing into existing HIV service delivery models including OST programs. The report can be found at the link.
The advocacy work of SoS partners in 4 countries with stakeholders culminated in the incorporation of self-testing into updated guidelines and HIV testing protocols, namely:
- In North Macedonia, a significant milestone was reached within SoS in 2023 with the inclusion of community-based testing and self-testing initiatives under the National HIV Program. Both community-based HIV testing and self-testing are part of the annual National HIV Program and both are delivered by civil society organizations. The evidence for community based testing and self-testing in 2024 is present in HIV report.
- In Albania, legislative and regulatory revisions have been made, including HIV self-testing, community-based testing, and decentralized testing with the approval in 2022 of the National Guidelines for HIV testing and prevention – on page 16 and in PrEP protocol. As evidence of availability of self testing please see on the page 14 in National 2023 HIV report from the IPH marked with yellow. In Montenegro, self-testing, community-based testing and decentralized testing were included in Voluntary Counselling and Testing protocol. Community based testing and new Protocol for HIV testing in Montenegro is modified on WHO guidelines for HIV testing.
- Community testing is done by CAZAS and community organizations in mobile vans and was integrated through cooperation with IPH during 2024. Several actions have been conducted and as evidence you can find public announcements of some of community testing activities organized in 2024 in Montenegro in supporting docs. Decentralized testing is done in 8 VCT centres in Montenegro.
- In Serbia, within SoS project new VCT protocol that integrate self and community based testing as a regular component of healthcare protocols was developed and approved by the Ministry of Health and the Health Institute. Information on self and community based testing is available. In 2024 community based testing was carried out exclusively through drop-in centers and mobile vehicles. Self-testing for HIV is recognized in the new guidelines and will be piloted for HIV and HCV through community-based services within the new national Global Fund program in Serbia in 2025.
Solutions
Implementer:
- Select an implementer
- EKPC
- APH
- SEE RCN
Period:
Reducing human rights-related barriers to HIV/TB services
Developing and launching call for “Gender and HIV” small grants with special eligibility focus on Monitoring situation with human rights of Trans* people
Progress to date
Small Grants Programme with 4 selected projects run by grass-root NGOs in 2022 included:
- “National Trans Coalition” NGO with the project titled “HIV prevention in Armenia through gender mainstreaming” (Armenia);
- “The Public Association “Union for Equity and Health” NGO with the project titled “Gender Equality for sex workers” (Moldova);
- “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Check your health – Equality for Trans Roma and Roma women/girls sex workers” (Serbia);
- “NON-GOVERNMENTAL ORGANIZATION «NASHA DOPOMOGA»” with the project titled “RIGHT TO HEALTH!” (Ukraine).
- The project applicant is the organization “Albanian Association of People Living with HIV/AIDS (PLWHA)” with the project titled “New approach on transforming the spiral of exclusion and marginalization, towards the right of recognition before the law, gender-diverse and reduce the violence in health-care settings for trans persons in Albania”.
- The project applicant is the “National Trans Coalition” NGO with the project titled “Strategic pathway to remove structural barriers for trans* communities to PrEP and PEP services in Armenia”. The proposed project has been designed to establish favorable conditions for improving access of Trans* communities to PrEP and PEP services in Armenia.
- The project applicant is the organization “STAR STAR” Skopje with the project titled “Community Mobilization to Mitigate Funding Cuts and Gender Inequality in National HIV Programs for Sex Workers in North Macedonia”. The project is envisioned as a response to the latest developments in North Macedonia related to provision and delivery of HIV prevention services for key populations.
- The project applicant is the organization “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Supporting health wellbeing and safety of Trans and Intersex Roma, sex workers and HIV+”.
In 2024, grants “Gender and HIV” were implemented in Albania, Georgia, Moldova and Ukraine.
Moldova
GENDERDOC-M, alongside a parent support group, aimed to create a safe and inclusive environment for transgender and gender-nonconforming youth. Two formal partnerships with youth clinics expanded access to health services and 24/7 hotline support. Parent education sessions led to increased understanding, school negotiations for name recognition, and medical referrals. As a result, a strategic plan for 2025 includes engaging health and education ministries to address systemic barriers.
Georgia
The Queer Association Temida established an informal network of trans-friendly professionals across three cities, despite restrictive anti-LGBT laws. The network held two meetings to discuss the legal landscape and continued service delivery. A memorandum with Psychea Mental Health Center helped maintain access to gender-affirming care. A peer educator training course was launched, and two trained educators provided online consultations to 32 beneficiaries, offering support on HIV and gender-affirming care.
Ukraine
The “Help Is Near” project by HPLGBT produced a comprehensive report on barriers and solutions in trans health services, especially for intersectional groups like sex workers and those using psychoactive substances. Recommendations for service decentralization were developed and are planned to be presented to the CCM in early 2025. HPLGBT aims to integrate these recommendations into national funding requests to the Global Fund, ensuring sustained support for marginalized trans communities.
