Positive Children Project in Ukraine

Project Overview

This CIDA-funded project seeks to address the critical need for professional capacity in the care, treatment and support of children and families living with HIV/AIDS in Ukraine. Having begun in 2005, the project works closely with Canadian experts, Ukraine's Ministry of Health and the All-Ukrainian Network of People Living with HIV in determining priority training areas. 

CSIH is committed to the principle of harm reduction and the protection of human rights in emphasizing the need for a multidisciplinary team approach to the care, treatment and support of children infected with and affected by HIV.

This project has mobilized Canadian expertise to support the Ministry of Health’s efforts in providing high-quality, professional training opportunities to a wide spectrum of Ukrainian professionals working in pediatric HIV/AIDS in Sevastopol, Donetsk, Zaporizhia and the recently created HIV clinic at OHMATDYT hospital in Kyiv.  To support patient-centered, multi-disciplinary prevention, treatment, care and support of HIV-positive children and their families, the project will engage the following professions: doctors, nurses, laboratory specialists, support and outreach workers, representatives of AIDS service organizations, non-governmental organizations and the local chapters of the All-Ukrainian Network of People Living with HIV/AIDS. 

 The project has four main components:

1. Interprofessional Training Program and Internships – Four five-day training workshops are planned between January 2007 and March 2008.  The focus will be on in-depth training to establish trained expertise in the field of pediatric HIV/AIDS in Ukraine.  The training will ensure a multi-disciplinary approach in the management of pediatric HIV/AIDS patients including incorporating both a strong laboratory component and psychosocial component for patients and their families.   These training workshops will be complemented by professional internship opportunities to Canada for a select group of project participants. 

2. Demonstration Project – The demonstration project aims to support Ukrainian interprofessional teams in providing improved health services to children living with HIV and AIDS.  It will also serve as a case-study for the iterative training workshops and may inform other aspects of the project, including professional internships.  It will focus on improved adherence counselling for HIV-positive children and will allow Canadian and Ukrainian partners to document treatment and care outcomes over the course of one year.  These outcomes may then be used as evidence for policy-making decisions.

3. Capacity-Building Grants for AIDS Service Organizations – Acknowledging the important role that AIDS Service Organizations (ASOs) and Non-Governmental Organizations (NGOs) play in combating the HIV/AIDS epidemic in Ukraine, the project will offer capacity-building grants to these organizations participating in the project.  These grants will provide an opportunity for Ukrainian partners to put into practice the skills and learning obtained in the four training workshops, provide case study examples to use in those workshops and strengthen the capacity of participants to seek out and obtain sustainable project funding in the future.

4. Communication of Results – Information and results pertaining to project activities will be disseminated in Ukraine, Canada and to other international stakeholders.   This will involve, inter alia, supporting Ukrainian professionals in sharing the results obtained from the demonstration project in the form of scientific papers or presentations at scientific conferences.

Please see the Positive Children project information sheet.

Events and Activities - 2006-2007

Training

• First Pediatric HIV/AIDS Care, Treatment and Support Workshop, Kyiv.  January 29 – February 2, 2007.

• Second Pediatric HIV/AIDS Care, Treatment and Support Workshop, Zaporizhia.  June 4 – June 8, 2007.

Laboratory Internship, Toronto and Ottawa. November 26 – December 9, 2006

• Ontario Public Health Laboratory

• Ontario Quality Management Program – Laboratory Services

• Public Health Agency National HIV/Retrovirology Laboratory

• Canadian Blood Services

Hospital Management Study Tour, Toronto, November 19 – December 3, 2006

• Hospital for Sick Children

• The Teresa Group

• Canadian AIDS Treatment Exchange (CATIE)

• Toronto General Hospital

• Ontario HIV Treatment Network (OHTN) research conference "Mobilizing Knowledge"

• Ontario Public Health Laboratory

Overview of the Epidemic in Ukraine
Ukraine has the most severe AIDS epidemic in the region of Europe and Central Asia, with an estimated adult prevalence of 1.46%.  Despite the significant scale-up of prevention programs, supported largely by the current Global Fund grant, HIV continues to spread rapidly, with 16,078 new cases of HIV officially diagnosed in 2006 – the highest number of new annually registered cases since the beginning of surveillance in 1987.  The recent increases in the coverage of treatment, care and support programs have not produced a concomitant reduction in AIDS morbidity and mortality. On the contrary, 4,723 new AIDS cases and over 2,416 deaths of persons with AIDS were reported in 2006 – the highest annual figures ever reported. (courtesy of UNAIDS)

The transmission route for infection was originally injecting drug use, mainly in young men, but infection is now spreading via unprotected heterosexual sex.  As of July 2005, the number of officially registered people living with HIV was 81,240, while people living with AIDS was 10,687 and 6,348 registered deaths from AIDS.  According to UNAIDS and WHO, the real numbers are significantly higher – approximately half a million Ukrainians are HIV-infected (data provided by the All-Ukrainian Network of People Living with AIDS).  While it is the government’s responsibility to organize epidemiological control, HIV testing, counseling and informing population on HIV/AIDS issues, medical services and monitoring is still extremely poor.  Only 3% of officially registered people living with HIV in Ukraine are treated with antiretroviral (ARV) therapy, more than half of those in need do not receive any medical help, insufficient financing from state budget being the main reason.  

Investment in healthcare services in Ukraine is generally inadequate, even within the Eastern European and Central Asia region.  There is a critical lack of investment in effective national strategies to control the spread of HIV.  Corruption, trafficking, and stigma triangulate to isolate HIV outside the mainstream of health systems, thus assuring that official action will be slow.  Public awareness of HIV risk is low, which is a consequence of the government’s neglect of public health.  Lack of investment, widespread poverty, social and judicial constraints on decriminalization of drug use, drug traf­ficking, and government corruption have been key influencing factors.  Poverty, the marginalization of risk groups, and ignorance of the health implications of personal behavior are the fuel that is ensuring spread of HIV.  Today, the number of officially registered children living with HIV is more than 10,000.  In infants, one of the main ways of HIV transmission is from HIV-positive mothers during pregnancy, delivery or breast feeding.  The next outburst of HIV infection is observed among teenagers, where the infection is mainly transmitted sexually and through injecting drug use.

For more information about HIV/AIDS in Ukraine, please see the following sites:

* UNAIDS' country assessment of Ukraine

* The Global Fund to Fight AIDS, Tuberculosis and Malaria's investment in Ukraine

* International AIDS Alliance - Ukraine (principal recipient of Global Fund grant)

* All-Ukrainian Network of People Living with HIV

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