The PATH-led USAID/PEPFAR Serving Life project introduced, scaled, and successfully transitioned an integrated, person-centered package of comprehensive health services in prison and community settings to enhance the delivery of testing and treatment services among key populations in Ukraine.
KYIV (9 September 2022): Earlier this week, the Serving Life project celebrated the achievements of its five-year implementation period with a two-day closing conference, as the project prepares to transition activities to the government of Ukraine for institutionalization and scale-up. Since 2017, the PATH-led United States Agency for International Development (USAID)/U.S. President’s Emergency Fund for AIDS Relief (PEPFAR) Serving Life project led efforts to reduce HIV, tuberculosis (TB) and Hepatitis C (HCV) transmission through detection, care, and treatment for people living with HIV, TB, drug-resistant TB (DR-TB), and HCV in pre-trial detention centers, prisons, post-prison settings, and communities in Ukraine. The closing conference was held at Recreation Center “SOBI Club,” Khotianivka Village, Kyivska oblast, from September 7–8, 2022.
Over the past five years, Serving Life increased HIV case detection and enhanced linkage, continuity in care, and treatment for people in closed settings, people who inject drugs (PWID), men who have sex with men (MSM), and their partners. Throughout project implementation, PATH and partners focused on increasing reach of HIV testing services, with 3,554 people living with HIV diagnosed and an increase in HIV testing coverage among these populations from 78% to 99.5% by project end. Serving Life surpassed PEPFAR’s treatment coverage goal, with 95.9% of those diagnosed with HIV enrolled on HIV treatment.
The overall HIV testing positivity increased from 2.8% at the beginning of the project to 4.5% at the project completion. This highlights Serving Life’s success in delivering focused HIV testing services that reached people more likely to be living with HIV, including use of index testing to reach partners and contacts of people living with HIV with HIV testing services.
Advancing integrated HIV and essential health services in Ukrainian prisons
Prior to 2018, there was no access to integrated comprehensive HIV/HCV/opioid agonist treatment (OAT) services in Ukrainian prisons. The Serving Life project focused on expanding access to integrated health care services at penal settings across the 12 project-supported regions of Ukraine. These efforts included developing standard operating procedures and other guidance documents to standardize health care for detainees and prisoners, developing an HIV/TB/HCV screening tool that was used to screen more than 33,000 prisoners, introducing provider-initiated counseling and testing to all project-supported penal settings, and implementing index testing. These activities were institutionalized upon project closeout to continue sustainably under government programming.
Serving Life integrated OAT into comprehensive health care package at Ukrainian prisons, a first in the history of the Ukraine and a major breakthrough facilitated by the project. At the start of 2022, the OAT program had been scaled to reach 187 prisoners in 4 prisons. As a result of this groundwork, OAT services will be fully institutionalized by the end of the Serving Life project in September 2022.
The Serving Life project also advocated successfully for expanded HCV diagnosis and treatment, as well as new, more effective TB drugs in penal settings. The project’s advocacy led to the Ministry of Justice (MOJ) increasingly funding HCV diagnostic and treatment services, starting with the procurement of 60,000 HCV rapid tests and 495 courses of HCV treatment for the first time. In 2020, the MOJ also financed HCV diagnostic services for more than 3,000 prisoners, and in 2021, the MOJ procured direct-acting antiviral courses to treat HCV among 2,600 prisoners. The project also worked with the MOJ to develop an action plan for introducing new TB drugs, resulting in USAID/Ukraine supplying prison TB hospitals in the 12 PEPFAR-supported regions with Clofazimine to treat DR-TB.
Launching a micro-epidemic elimination strategy
Serving Life adopted a micro-epidemic elimination approach to curb HIV transmission among PWID and MSM communities and social networks, launching new interventions to improve diagnosis of people living with HIV unaware of their status and rapid linkage to treatment or prevention services. Specifically, Serving Life introduced and expanded efforts to mitigate recent HIV transmission, providing HIV testing services to sexual and injecting drug use partners and social contacts of people living with HIV through index testing. The project also made HIV testing services more convenient and flexible within communities, offering HIV self-testing as an additional option for people who prefer to test outside of a clinic setting, with options for self-tests to be delivered at home, picked up in a community setting, or done with a health care provider. [CV(3]
Sustaining high-quality, integrated health services through social contracting and increased public-sector financing
In 2021, Serving Life, together with the MOJ’s Center of Health Care, for the first time provided detainees in a pretrial detention center (SIZO) with sustainable HIV/TB/HCV and psychosocial support services through the placement of a social worker. Serving Life financed the social worker's activities during the one-year pilot while advocating to MOJ’s Center of Health Care for staffing changes to add this position as part of the SIZO’s regular staffing roster. As a result of this advocacy, as of January 2022, the first social worker was officially included in the SIZO’s health care unit staff, employed using state funds.
Serving Life provided technical support to local state administrations in 12 PEPFAR-supported regions to identify, introduce, and scale an appropriate social contracting mechanism for non-governmental organizations (NGOs) to continue providing a package of comprehensive care services for people on probation in 12 regions of Ukraine.
PATH implemented the Serving Life project in consortium with its core partners, the Ukrainian Coalition of HIV-Service Organizations, the All-Ukrainian Network of Organizations Working in the Penal System and 100 Percent Life (former All-Ukrainian Network of People Living with HIV/AIDS), and in partnership with MOJ of Ukraine; Ministry of Health of Ukraine (MOH); State Enterprise (SE); Public Health Center of the Ministry of Health of Ukraine; SE “Center of Health Care of State Criminal Executive Service of Ukraine”; SE “Center of Probation”; Health Care Departments of the Oblast State Administrations; regional AIDS centers; drug abuse clinics; and international, national, and regional NGOs.