Reducing human rights-related barriers to HIV/TB services
REAct (https://react-aph.org/): Monitoring of human rights violations and discrimination against PLHIV and KPs. Responding to such cases through provision or referring to legal or social services to victims and through advocacy actions. In Georgia, Kyrgyzstan, Moldova and Tajikistan, REAct system was initiated within SoS_project#1.0 in 2020, and in 2022 is transferred to national funding, meanwhile APH continues to provide technical support to users. In Ukraine, REAct was implemented in 2019 and is functional within national GF grant. REAct system is supported by APH in Uzbekistan for 2022-2023, in 5 Balkan countries – for 2022-2024, and in Armenia and Azerbaijan – for 2023-2024. At the same time, regional networks ECOM and ENPUD started to use REAct program for documentation in several countries of the region and are supported for 2022-2024 within SoS_project#2.0 grant.
Progress to date
Cumulatively, during 2022 there were registered 6700+ cases in 13 countries (Albania, Armenia, Bosnia and Herzegovina, Georgia, North Macedonia, Moldova, Montenegro, Kazakhstan, Kyrgyzstan, Tajikistan, Serbia, Ukraine, Uzbekistan) involving 170+ CBOs, as well as regional networks such as ECOM (in Uzbekistan, Tajikistan, Armenia, Kazakhstan, Kyrgyzstan) and ENPUD (Georgia, Moldova, Ukraine, Kyrgyzstan, Kazakhstan, Tajikistan, Belarus).
The following publications are available:
- Statistic country reports by APH on human rights violations based on REAct data collected in 2021 in Kyrgyzstan, in Georgia, in Moldova, in Tajikistan.
- Protectors or Perpetrators: the impact of unlawful policing on human rights and HIV. Join analytical publication in partnership with Frontline AIDS, Alliance for Public Health (Ukraine, Kyrgyzstan, Tajikistan, Moldova, Georgia, Uzbekistan), AIDS Foundation (South Africa), Gender Dynamix.
- Report on the results of the analysis of the Hotline calls by APH: Domestic and other forms of violence against women living with HIV and women in key populations during the COVID-19 pandemic in Tajikistan.
- REAct Statistical Report for the 1st half of 2022 by APH. Violations of the rights of people living with HIV and representatives of vulnerable groups in Georgia.
Situational Report by APH: Drug policy in Georgia and Challenges. - Series of publications by APH based on REAct data within regional campaign “16 days against gender-based violence”.
REAct system is available and functional at the national level in the following counties. It enables documentation of cases of human rights violations: Albania (45 cases), Armenia (182), Azerbaijan (174), B&H (70), Montenegro (60), Kazakhstan (363), North Macedonia (42), Tajikistan (1155), Serbia (24), Uzbekistan (835). More detailed data of 2023 is available in REAct Regional Digest and REAct website.
Cumulatively in 10 countries, 49,9% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions. During 2023 in 10 countries, there were provided 2162 consultations about human rights, 1022 consultations with professional lawyers. In 168 cases REActors helped to draft simple legal documents, such as complains or statement to police, in 236 cases represented client’s interests in medical facilities, assisted in getting medical services and support, in 336 cases – accompanied the client in the initial appeal to the police. There were at least 20 strategic court cases, and at least 162 cases were used for shadow reports to UN Treaty Bodies.
Cumulatively in 8 countries (Armenia, Azerbaijan, Kazakhstan, Albania, Bosnia and Herzegovina, Montenegro, North Macedonia, Serbia) 56,2% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions (https://drive.google.com/drive/folders/1wtJaecXERatg8cmrAE1mzaoshtdLQY_w). Numerous success stories of cases resolutions are available at REAct website.
Solutions
Implementer:
- Select an implementer
- SEE RCN
Period:
HSS: Health sector governance and planning
Municipal budget advocacy for cities that chose the Fast Track approach: Skopje cities in the Balkan region
Progress to date
As the result of budget advocacy the city administrations in Dushanbe ($130 000), Podgorica ($43 000), Skopje ($35 000), Tirana (USD 32,000), Novi Sad (USD 9,000), Sabac ($7 500) and Zvezdara ($4 000) allocated funds for the implementation of activities that would achieve the goals of the Paris Declaration.
Solutions
Implementer:
- Select an implementer
- SEE RCN
- SEE RCN
Period:
RSSH: Health sector governance and planning
Assessment of the legal framework to fund HIV services with domestic funds: sustainability planning; advocacy campaign on change of laws and regulations; establishment of Parliamentary group for HIV,TB, Hepatitis and STIs
Progress to date
Preliminary consultations were held in 2022and assessment was planned in 2023.Domestic funding for HIV services is increased. The funding of Tirana municipality for NGOs offer HIV services was $32,000. The level of funding for HIV-related activities from the City of Skopje remained approximately the same as is in 2021 –approximately 35,000 USD. MoH from Montenegro allocated 100.000 EUR for funding NGO HIV programs in 2022. In Bosnia and Herzegovina for increase services for key populations and PLWHA. was two grants. One grant was from Ministry of Civil affairs, Department for Health and it was about 26 000 Euro for nine CSOs, Partnerships in Health was one of them but also our partners from the Project, Victoria and Ruka Ruci. The second grant was from Federal Ministry of Health, and it was for HIV testing and counselling on HIV, education for KAP and youth. It was about 13 500 Euro and it was granted to the Partnerships in Health. In Serbia there was 19214 USD in total from municipality funding for HIV services in Serbia.
