War in Ukraine: Maintaining Lifesaving HIV and TB Services

Since the expansion of the war in Ukraine in late February 2022, more than 14 million people have been internally displaced or forced to flee to neighboring countries as refugees, often losing access to health care. HIV and tuberculosis (TB) prevention and diagnosis services have been disrupted, and many people with HIV and TB have been forced to interrupt their lifesaving treatment.

Even before the war, Ukraine had a high HIV and TB disease burden. Over the past two years, more than 1,500 health facilities have been attacked, leaving health care workers and patients displaced, injured or killed. Our work with partners in Ukraine and neighboring countries on prevention, testing and treatment for HIV and TB has been challenged by the dangerous environment caused by the war.

Emergency Funding for HIV and TB Services

Between March 2022 and August 2023, the Global Fund approved US$27.7 million in emergency funding to support the continuity of HIV and TB prevention, testing and treatment services in Ukraine. This is in addition to the US$165.5 million approved in December 2023 for the 2024-2026 implementation period to support Ukraine to fight HIV and TB and strengthen their systems for health. This new funding builds on the US$135.7 million in grants and catalytic matching funds allocated to Ukraine to support the fight against HIV and TB in the country over the 2021-2023 implementation period, and US$54.5 million for the country's COVID-19 response – totaling nearly US$190 million. The Global Fund has also approved US$28 million to reprogram existing grants to respond and adapt to the programmatic needs in the country.

Our Principal Recipients – Public Health Center, Ministry of Health, 100% Life, and Alliance for Public Health – and over 100 community-based and community-led organizations have been delivering HIV and TB services to vulnerable people. We continue working closely with all our partners to carry out critical work required to strengthen health care and community systems and ensure patients have ongoing access to prevention, testing and treatment for HIV and TB. This includes funding for:

Generators for regional laboratories where power supplies are limited or at risk.
Retrofitting vans to deliver essential medicines and supplies.
Procurement of HIV and TB drugs, and diagnostic equipment and reagents.
Community-led organizations to support affected and displaced members of their communities and link them to HIV and TB services.
Work to help patients displaced in Ukraine and nearby countries get reconnected to the health care and medicine they need.
Providing food and care packages for TB and HIV patients and beneficiaries of prevention/testing programs.
Funding legal support for communities and displaced people.
Locating appropriate accommodation for patients with infectious conditions like multidrug-resistant tuberculosis.
Providing funding for additional mental health services, with a particular focus on support for women who have suffered sexual and gender-based violence as a result of the war.

The HIV and TB Situation in Ukraine

Prior to the war, Ukraine had made remarkable achievements in combatting HIV and TB.

Good progress has been made on HIV since the Global Fund began investing in the country over 20 years ago, both in terms of linkage to treatment and viral suppression, as well as in significantly reducing infections and deaths. In 2021, 75% of people living with HIV knew their status, 83% of those diagnosed were on antiretroviral therapy (ART) treatment and 94% were virally suppressed. Domestic financing for HIV prevention services for key and vulnerable populations also increased, as did the capacity of community-led organizations.

The incidence rate of TB fell steadily between 2015 and 2021, from 91 to 73 cases per 100,000 population, but increased to 90 cases per 100,000 in 2022 according to World Health Organization data. ART coverage among people living with both TB and HIV increased from 65% in 2015 to 92% in 2022. However, the prevalence and mortality level of TB remain high in the country and drug-resistant TB remains a public health threat.

Despite the challenging context, HIV and TB programs supported by the Global Fund have maintained operations based on an adapted model and by using more mobile units, extending HIV and TB testing to the military and offering social support, home deliveries, and mental health services for displaced people and health workers.

To date, the Global Fund has invested more than US$1 billion in Ukraine for HIV and TB programs since 2003, as well as investments to support the adaptation of health service delivery through the COVID-19 pandemic. This adaptation and increased resilience of health services and community systems have proven invaluable, especially as hospitals have been damaged or destroyed and people continue to be displaced, causing them to lose access to health care, including treatment for HIV and TB.