Bringing Life: How SAFEMed’s Last-Mile Delivery Model Ensures HIV Treatment Continuity During Wartime

As Ukraine’s full-scale war continues into its third year, the country’s HIV response remains under extraordinary strain. Disrupted supply chains, attacks on health facilities, and shifting security conditions have all made it harder to ensure that lifesaving antiretroviral therapy (ART) reaches those who need it. Changes in global funding streams have compounded the risks, putting treatment continuity in jeopardy for tens of thousands of people living with HIV.

In this context, the Last-Mile Delivery Model developed by USAID’s SAFEMed Activity has proven to be a critical safeguard. By partnering with private logistics companies and strengthening regional delivery systems, the model ensures that essential HIV and tuberculosis medicines reach even the most difficult-to-access health facilities. What began as a targeted logistics solution has become a lifeline—one that is sustaining treatment, strengthening resilience, and protecting health amid war.

A Model Rooted in Urgency

Even before the war, many patients in Ukraine faced serious challenges accessing ART, a treatment that must be taken daily without interruption. Gaps in delivery—due to inadequate storage conditions, fragmented distribution systems, and a lack of specialized transport—posed serious risks to continuity of care and patient health.

To close these gaps, SAFEMed designed a new Last-Mile Delivery Model in 2019, shifting distribution from government-run systems to private logistics providers with the capacity and expertise to meet strict storage and transport standards. The model aimed to build a sustainable, accountable, and responsive system to ensure medicines reached facilities safely and on time, no matter the circumstances.

In partnership with the Center for Public Health (CPH) of the Ministry of Health of Ukraine, the model was first piloted in Odesa—home to the country’s highest HIV burden. Following its success, the model expanded to 16 regions by 2022. Between 2021 and 2025, more than $8.1 million worth of HIV and TB medicines were delivered to 245 HIV service delivery points and 236 TB treatment sites.

Adapting Under Fire

Since the start of Russia’s full-scale invasion in 2022, the Last-Mile Delivery Model has faced—and withstood—immense challenges. Shelling, road blockades, and mined infrastructure have made it dangerous to transport medicines, especially to frontline areas. Yet the model has continued to function—even in high-risk regions like Donetsk and Sumy—thanks to constant route revisions, security adaptations, and the dedication of health workers and logistics teams.

“I work for the well-being of our people and our country. Everyone deserves access to healthcare and a chance for a better life.”

Ms. Krystyna, chief specialist at the Donetsk Regional Department of Health

As of February 2025, all seven ARV sites in Donetsk region remain operational, serving nearly 5,000 patients.

“All the ARV sites in the region are functioning and continue to provide lifesaving treatment,” says Ms. Krystyna, chief specialist at the Donetsk Regional Department of Health. “This ensures continuity of treatment even during the war.”

For Krystyna, the work is deeply personal: “I work for the well-being of our people and our country. Everyone deserves access to healthcare and a chance for a better life.”

The same dedication is shared by Iryna, deputy director of transport operations at a partner logistics firm: “At the beginning of the invasion, we used our own vehicles, adjusted to curfews and checkpoints, and constantly revised routes to meet the new security conditions and ensure medicines got through.”

Scaling for National Resilience

The model’s success has prompted Ukraine’s Ministry of Health to explore broader adoption. SAFEMed has been asked to assess the capacity of facilities receiving state-funded medicines and support the design of a national delivery model for all essential health commodities. This process includes analyzing the cost-effectiveness and feasibility of scaling up the Last-Mile approach to strengthen pharmaceutical access nationwide.

In a time of crisis, the model has become more than a logistics tool—it’s a symbol of resilience and a practical foundation for a stronger health system. By demonstrating how essential medicines can be delivered safely, consistently, and efficiently even under the most extreme conditions, SAFEMed is helping to protect continuity of care and build a more equitable future for people living with HIV in Ukraine.