Until now there is Parliamentary group for HIV, TB Hepatitis and STIs established in Bosnia and Herzegovina.
The main achievements of the project were the removal of legislative barriers, approval of standards and tariffs for services, adoption of regulatory acts that allow the implementation of social contracting mechanisms, as well as expansion of financing from state budgets. The cumulative domestic budget expenditures for servicing key populations and People Living with HIV/AIDS in 5 countries of Southeastern Europe (SEE) amounted to $1 061 383 in 2024. During SoS project 2.0 – $ 3 236 260 were allocated for social contracting in SEE region.
HSS: Health sector governance and planning
Regulation of service packages for key groups
Progress to date
Strategic Brief on Business Continuity (link) and Strategic Brief on Social contracting (link) were developed. In addition, Analysis of Quality of Services Provided in Azerbaijan was held and is available at the link.
Objective Description:
OBjective task:
- Select a objective task
- Removing structural barriers to increase of HIV testing in EECA
- Launching critical enabling interventions to improve HIV care cascade
- Select a objective task
- Monitoring situation with human rights of KPs, responding to viloations
- Select a objective task
- Developing necessary legal framework and technical solutuions for cost-effective care package for KPs in EECA
- Advocacy for domestic resource allocation for KP services in EECA
Solutions
Implementer:
- Select an implementer
- EHRA
Period:
Integrated service delivery and HIV service quality improvement
Assessment of OAT sustainability
Progress to date
Assessment of the sustainability of the opioid agonist therapy programme in the context of transition from donor support to domestic funding was conducted in Moldova and Tajikistan. The reports are being finalized and sent for design, they’ll be published by the end of Q1 2023. The assessments in Albania, Kyrgyzstan and Ukraine are ongoing and will be finalized in 2023.
PULS Communitar conducted CLM study to evaluate OAT programs in the Republic of Moldova, identify the level of the availability and acceptability of programs, outline achievements, and identify and evaluate difficulties faced by the program participants. Report with findings and conclusions was prepared and presented on the meeting with service providers and decision makers. Next steps and recommendations for CCM were elaborated.
GENDERDOC-M conducted a CLM study to identify the barriers in access to PrEP among MSM/TG. The results were presented to the Key Affected Populations (KAP) committee. After the presentation, it was strongly recommended to showcase these results at the National Dialogue event. The aim is to leverage the platform to advocate for a comprehensive revision of the National Clinical Protocol on Pre-Exposure Prophylaxis (PrEP) in the first quarter of 2024. This strategic move aligns with the commitment to fostering meaningful changes in the national approach to PrEP in response to the insights gained through the CLM survey.
Forum of PWUD conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian is prepared. Meeting with CCM is planned to be organized in January 2024.
Rubikoni conducted a study on the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Furthermore, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Equal to equal conducted a study on the client satisfaction with OAT. Report in Russian was prepared. Moreover, the meeting with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
Intighob (Initiative group based on SPIN PLUS) conducted a study of the impact of the absence of take-home OAT on the life of patients and adherence to treatment. Report in Russian language was prepared. Moreover, the meetings with service providers and decision makers was organized, where results of the CLM were presented and discussed recommendations and next steps.
“New Generation” conducted Community Based Assessment of HIV Services Provided to MSM Living With HIV In Armenia through a focus group with broad number of experts and MSM community members (including representatives from CCM). The results were included to “Funding Priorities of Civil Society and Communities Most Affected by HIV, Tuberculosis and Malaria” by Global Fund under the number 9 (The funding priorities and minutes from CRG group meeting attached). These priorities are in active use to prepare an application for the Global Fund grant in Armenia. In addition, results are in active use in the National dialogue now.
Solutions
Implementer:
- Select an implementer
- SEE RCN
- SEE RCN
Period:
Integrated service delivery and HIV service quality improvement
Country level support to adoption and implementation of HTS guidelines and introduction of self-testing, community-based testing and decentralized testing into national policy documents and clinical guidelines, and harmonized testing policies and processes with new WHO recommendations in four (4) countries of the SEE sub-region (Albania, Montenegro, North Macedonia and Serbia)
Progress to date
In 2022, the project conducted an assessment on policies, regulations, and practice of HIV Rapid Testing/Self-testing in 4 SEE countries and developed a report on findings and recommendations. The purpose of this assessment was to evaluate country-specific policies, regulations, and practical factors that are currently facilitating or affecting community-level access to rapid diagnostic tests, including self-testing of HIV.
The SoS project has been instrumental in advancing self-testing and community-based HIV testing in SEE through persistent advocacy, strategic meetings, and expert consultations. Our partners have actively engaged with ministries and public health institutes to push for the integration of self-testing into national HIV strategies and the expansion of community-based testing services.
