Challenges of NGO-to-state Referral in the Delivery of HIV Prevention Programs in Ukraine Supported by the Global Fund
Main Article Content
Background: Ukraine has one of the world’s fastest growing HIV rates and was one of the largest recipients of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GF). The objective of this study was to close the gaps in the literature on the delivery of HIV prevention services by NGOs and the perceptions of NGO delivered services, using as an example HIV prevention programs in Ukraine funded by the GF.
Methods: The aim of this qualitative study was to determine how NGO-based services were implemented in the context of a state-owned healthcare system of Ukraine. An ethnographic study, which included 50 participant interviews, was conducted in three oblasts in Ukraine and in the capital, Kyiv, between 2011 and 2013. This article presents some of the findings that emerged from the analysis.
Results: Participants reported that NGOs were focused more on reporting numbers of rapid tests, and less on motivating clients to continue onto treatment. The role division between NGOs and the state in HIV services was largely perceived by participants as unclear and challenging. Overall, lack of clarity on the role of government healthcare providers and NGOs in providing HIV services compromised the process of finding, referring, and retaining HIV patients in care.
Conclusions: Gaps in linking HIV patients to the HIV care continuum have been identified as a potentially problematic issue in delivery of HIV prevention services by GF funded NGOs. With an anticipated GF exit from Ukraine, the lack of clearly defined NGO-to-state referrals of HIV patients complicates the transition of NGO run services into state funding. Further steps to improve referral systems are necessary to ensure a smooth transition and enable Ukraine to fight its HIV epidemic effectively.
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UNAIDS. UNAIDS World AIDS Day report. Geneva: UNAIDS;2011.
Kruglov YV, Kobyshcha YV, Salyuk T, Varetska O, Shakarishvili A, Saldanha VP. The most severe HIV epidemic in Europe: Ukraine's national HIV prevalence estimates for 2007. Sex Transm Infect. 2008;84 Suppl 1:i37-i41.
UNAIDS. Second Independent Evaluation 2002-2008. Country Visit to Ukraine. Summary Report. 2008; http://data.unaids.org/pub/BaseDocument/2009/20090417_sie_countrysummaryreport_ukraine_en.pdf. Accessed November 20, 2012.
UCDC. Ukrainian center for Socially Dangerous Disease Control of the Ministry of Health of Ukraine. Operatyvna informaciya. In Ukrainian. 2014; http://ucdc.gov.ua/attachments/article/972/%D0%A1%D1%96%D1%87%D0%B5%D0%BD%D1%8C%202014.pdf. Accessed April 30, 2015.
Martin N. War-Torn Ukraine Facing AIDS Care 'Disaster' Sky News. February 6, 2015.
OIG. The Office of the Inspector General. Review of the suspension/termination processes for Global Fund grants. The Global Fund;2008. Audit Report No: TGF-OIG-08-003
Lekhan V. RV, Richardson E. Ukraine: Health System Review. Health Systems in Transition. Geneva: WHO;2010.
Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6):793-800.
WHO. Providing integrated services at healthcare facilities for people who use drugs in Ukraine. Guidelines. 2012; http://www.euro.who.int/__data/assets/pdf_file/0005/167315/e96608-update.pdf.
The Complex plan of scaling up population access to HIV prevention, diagnostics, treatment and care in Q2-Q4 of 2012, and Q1 of 2013. Kyiv: The Ministry of Health of Ukraine;2012.
Varban M, Grishaeva, I., Zhitkova, Y., Parkhomenko, Zh.,Sidorenko, O. Counselling and Testing for HIV using quick tests in prevention projects for groups of high risk to HIV. In Russian. Kyiv: International HIV/AIDS Alliance in Ukraine;2012.
Perehinets I. HIV testing and counselling services in Ukraine: what else should be done? . Paper presented at: WHO 'HIV in Europe' Conference2012; Copenhagen.
APMG. From Beyond Boutique to Epidemic Control - Evaluation Report of HIV prevention activities by International HIV/AIDS Alliance Ukraine funded by the Global Fund to Fight AIDS, TB and Malaria. AIDS Projects Management Group. 2009; http://www.aidsprojects.com/wp-content/uploads/2011/05/APMG-Eval-Ukr-Alliance-Final-Report.pdf. Accessed September 20, 2012.
Judice N, Zaglada, O., Mbuya-Brown, R. HIV Policy Assessment: Ukraine. Washington, DC: Futures Group, Health Policy Project;2011.
Atlani-Duault L. Humanitarian Aid in Post-Soviet Countries: An Anthropological Perspective. New York: Routledge; 2007.
Hrycak A. From global to local feminisms: transnationalism, foreign aid and the women's movement in Ukraine. Sustainable Feminisms. Advances in Gender Research 2007;11:75-93.
Kichorowska-Kebalo M. Personal narratives of women's leadership and community activism. Ann Arbor, MI: ProQuest LLC, The City University of New York; 2011.
Owczarzak J. Defining HIV Risk and Determining Responsibility in Postsocialist Poland. Medical Anthropology Quarterly. 2009;23(4):417-435.
Wedel J. Collision and Collusion: The Strange Case of Western Aid to Eastern Europe. New York: Palgrave;2001.
Corden A, Sainsbury, R. Using verbatim quotations in reporting qualitative social research: researchers’ views – SPRU. 2006; https://www.york.ac.uk/inst/spru/pubs/pdf/verbquotresearch.pdf. Accessed June 18, 2015.
Semigina T. Tracking Global HIV/AIDS Initiatives and their Impact on the Health System in Ukraine Final Report. Kyiv: Global HIV/AIDS Initiatives Network;2009.
WHO. Systematic screening for active tuberculosis principles and recommendations. 2013; http://apps.who.int/iris/bitstream/10665/84971/1/9789241548601_eng.pdf?ua=1. Accessed December 12, 2014.
Spicer N, Bogdan, D., Brugha, R., Harmer, A., Murzalieva, G. and Semigina, T. 'It's risky to walk in the city with syringes': understanding access to HIV/AIDS services for injecting drug users in the former Soviet Union countries of Ukraine and Kyrgyzstan. Globalisation and Health. 2011;7:22.
UNAIDS. Comprehensive External Evaluation of the National AIDS Response in Ukraine: Consolidated Report (English original, January 2009). Geneva: UNAIDS;2009.
McGill S. NGO Hybridisation as an Outcome of HIV Services Delivery in Global Fund-Supported Programmes in Ukraine. VOLUNTAS: International Journal of Voluntary and Nonprofit Organizations. June 2015.