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Moldova

01. HIV care cascade

Institutionalizing effective models of, and processes in, HIV responses in the EECA region to impact the HIV care cascade in the region
ACTIVITIES

Community-led advocacy of elimination of identified critical discrepancies with the WHO prevention, testing and treatment guidelines

Implementer
Contact
Period
100% Life
Daryna Bondarenko
2022-2024
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.

Decentralization of HIV testing services through integration to primary healthcare

Implementer
Contact
Period
SEH
Giorgi Soselia
2022-2024
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.

Assessment of OAT sustainability

Implementer
Contact
Period
EHRA
2022-2023
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.

Community groups conduct community-led assessment of national quality standards in accordance to IDUIT and organize dialogue with service providers and MOH/local authorities

Implementer
Contact
Period
EHRA
2023-2024
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.

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)

Implementer
Contact
Period
ECOM
Nikolay Lunchenkov
EHRA
2022-2024
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. “

Provision of HIV prevention services with precautions against COVID-19

Implementer
Contact
Period
APH
Nadiya Yanhol
2022
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.

National Contingency Planning

Implementer
Contact
Period
APH
Nadiya Yanhol
2022
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.

Decentralization of HIV treatment through integration to primary healthcare

Implementer
Contact
Period
SEH
Giorgi Soselia
2022-2023
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.

Technical support in implementation of long-term contracts for ARV procurement

Implementer
Contact
Period
HAC
Yevheniia Kononchuk
2022-2024
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.

Technical support in implementation of simplified registration for ARVs

Implementer
Contact
Period
HAC
Yevheniia Kononchuk
2022-2024
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.

Advocacy for engagement of patient community experts into national working groups to develop and adopt medicine procurement lists and technical procurement documentation

Implementer
Contact
Period
HAC
Yevheniia Kononchuk
2022-2024
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.

Community-led advocacy of elimination of identified critical discrepancies with the WHO prevention, testing and treatment guidelines

Implementer
Contact
Period
100% Life
Daryna Bondarenko
2022-2024
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.

02. Removing HR/gender barriers

Removing barriers to services for key populations to promote quality health interventions based on human rights principles; addressing gender barriers to services
ACTIVITIES

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.

Implementer
Contact
Period
APH
Victoria Kalyniuk
ENPUD
Olga Belyaeva
2022-2023
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:

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.

Ensure a monitoring system for the implementation of the human right to health in prisons through national preventive mechanisms

Implementer
Contact
Period
FreeZone
Oleksiy Zagrebelnyi
2022-2024
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: MoldovaKazakhstan.

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.

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

Implementer
Contact
Period
EWNA
Svitlana Moroz
2023
Progress to date

Community-led monitoring on types of violence against women living with HIV was held in Kazakhstan (in English and in Russian) and Moldova (in English and in Russian).

Developing and launching call for “Gender and HIV” small grants with special eligibility focus on Monitoring situation with human rights of Trans* people

Implementer
Contact
Period
EKPC
Dr. Karen Badalyan
2022-2024
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+”.

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

Implementer
Contact
Period
ECECACD
2022-2024
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.

03. Budget advocacy

Budget advocacy for sustainable services for key populations in the EECA region
ACTIVITIES

REGIONAL: regional dashboard (with 2 integrated portals) + preliminary results to be reflected on the timeframe / deadlines, at least for this year

Implementer
Contact
Period
APH
Maria Malakhova
2022-2024
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.

Legal framework for financing HIV services from domestic funds – development and approval

Implementer
Contact
Period
SEH
Kateryna Ryzhkova-Siebielieva
2022-2024
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.

Increasing domestic financing of countries for services to key groups

Implementer
Contact
Period
SEH
Kateryna Ryzhkova-Siebielieva
2022-2024
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.

Regulation of service packages for key groups

Implementer
Contact
Period
SEH
Kateryna Ryzhkova-Siebielieva
2022-2024
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.