The advocacy work of SoS partners in 4 countries with stakeholders culminated in the incorporation of self-testing into updated guidelines and HIV testing protocols, namely:
- In North Macedonia, a significant milestone was reached within SoS in 2023 with the inclusion of community-based testing and self-testing initiatives under the National HIV Program. Both community-based HIV testing and self-testing are part of the annual National HIV Program and both are delivered by civil society organisations. The evidence for community based testing and self-testing in 2024 is present in HIV report.
- In Albania, legislative and regulatory revisions have been made, including HIV self-testing, community-based testing, and decentralised testing with the approval in 2022 of the National Guidelines for HIV testing and prevention – on page 16 and in PrEP protocol. As evidence of availability of self testing please see on the page 14 in National 2023 HIV report from the IPH marked with yellow.
- In Montenegro, self-testing, community-based testing and decentralized testing were included in Voluntary Counselling and Testing protocol. Community based testing and new Protocol for HIV testing in Montenegro is modified on WHO guidelines for HIV testing. Community testing is done by CAZAS and community organizations in mobile vans and was integrated through cooperation with IPH during 2024. Several actions have been conducted and as evidence you can find public announcements of some of community testing activities organized in 2024 in Montenegro in supporting docs. Decentralized testing is done in 8 VCT centres in Montenegro.
- In Serbia, within SoS project new VCT protocol that integrate self and community based testing as a regular component of healthcare protocols was developed and approved by the Ministry of Health and the Health Institute. Information on self and community based testing is available. In 2024 community based testing was carried out exclusively through drop-in centers and mobile vehicles. Self-testing for HIV is recognized in the new guidelines and will be piloted for HIV and HCV through community-based services within the new national Global Fund program in Serbia in 2025.
HSS: Health products management systems
Introduction of self-testing, community-based testing and decentralized testing into national policy documents and clinical guidelines, and harmonized testing policies and processes with new WHO recommendations, including with TA provided by the WHO Regional Office, Europe
Progress to date
In 2022, the project conducted an assessment on policies, regulations, and practice of HIV Rapid Testing/Self-testing in 4 SEE countries and developed a report on findings and recommendations. The assessment was conducted in North Macedonia, Albania, Montenegro, and Serbia. The purpose of this assessment was to evaluate country-specific policies, regulations, and practical factors that are currently facilitating or affecting community-level access to rapid diagnostic tests, including self-testing of HIV. Some of the key recomendations which are suggested: to update National Guidelines/Protocols for HIV testing, outlining clear HIV testing algorithm in line with WHO recommendation including community based testing and HIV self-testing; update the existing internal protocol on HIVST; develop policy and advocacy recommendations for reducing HIV-related stigma and discrimination; integrate HIV self-testing into existing HIV service delivery models including OST programs. The report can be found at the link.
The advocacy work of SoS partners in 4 countries with stakeholders culminated in the incorporation of self-testing into updated guidelines and HIV testing protocols, namely:
- In North Macedonia, a significant milestone was reached within SoS in 2023 with the inclusion of community-based testing and self-testing initiatives under the National HIV Program. Both community-based HIV testing and self-testing are part of the annual National HIV Program and both are delivered by civil society organizations. The evidence for community based testing and self-testing in 2024 is present in HIV report.
- In Albania, legislative and regulatory revisions have been made, including HIV self-testing, community-based testing, and decentralized testing with the approval in 2022 of the National Guidelines for HIV testing and prevention – on page 16 and in PrEP protocol. As evidence of availability of self testing please see on the page 14 in National 2023 HIV report from the IPH marked with yellow. In Montenegro, self-testing, community-based testing and decentralized testing were included in Voluntary Counselling and Testing protocol. Community based testing and new Protocol for HIV testing in Montenegro is modified on WHO guidelines for HIV testing.
- Community testing is done by CAZAS and community organizations in mobile vans and was integrated through cooperation with IPH during 2024. Several actions have been conducted and as evidence you can find public announcements of some of community testing activities organized in 2024 in Montenegro in supporting docs. Decentralized testing is done in 8 VCT centres in Montenegro.
- In Serbia, within SoS project new VCT protocol that integrate self and community based testing as a regular component of healthcare protocols was developed and approved by the Ministry of Health and the Health Institute. Information on self and community based testing is available. In 2024 community based testing was carried out exclusively through drop-in centers and mobile vehicles. Self-testing for HIV is recognized in the new guidelines and will be piloted for HIV and HCV through community-based services within the new national Global Fund program in Serbia in 2025.
Solutions
Implementer:
- Select an implementer
- APH
- SEE RCN
- EKPC
Period:
Reducing human rights-related barriers to HIV/TB services
REAct (https://react-aph.org/): Monitoring of human rights violations and discrimination against PLHIV and KPs. Responding to such cases through provision or referring to legal or social services to victims and through advocacy actions. In Georgia, Kyrgyzstan, Moldova and Tajikistan, REAct system was initiated within SoS_project#1.0 in 2020, and in 2022 is transferred to national funding, meanwhile APH continues to provide technical support to users. In Ukraine, REAct was implemented in 2019 and is functional within national GF grant. REAct system is supported by APH in Uzbekistan for 2022-2023, in 5 Balkan countries – for 2022-2024, and in Armenia and Azerbaijan – for 2023-2024. At the same time, regional networks ECOM and ENPUD started to use REAct program for documentation in several countries of the region and are supported for 2022-2024 within SoS_project#2.0 grant.
