The goals of the MOH Capacity Building mechanism are to develop capacity in Strategic Information (SI), Laboratory Strengthening, and Blood Safety within the Ukrainian AIDS Center (UAC) and the regional AIDS center network. In 2009, a National M&E Unit (NMEU) was created in UAC to oversee HIV SI as part of the Three Ones. UAC is restructuring three lab units as a National HIV Reference Laboratory, to be located in a single facility. Both the NMEU and NHRL will need substantial technical assistance to develop strategic plans, policies, procedures, and staff capacity to assume their roles. The NHRL will need additional equipment and renovated facilities. The UAC recently became the first GOU GF Principal Recipient and needs extensive capacity development to fill the roles planned for the grant period. CDC support through this mechanism was included in GF grant planning to avoid overlap while providing for capacity development not covered by GF.

Obstacles to implementation include a lack of MOH experience with assistance as no previous grants had been implemented. The original MOH unit (State Committee on HIV/AIDS) slated to be the implementer was dissolved in GoU administrative reforms in 2011 and a new State Service on HIV/AIDS was established. After extensive intraGOU discussions, the State Service is taking steps with the Ministry of Economy to develop and approve administrative procedures to receive funds and conduct activities under this agreement.

The MOH project contributes to all goals of Ukraines Partnership Framework: directly to goals 2 (improved quality/cost effectiveness of HIV services for MARPs) and 3 (strengthened national/local ability to achieve national program objectives); and indirectly to goal 1 (reduction of HIV transmission among MARPs).

Because of the ongoing intra-GOU administrative process to achieve activation of the cooperative agreement that the award, activities planned for FY11 will be conducted in FY12 using the previously programmed funds. As administrative issues are resolved, the MOH will proceed with implementation of the original workplan with modifications introduced to reflect intervening changes. Limited additional resources are requested to support management and operation activities under this budget code.

The program will develop the infrastructure and the human/technical capacity of the NHRL to lead the national HIV laboratory network, develop standards for the function of the NRHL and network laboratories, and implement the needed improvements in infrastructure, human and technical capacity, and systems, to provide for improved quality and access to HIV laboratory support.

The initial steps will be to enhance the human, organizational, and physical capacity of the NHRL. The NHRL staff will be trained (to be trainers) in areas relevant to reference laboratories 1) laboratory management, 2) HIV laboratory techniques at international standards; 3) developing and implementing QA/QC systems; 4) laboratory information management. A plan for the NHRL to participate in external QA will be developed and implemented (including reform of regulations prohibiting use of test kits for QA and prohibiting export of specimens). National standards and SOPs that meet international standards will be developed and implemented for HIV related laboratory techniques. New national standards (meeting international standards (ISO 15189)) will be developed for laboratory accreditation. The NHRL will develop, get approved, and implement a plan to assess test kits purchased for national use. Equipment (including equipment for ARV resistance testing, quality control of ELISA tests, and a laboratory information system will be procured in a transparent tendering process and a maintenance program developed. The laboratory currently operates in two separate locations with inadequate space and infrastructure. Space for both units will be found, renovated, and the units relocated.

Additional steps will enhance the physical, human, and organizational capacity of the regional HIV laboratories, especially those conducting HIV confirmation and clinical monitoring. Trained NHRL staff (with APHL/ASCP staff as needed) will train the regional laboratory staff in the above subject areas. A unified QA/QC system will be extended to the regional laboratories, initially for HIV serology with extension to other assays as panels are developed or purchased and registered. NHRL staff will conduct regular monitoring visits to regional HIV laboratories and assist them in implementing new SOPs and becoming accredited. Limited WB/CD4/VL/ equipment purchases will equip the regional confirmatory and clinical monitoring laboratories that lack them. Regional laboratory heads will be trained in laboratory management/strategic planning.

Because of the ongoing intra-GOU administrative process to achieve activation of the cooperative agreement that the award, activities planned for FY11 will be conducted in FY12 using the previously programmed funds. As administrative issues are resolved, the MOH will proceed with implementation of the original workplan with modifications introduced to reflect intervening changes. Limited additional resources are requested to support management and operation activities under this budget code.

The program of activities remains the same as in the previous year. The program will develop the capacity of the new national M&E Center (NMEC) to lead the system of regional M&E centers. The program will improve the NMEC infrastructure and human/technical capacity and will incorporate specific activities to improve HIV surveillance, to improve data collection from other services (TB, ANC, prison, STD), to coordinate the analysis of these data streams, to improve modeling and data triangulation, to progressively lead surveillance among risk-groups, and to generate and disseminate the analyses needed to direct the epidemic response. The capacity of the regional M&E centers to implement new M&E functions will also be improved.

The initial critical steps are to enhance the physical, human, and organizational capacity of the NMEC and the network of regional M&E centers. The UAC including the NMEC has had a new space identified that will allow all units to be housed together. Renovations will be needed to bring the space to standard condition. . Improving the infrastructure of the NMEC will require small amounts of computer equipment and furniture.

The NMEC and regional M&E staff will be trained in areas of surveillance and monitoring and evaluation including 1) management/strategic planning/project implementation, 2) data management, 3) data analysis, 4) cost effectiveness and prevention effectiveness assessment, and 5) effective dissemination of results. Training in management issues will begin in year 1; a training plan for national and regional levels will be developed using assessment results.

New national reporting documents and guidelines for HIV surveillance will be developed to take into account international standards and changing information needs, using input from national statistics and reporting experts and CDC technical assistance. These guidelines will improve data availability from other health services, including TB, drug treatment, and maternal health services. Experts and staff from these services will help develop and review draft guidelines, with training of services staff after approval.

Currently, sentinel surveillance among risk-groups is funded by Global Fund and led by GF grantees. Efforts to progressively increase the role of the UAC and NMEC in this surveillance will focus on development of guidelines and increasing the role of UAC/NMEC staff in planning and interpreting these studies.

Because of the ongoing intra-GOU administrative process to achieve activation of the cooperative agreement that the award, activities planned for FY11 will be conducted in FY12 using the previously programmed funds. As administrative issues are resolved, the MOH will proceed with implementation of the original workplan with modifications introduced to reflect intervening changes. Limited additional resources are requested to support management and operation activities under this budget code.

The Project will focus on strengthening the National Blood Services through improving infrastructure, human capacity, and the regulatory framework.

An initial assessment will inform further activities. A team of international and national experts, and assess the blood service/blood safety in Lugansk, Kyiv Oblast, and Rivne, reviewing policies, procedures, and materials for QA/QC screening for HIV/ blood borne pathogens. The team will develop a TA and training plan for blood service staff in the three oblasts based on the assessment.

The improvement of infrastructure and human capacity will develop three centers of excellence in eastern, central, and western Ukraine with updated equipment and fully trained staff. Priority equipment are centrifuges and equipment for computerized (bar-coded) tracking of donors, blood, and recipients to allow introduction of hemovigilance. Additional equipment (viral inactivation) will be added in Centers of Excellence within budgetary constraints; additional donors will be sought. In collaboration with the NHRL, a system of external QA/QC will be introduced. The Centers of Excellence will serve as regional training centers to allow expansion of infrastructure and human capacity improvements. Training activities will focus on QA/QC. The project will also develop programs to improve voluntary donation through the NBS and community organizations to expand the pool of eligible and willing donors.