PEPFAR Has Been a Lifeline in Ukraine. Now It’s under Threat

In Ukraine, a little bit of good news can go a long way, and the lifesaving work being done as a result of the President’s Emergency Plan for AIDS Relief (PEPFAR) has been a rare but reliable source of good news. That’s why the U.S. Congress’ delay in reauthorizing this program has been so difficult to hear about.

Much has been written about the impact of PEPFAR since its inception in 2003. All over the world, millions of lives have been saved through HIV testing and treatment made possible by this landmark legislation, which has enjoyed decades of near-unanimous support in the U.S. Congress. Unfortunately, a small group of lawmakers are threatening to derail the program’s routine renewal based on the repeatedly debunked falsehood that PEPFAR funds abortion services.

We have seen the impact of this important program here in Ukraine, where we have one of the highest HIV prevalence rates in Eastern Europe and Central Asia. In 2004, when the epidemic was described as “exploding” here, UNAIDS reported, “Currently, just over 500 of the estimated 45,000 people who need antiretroviral treatment in Ukraine are receiving it.” Since 2007, more than $300 million in PEPFAR funding has enabled Ukraine to enhance our public supply chain and strengthen the overall health system to ensure that we can procure and distribute medical supplies effectively, among many other accomplishments. This means that Ukrainian patients receive the critical treatment they need and that we were better equipped to handle a global pandemic and a war.

For years our organization, Management Sciences for Health (MSH), has led the U.S. Agency for International Development’s (USAID) Safe, Affordable, and Effective Medicines (SAFEMed) for Ukrainians Activity. The program supports the government of Ukraine in its ongoing efforts to reform its health care system and expand access to affordable and reliable medicines. With PEPFAR and other funding sources, SAFEMed provides technical and legal assistance to strengthen Ukraine’s pharmaceutical sector.

We have worked in partnership with Ukraine’s Ministry of Health and Center for Public Health as they addressed unpredictable and insufficient medicine stock levels to prevent interruptions in treatment. This included piloting a program that engaged a private company for last-mile distribution of HIV medicines, streamlining fragmented public-sector logistic services, and strengthening the nation’s supply chains. The pilot’s success led to its rapid scale-up, and by the start of 2022, this model was being used to cover deliveries across more than 60% of the country. As a result, 62% of the more than 200,000 people living with HIV across Ukraine were on antiretroviral therapy (ART), and more than 18,000 newly registered tuberculosis patients received daily treatment and ongoing monitoring.

Russia’s invasion in February 2022 threatened to jeopardize all of this progress. However, thanks to locally led efforts supported by PEPFAR, the country quickly adapted its national pharmaceutical distribution program and ensured that the overwhelming majority of Ukrainian patients would still get their lifesaving therapy despite a full-scale invasion. PEPFAR stepped in quickly during the opening months of the conflict to ensure that Ukrainians will continue to get antiretrovirals through 2024.

These accomplishments are important not just to people living with HIV and AIDS. The infrastructure built with PEPFAR funding has helped Ukraine deal with both the COVID-19 pandemic and the humanitarian crisis resulting from the war. With the public-private sector partnership that was already in place to move supplies, the Ukrainian government adapted this partnership to respond quickly to the need for COVID-19 vaccines and the medicines, equipment, and supplies critical to supporting a population at war. Due in part to supply chain improvements made with PEPFAR funding to move HIV medicines, SAFEMed supported the Ukrainian government in distributing nearly 5 million COVID-19 tests and doses of COVID-19 vaccines. Ukraine is not alone in this. A recent report showed that in sub-Saharan Africa, countries with PEPFAR funding for surveillance, laboratories, and health care workers were able to pivot quickly to COVID-19 diagnosis and care. These countries reported nearly three times the COVID-19 test results than non-PEPFAR countries.

Here in Ukraine, after the invasion, we assisted with moving more than $500 million worth of humanitarian medical aid across the country. The 12,800 tons of goods delivered included surgical instruments, trauma kits, medicines, and other equipment to 4,544 health facilities.

SAFEMed has also been working with the Ukrainian government on an e-tool to track the need for ART, the recommended treatment for people living with HIV and AIDS. This process is ongoing and will ultimately be linked to patient data, which will allow for better tracking of people who may have moved or fled conflict. This technology will allow for stronger epidemiological surveillance, which is necessary to not only better serving people living with HIV and TB but also better prepare the country for infectious disease outbreaks like COVID-19.

While PEPFAR funding has saved the lives of thousands of people living with HIV and AIDS in Ukraine, the full measure of its success is incalculable when you consider how the program has allowed our health system to withstand first a pandemic and then the full-scale invasion of our country. This resiliency will put the country on stronger footing to rebuild our infrastructure after the war ends, and more importantly, ensure that more people can continue to receive life saving medical treatment while we progress toward ending the AIDS epidemic.

In Ukraine, as in many other countries, PEPFAR has helped countless families and communities weather some of the most daunting health challenges and build a better future. We urge Congress to reauthorize PEPFAR without delay and provide some much-needed good news to the people of Ukraine and the millions around the world whose lives have been saved by PEPFAR.

---

Sergey Strashuk is a medical supply chain expert and deputy chief of party for SAFEMed, a USAID-funded project implemented by global health nonprofit Management Sciences for Health that supports the government of Ukraine to reform its health care system and expand access to affordable and reliable medicines. Vira Horovenko is a senior technical adviser for supply chain with SAFEMed.