Progress to date
Cumulatively, during 2022 there were registered 6700+ cases in 13 countries (Albania, Armenia, Bosnia and Herzegovina, Georgia, North Macedonia, Moldova, Montenegro, Kazakhstan, Kyrgyzstan, Tajikistan, Serbia, Ukraine, Uzbekistan) involving 170+ CBOs, as well as regional networks such as ECOM (in Uzbekistan, Tajikistan, Armenia, Kazakhstan, Kyrgyzstan) and ENPUD (Georgia, Moldova, Ukraine, Kyrgyzstan, Kazakhstan, Tajikistan, Belarus).
The following publications are available:
- Statistic country reports by APH on human rights violations based on REAct data collected in 2021 in Kyrgyzstan, in Georgia, in Moldova, in Tajikistan.
- Protectors or Perpetrators: the impact of unlawful policing on human rights and HIV. Join analytical publication in partnership with Frontline AIDS, Alliance for Public Health (Ukraine, Kyrgyzstan, Tajikistan, Moldova, Georgia, Uzbekistan), AIDS Foundation (South Africa), Gender Dynamix.
- Report on the results of the analysis of the Hotline calls by APH: Domestic and other forms of violence against women living with HIV and women in key populations during the COVID-19 pandemic in Tajikistan.
- REAct Statistical Report for the 1st half of 2022 by APH. Violations of the rights of people living with HIV and representatives of vulnerable groups in Georgia.
Situational Report by APH: Drug policy in Georgia and Challenges. - Series of publications by APH based on REAct data within regional campaign “16 days against gender-based violence”.
REAct system is available and functional at the national level in the following counties. It enables documentation of cases of human rights violations: Albania (45 cases), Armenia (182), Azerbaijan (174), B&H (70), Montenegro (60), Kazakhstan (363), North Macedonia (42), Tajikistan (1155), Serbia (24), Uzbekistan (835). More detailed data of 2023 is available in REAct Regional Digest and REAct website.
Cumulatively in 10 countries, 49,9% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions. During 2023 in 10 countries, there were provided 2162 consultations about human rights, 1022 consultations with professional lawyers. In 168 cases REActors helped to draft simple legal documents, such as complains or statement to police, in 236 cases represented client’s interests in medical facilities, assisted in getting medical services and support, in 336 cases – accompanied the client in the initial appeal to the police. There were at least 20 strategic court cases, and at least 162 cases were used for shadow reports to UN Treaty Bodies.
Cumulatively in 8 countries (Armenia, Azerbaijan, Kazakhstan, Albania, Bosnia and Herzegovina, Montenegro, North Macedonia, Serbia) 56,2% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions (https://drive.google.com/drive/folders/1wtJaecXERatg8cmrAE1mzaoshtdLQY_w). Numerous success stories of cases resolutions are available at REAct website.
Reducing human rights-related barriers to HIV/TB services
Developing and launching call for “Gender and HIV” small grants with special eligibility focus on Monitoring situation with human rights of Trans* people
Progress to date
- The project applicant is the organization “Albanian Association of People Living with HIV/AIDS (PLWHA)” with the project titled “New approach on transforming the spiral of exclusion and marginalization, towards the right of recognition before the law, gender-diverse and reduce the violence in health-care settings for trans persons in Albania”.
- The project applicant is the “National Trans Coalition” NGO with the project titled “Strategic pathway to remove structural barriers for trans* communities to PrEP and PEP services in Armenia”. The proposed project has been designed to establish favorable conditions for improving access of Trans* communities to PrEP and PEP services in Armenia.
- The project applicant is the organization “STAR STAR” Skopje with the project titled “Community Mobilization to Mitigate Funding Cuts and Gender Inequality in National HIV Programs for Sex Workers in North Macedonia”. The project is envisioned as a response to the latest developments in North Macedonia related to provision and delivery of HIV prevention services for key populations.
- The project applicant is the organization “Rromnjako Ilo” Zrenjanin he Public Association” NGO with the project titled “Supporting health wellbeing and safety of Trans and Intersex Roma, sex workers and HIV+”.
In 2024, grants “Gender and HIV” were implemented in Albania, Georgia, Moldova and Ukraine.
Albania
The project led by AAPLWHA focused on improving HIV services for transgender individuals and sex workers. Key outcomes include the approval of a national hormone therapy protocol and ongoing legislative revisions concerning PrEP, PEP, and age of consent. Multiple workshops for NGOs and healthcare workers built advocacy capacity, and consultations with the Ministry of Health and Parliament resulted in commitments to legal reform. A working group is being formed to amend the HIV Control and Prevention Law.
