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Evaluation report

2007 Ukraine: Comprehensive External Evaluation of the National AIDS Response in Ukraine



Author: Dr. Claire Thorne

Executive summary

Background:
Since 2004, outstanding progress has been made in the prevention of mother to child transmission of HIV (PMTCT) and the treatment and care of children living with HIV. While the number of pregnant women with HIV continues to increase rapidly – reaching 3,430 in 2007, the coverage of medical prophylaxis for PMTCT has increased to over 92%. The impact of these services is significant – the data of the Ministry of Health indicates that rate of transmission has decreased from 27.8% in 2001 to 7.1% in 2006.

Purpose/Objective:
The purpose of the evaluation was to identify why the epidemic has been unresponsive to efforts to control it, and to generate recommendations to strengthen Ukraine’s response to AIDS, to assess the achievements, strengths, shortcomings and challenges to the national AIDS response.

Methodology:
- Desk Review;
- Informant Interviews and Focus-Group Discussions;
- Site visits

Findings and Conclusions:
There is a strong political commitment to PMTCT in Ukraine, recognition that a multi-sectoral approach is essential, and strong opportunities for improved collaboration and coordination and for primary prevention activities to reach broad populations. The integration of PMTCT within mother and child health services has been instrumental in the successes achieved to date. The substantial reductions in Ukraine’s rate of mother to child transmission (from >25% in 2000 to 7.1% in 2006, according to official statistics of the Ministry of Health) reflects the high coverage of HIV antenatal testing and the high and increasing coverage of ARV prophylaxis among infected women (92.5% in 2007). However, there are limitations of the current PMTCT programme relate to management, implementation, and prioritization. In particular in Surveillance, Monitoring and Evaluation and Antenatal HIV screening and medical prophylaxis of mother to child transmission and Primary HIV prevention and prevention of unwanted pregnancies in women with HIV.

Recommendations:
Immediate:
- Ensure treatment and care targets for 2010 (Universal Access) and 2013 (end of new National AIDS Programme) are based on total estimated number of estimated number of children with HIV in Ukraine, including those diagnosed positive with DNA PCR
- Provide universal coverage of DNA PCR for newborns and HAART for PMTCT by end of 2009
Short-Term:
- Require regions to set and revise their own targets for treatment, care and support of children with HIV
- Designate a single national centre with responsibility for coordinating national programme for the prevention of mother to child transmission
- Provide urgent training of pediatric subspecialists, particularly for TB, oncology, neurology and neurosurgery
- Ensure pediatric HIV specialists may provide admissions and consultations for any patients that require hospitalization
- Train and support pediatric HIV specialists to diagnose and treat patients with active TB
Medium-Term:
- Provide access to condoms and other forms of birth control at AIDS Centres and women’s health clinics
- Develop an effective system for monitoring and evaluation of the national pediatric AIDS programme, which will include a revised definition of HIV status of children based on DNA PCR, as well as outcome measures of management regimens for pediatric patients
- Implement a national pediatric HIV management network, and a system for referring patients to the National Pediatric HIV/AIDS Centre in Kyiv (Kiev)

Lessons Learned (Optional):
There is a time to ahieve larger reductions in PMTCT, strengthening the comprehensive approach across four pillars of PMTCT strategy, attending to the needs of of vulnerable groups with poor access to PMTCT services and improving its quality.



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