Maintaining Last-Mile Distribution of Critical HIV and TB Treatments Despite the War: View from the Front Lines

March 17, 2023

Maintaining Last-Mile Distribution of Critical HIV and TB Treatments Despite the War: View from the Front Lines

Before the ongoing war with Russia began, Ukraine had long been battling another threat: epidemics of HIV and tuberculosis (TB). The rates of both diseases in Ukraine are high—the country has one of the world’s highest HIV incidence rates and the second-largest HIV epidemic in Europe and the Central Asia region, and TB is the country’s leading cause of death among infectious diseases. Russia’s unjust invasion of Ukraine in February 2022 threatened to jeopardize years of progress toward ensuring safe and affordable access to medicines for all Ukrainians, including people living with HIV and TB. From the moment the invasion began, thousands of people found themselves living in regions impacted by fighting and facing life-threatening interruptions to their treatment plans. But, thanks to locally led efforts, the country quickly adapted its national distribution program, and Ukrainian patients continue to receive the critical treatment they need.

Long before the war broke out, the Ministry of Health of Ukraine (MOH) and its Center for Public Health (CPH) had set its focus on addressing unpredictable and insufficient medicine stock levels to prevent interruptions in HIV and TB treatment. With support from USAID’s Safe, Affordable, and Effective Medicines (SAFEMed) for Ukrainians Activity, MOH launched a public–private partnership logistics pilot in 2019 to close a gap in delivering medicines to Odesa, a region heavily affected by the HIV and AIDS epidemic. The pilot engaged a private logistics company for last-mile distribution of HIV and TB medicines, helping streamline fragmented public-sector logistic services while following supply chain best practices and improving patient outcomes. The pilot’s success led to its rapid scale-up, and by the start of 2022, this model was being used to cover last-mile deliveries across 16 regions of the country. As of January 2022, many of the more than 130,000 people living with HIV across Ukraine were on antiretroviral treatment (ART), and more than 18,000 newly registered TB patients received daily treatment and ongoing monitoring.

When the war broke out, last-mile logistics activities were interrupted. Destruction of critical infrastructure, active shelling of bridges and roads, mass migration of citizens (both internally and abroad), and lack of medical personnel all contributed to slowdowns and a near-halting of the activity, especially during the first months of the invasion. Yet, even by April, deliveries resumed in four regions, and within the next several months, the number of regional distribution centers using the delivery services increased to eight.

Ukraine’s institutions and its leaders across CPH, regional health departments, and HIV and TB distribution were seeking alternative ways to bring medical care to patients in need. This involved reliance on vehicles owned by sub-regional distribution centers, humanitarian organizations, and individual local volunteers, as well as postal services.

One of the countless individuals working tirelessly to keep these last-mile activities running is Tetiana, a medical nurse working at Sumy TB warehouse. “From the first war days–due to problems with transportation and the impossibility to reach even the warehouse–we understood the importance of the last-mile intervention to be able to provide patients with treatment,” Tetiana recalls.

Despite the dire situation in the country, everybody proceeded with their work remotely to the extent possible. Doctors could have consultations from their homes and drivers found the best possible itineraries and delivered medicines in time, even to barely accessible locations. Because of the successful, widespread scale-up of last-mile activities before the war, stock surpluses at service delivery points helped ensure patient treatment was not interrupted.

“During the year of the full-scale invasion, it was still possible to deliver medicines for HIV and TB to reach patients who need them, even in regions where active hostilities were conducted, and in some places are ongoing,” comments Lyudmila Pavlyuk, head of the department of pharmaceutical management and inventory management of CPH. “This was an extremely difficult task, but the problem needed a solution. The interruption of treatment [due to the war] would not only nullify all the gains of the previous years, but also directly threaten the lives and health of patients.” Despite the ongoing hostilities, Ukraine has maintained deliveries throughout the entire country–including to front-line border regions–thanks to the close coordination, innovation, and unwavering resilience of its many partners committed to getting lifesaving medicines to the last mile.