Solutions
Implementer:
- Select an implementer
- SEE RCN
Period:
HSS: Health sector governance and planning
Municipal budget advocacy for cities that chose the Fast Track approach: in Tirana and Shkoder cities in the Balkan region
Progress to date
As the result of budget advocacy the city administrations in Dushanbe ($130 000), Podgorica ($43 000), Skopje ($35 000), Tirana (USD 32,000), Novi Sad (USD 9,000), Sabac ($7 500) and Zvezdara ($4 000) allocated funds for the implementation of activities that would achieve the goals of the Paris Declaration.
Solutions
Implementer:
- Select an implementer
- SEE RCN
- SEE RCN
Period:
RSSH: Health sector governance and planning
Assessment of the legal framework to fund HIV services with domestic funds: sustainability planning; advocacy campaign on change of laws and regulations; establishment of Parliamentary group for HIV,TB, Hepatitis and STIs
Progress to date
Preliminary consultations were held in 2022and assessment was planned in 2023.Domestic funding for HIV services is increased. The funding of Tirana municipality for NGOs offer HIV services was $32,000. The level of funding for HIV-related activities from the City of Skopje remained approximately the same as is in 2021 –approximately 35,000 USD. MoH from Montenegro allocated 100.000 EUR for funding NGO HIV programs in 2022. In Bosnia and Herzegovina for increase services for key populations and PLWHA. was two grants. One grant was from Ministry of Civil affairs, Department for Health and it was about 26 000 Euro for nine CSOs, Partnerships in Health was one of them but also our partners from the Project, Victoria and Ruka Ruci. The second grant was from Federal Ministry of Health, and it was for HIV testing and counselling on HIV, education for KAP and youth. It was about 13 500 Euro and it was granted to the Partnerships in Health. In Serbia there was 19214 USD in total from municipality funding for HIV services in Serbia.
Until now there is Parliamentary group for HIV, TB Hepatitis and STIs established in Bosnia and Herzegovina.
The main achievements of the project were the removal of legislative barriers, approval of standards and tariffs for services, adoption of regulatory acts that allow the implementation of social contracting mechanisms, as well as expansion of financing from state budgets. The cumulative domestic budget expenditures for servicing key populations and People Living with HIV/AIDS in 5 countries of Southeastern Europe (SEE) amounted to $1 061 383 in 2024. During SoS project 2.0 – $ 3 236 260 were allocated for social contracting in SEE region.
HSS: Health sector governance and planning
Regulation of service packages for key groups
Progress to date
Strategic Brief on Business Continuity (link) and Strategic Brief on Social contracting (link) were developed. In addition, Analysis of Quality of Services Provided in Azerbaijan was held and is available at the link.
Objective Description:
OBjective task:
- Select a objective task
- Select a objective task
- Monitoring situation with human rights of KPs, responding to viloations
- Revision of legisation and other regulations on KPs that pose barriers to accessing HIV services:
- Select a objective task
- Developing necessary legal framework and technical solutuions for cost-effective care package for KPs in EECA
- Advocacy for domestic resource allocation for KP services in EECA
Solutions
Implementer:
- Select an implementer
- APH
Period:
Reducing human rights-related barriers to HIV/TB services
REAct (https://react-aph.org/): Monitoring of human rights violations and discrimination against PLHIV and KPs. Responding to such cases through provision or referring to legal or social services to victims and through advocacy actions. In Georgia, Kyrgyzstan, Moldova and Tajikistan, REAct system was initiated within SoS_project#1.0 in 2020, and in 2022 is transferred to national funding, meanwhile APH continues to provide technical support to users. In Ukraine, REAct was implemented in 2019 and is functional within national GF grant. REAct system is supported by APH in Uzbekistan for 2022-2023, in 5 Balkan countries – for 2022-2024, and in Armenia and Azerbaijan – for 2023-2024. At the same time, regional networks ECOM and ENPUD started to use REAct program for documentation in several countries of the region and are supported for 2022-2024 within SoS_project#2.0 grant.
Progress to date
REAct system is available and functional at the national level in the following counties. It enables documentation of cases of human rights violations: Albania (45 cases), Armenia (182), Azerbaijan (174), B&H (70), Montenegro (60), Kazakhstan (363), North Macedonia (42), Tajikistan (1155), Serbia (24), Uzbekistan (835). More detailed data of 2023 is available in REAct Regional Digest and REAct website.
Cumulatively in 10 countries, 49,9% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions. During 2023 in 10 countries, there were provided 2162 consultations about human rights, 1022 consultations with professional lawyers. In 168 cases REActors helped to draft simple legal documents, such as complains or statement to police, in 236 cases represented client’s interests in medical facilities, assisted in getting medical services and support, in 336 cases – accompanied the client in the initial appeal to the police. There were at least 20 strategic court cases, and at least 162 cases were used for shadow reports to UN Treaty Bodies.
Cumulatively in 8 countries (Armenia, Azerbaijan, Kazakhstan, Albania, Bosnia and Herzegovina, Montenegro, North Macedonia, Serbia) 56,2% of documented cases were responded by REActors, their organizations or through referral to partner NGOs or institutions (https://drive.google.com/drive/folders/1wtJaecXERatg8cmrAE1mzaoshtdLQY_w). Numerous success stories of cases resolutions are available at REAct website.
Solutions
Implementer:
- Select an implementer
- REGMH
Period:
Reducing human rights-related barriers to HIV/TB services
Evidence-based advocacy interventions with the aim of removing legal barriers to, and improve the rights of, migrant access to HIV and TB care in sending and receiving countries of in EECA region: national and regional (EECA) meeting and roundtables with participation of civil society, migrant organizations, healthcare officials and parliamentarians
Progress to date
On December 9, the REGMH with the assistance of the NCC Secretariat held in Dushanbe a Roundtable “Protection of health of migrants from Tajikistan”. The event was timed to presentation of a new study conducted by the REGMH: “Situation and Economic analysis of HIV-related health services in the field of migration in Tajikistan”.
On December 13, 2022, the Regional Expert Group on Migration and Health together with Central Asian Association of People Living with HIV held a Roundtable in Almaty “Health of HIV positive migrants in Kazakhstan”. The aim of the Round Table was to promote effective and timely treatment of international migrants living with HIV. During the meeting, the Situational and Economic analysis on the provision of HIV-related health services for international migrants in Kazakhstan was presented and discussed.
On December 19, REG together with local NGO “Real World. Real People” held a Roundtable in Armenia, Yerevan aimed to buster a discussion and exchange of experience on the provision of services for international HIV-positive migrants between heads of health authorities of the Republic of Armenia, government departments responsible for migration and civil society organizations. At the meeting, a study “Analysis of legal and institutional barriers to accessing HIV services among migrants in the Republic of Armenia” (developed by REG in 2021) was presented.
On October 11, REG held an online meeting “Migrants’ access to HIV services in Central Asia and Caucasus” that gathered representatives of UNAIDS, Central Asian Association of PLHIV (Kazakhstan), TB People (Georgia), NGO “Real World, Real People” (Armenia), IFRC Central Asia, WHO Europe, Elton John AIDS Foundation, NGO Equality Movement (Georgia), AFEW (Kyrgyzstan), IFRC South Caucasus, Global Fund, WHO, and MSF. The goal of the meeting was to initiate a discussion and work out possible solutions to provide access to HIV services for those who urgently left the countries following the political situation.
REGMH held a number of online and offline seminars and rioundtables to present and discuss the results of their studies in Azerbaijan, Tajikistan and Kyrgyzstan. A number of discussions was also held to scale up remote registration of migrants with HIV to get access to HIV services. For now, remote registration is functional in Tajikistan, and the preparatory work is implemented in Armenia, Azerbaijan and Kazakhstan.
In particular, on June, 6 in Dushanbe REGMH held a Round Table on protecting health of Tajik migrants. The purpose of the meeting that gathered together the staff of the AIDS Center, the patients’ community, specialists from NGOs in the region and host countries was to discuss the maintaining of the algorithm for remote registration of citizens of Tajikistan with HIV living abroad, and to formulate further steps to improve access of migrants to HIV services. Deputy Director of the Republican AIDS Center made a proposal to develop and sign a Memorandum for Mutual Recognition of Medical Tests at the level of Republican AIDS Centers in the Central Asian region.
On December 4, REGMH held a Round Table in Yerevan, Armenia. The key focus of the meeting was the provision of HIV services for Armenian citizens living abroad.
On December, 25 REGMH participated in online meeting to discuss current issues of implementation/piloting of “Remote registration of migrants with HIV in Uzbekistan”, organized by a consortium of organizations in Uzbekistan to promote the protocol, including IOM, CCM, AFEW, and REGMH. During the meeting, representative of CCM informed that the protocol was accepted and signed by the Center for State Sanitary and Epidemiological Surveillance of the Republic of Uzbekistan. What is very important, the final version includes recommendations suggested by REGMH making it easier to register a migrant than it was in an initial version of the document.
On June 15, REGMH held its quarterly Working group meeting on remote registration of PLWH living abroad. As a result of the Round Table held earlier in Uzbekistan, the group managed to attract specialists from the Republican AIDS Center and the CCM of Uzbekistan. During the meeting, the Group discussed the issue of accepting medical documentation (certificates, test results) issued by country of migrant’s destination, which are necessary for remote registration; also, the standard for the minimum set of documents for remote registration of citizens in migration (based on WHO’s recommendations) were presented to participants on order to foster the development of remote registration in the EECA countries.
REGMH has launched a series of Webinars “Health of Refugee and Migrants from the EECA countries”, designed both for those who flee and seek help in the host country and for those who organize help in receiving countries. Also, webinars could be of interest to those who research and solve systemic problems.
The first webinar took place on August 09 and was devoted to revision of problems that Ukrainian refugees who use drugs face: “People Who Use Drugs from Ukraine: Challenges and Solutions”.
Migration and Health Summer School was hekd on 21-22 Aug 2023 in Yerevan, Armenia. where participants discussed best practices and solutions for providing medical care to migrants and refugees from the EECA region. Country representatives of REGMH from the EECA region, representatives of health authorities from the EECA countries, experts from regional and international organizations, WHO, UNAIDS, UNDP, and MSF attended the event, totally, 40 participants from 12 countries.
On November 24, 2023 REGMH held a Round table in Bishkek, Kyrgyzstan to discuss current issues of migrant health in the context of HIV. The event brought together experts from relevant ministries and departments, non-governmental and civil sectors, as well as representatives of international organizations. A key part of the round table was the presentation of study’s results conducted by REG in 2023 “Situational and economic analysis in the field of migration and the provision of medical services related to HIV in the Kyrgyz Republic” to identify legal and institutional barriers related to HIV faced by citizens of Kyrgyzstan returning from migration.
Regional Meeting on Migrant Health and HIV Response took place on September 19-20, 2024, in Samarkand. Experts from EECA countries gathered to discuss adapting health services for migrants amidst mass population movements. Organized under the Global Fund framework, the event highlighted key challenges migrants face, including access to HIV/TB treatment, language barriers, and mental health support. The #HelpNOW HUB, which assisted 37,500 Ukrainians in 50 countries, was presented as a best practice model. Participants emphasized the need for migrant-sensitive policies, digital health solutions, and sustainable healthcare partnerships to ensure uninterrupted medical services across borders.
Solutions
Implementer:
- Select an implementer
- SEH
- SPIN Plus
Period:
HSS: Health sector governance and planning
Increasing domestic financing of countries for services to key groups
Progress to date
Targeted activities were held in all project countries to discuss with national and international, governmental and non-governmental stakeholders the changes needed to enable sustainable and uninterrupted funding of HIV-related activities from national resources. Through targeted advocacy, technical support, and an integrated approach to HIV funding, in 2022 the project team managed to allocate approximately 1,7 million USD at the national level to programs for key populations, using social contracting mechanisms: Moldova – 154,126.84 USD; Kazakhstan – 118,529.33 USD; Kyrgyzstan – 61,000 USD; Tajikistan – 19,200.00 USD; Georgia – 357,000 USD; Ukraine – 931,453.96 USD.
Thanks to budget advocacy within the SoS project 2.0, the amount of money allocated from national budgets for HIV services through social contracting mechanisms in EECA project countries amounted to $3 269 959 in 2024. During SoS project 2.0 – $ 6 273 049 were allocated for social contracting in EECA region. The cumulative domestic budget expenditures for servicing key populations in 5 countries of SEE amounted to $1 061 383 in 2024. During SoS project 2.0 – $ 3 236 260 were allocated for social contracting in SEE region.
HSS: Health sector governance and planning
Municipal budget advocacy for cities that chose the Fast Track approach Azerbaijan
Progress to date
As the result of budget advocacy the city administrations in Dushanbe ($130 000), Podgorica ($43 000), Skopje ($35 000), Tirana (USD 32,000), Novi Sad (USD 9,000), Sabac ($7 500) and Zvezdara ($4 000) allocated funds for the implementation of activities that would achieve the goals of the Paris Declaration.
Solutions
Implementer:
- Select an implementer
- SEH
- SEH
Period:
HSS: Health sector governance and planning
Legal framework for financing HIV services from domestic funds – development and approval
Progress to date
Targeted activities were held in all project countries to discuss with national and international, governmental and non-governmental stakeholders the changes needed to enable sustainable and uninterrupted funding of HIV-related activities from national resources. Through targeted advocacy, technical support, and an integrated approach to HIV funding, in 2022 the project team managed to allocate approximately 1,7 million USD at the national level to programs for key populations, using social contracting mechanisms: Moldova – 154,126.84 USD; Kazakhstan – 118,529.33 USD; Kyrgyzstan – 61,000 USD; Tajikistan – 19,200.00 USD; Georgia – 357,000 USD; Ukraine – 931,453.96 USD.
Over three years of implementation of SoS_project 2.0 has contributed to significant changes in the financing of HIV services in 14 countries in SEE and EECA regions. The project supported the development of service delivery standards, pricing methodologies, and quality control procedures, which are critical for sustainable financing from the state budget.
The practice of social contracting is applied without interruption in 14 countries.
HSS: Health sector governance and planning
Regulation of service packages for key groups
Progress to date
In the reporting period, the Emergency package of services for key and vulnerable groups of the population in the field of HIV, and TB in the context of military conflicts was finalized, including tariffication. On its basis, in 2023, the process of advocacy and promotion of implementation at the level of countries in the EECA region will be launched.
Strategic Brief on Business Continuity (link) and Strategic Brief on Social contracting (link) were developed. In addition, Analysis of Quality of Services Provided in Azerbaijan was held and is available at the link.
Over three years of implementation of SoS_project 2.0 has contributed to significant changes in the financing of HIV services in 14 countries in SEE and EECA regions. The project supported the development of service delivery standards, pricing methodologies, and quality control procedures, which are critical for sustainable financing from the state budget.
The practice of social contracting is applied without interruption in 14 countries.