MEASURE Evaluation in Ukraine

With an estimated adult HIV prevalence rate of 1.1 percent, the eastern European nation of Ukraine has a generalized epidemic. And with new infections on the rise – annual diagnoses have more than doubled in the past decade – the HIV/AIDS epidemic is growing. Ukraine’s first case of the virus was reported in 1987, and in the mid-1990s new infections among injecting drug users in the southern and eastern regions rose dramatically. These regions continue to be the most affected by the virus, but other parts of the country, especially urban areas, have seen heightened prevalence rates as well.

Tuberculosis infection rates are also accelerating in Ukraine. According to the World Health Organization, 132 of every 100,000 people in the country has the disease.

Each year about 40,000 cases of tuberculosis are registered in the country and 7,500 people die of the disease, making Ukraine the second highest priority country in Europe for tuberculosis control. Sixteen percent of newly detected tuberculosis cases and 44 percent of previously treated cases are multi-drug resistant, raising the number of new multi-drug resistant tuberculosis (MDR-TB) patients in need of treatment every year to almost 8,000.  

The relationship between tuberculosis and AIDS makes combating the two diseases even more urgent. With tuberculosis being the most common cause of death among people with AIDS, the number of deaths from tuberculosis is expected to grow as the HIV infection rate increases in Ukraine. In turn, because about 40 percent of AIDS deaths are associated with tuberculosis, the tuberculosis burden can significantly affect the level of AIDS mortality.

Technical Assistance for HIV/AIDS Programs

In response to Ukraine’s growing HIV/AIDS epidemic, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) began supporting HIV/AIDS prevention, treatment and care programs in 2007. Assessing the effectiveness of these programs requires a strong monitoring and evaluation (M&E) system, which requires good data. To ensure that HIV/AIDS programs are reporting accurate and high quality data to USAID and PEPFAR, MEASURE Evaluation began conducting data quality audits (DQAs) in Ukraine.

MEASURE Evaluation completed DQAs on four USAID projects:

• Futures Group International’s HIV/AIDS Service Capacity Project
• PATH’s Ukraine Tuberculosis Control Partnership Project 
• Alliance-Ukraine’s SUNRISE Project 
• Peace Corps’ HIV/AIDS Prevention Project.  

The Data Quality Audit Tool was used to verify the quality of reported data and to assess each program’s underlying data management and reporting systems.

“The overall findings were that the quality of data being reported by these programs is very good,” said Silvia Alayon, who served as MEASURE Evaluation’s Country Focal Person for Ukraine.

MEASURE Evaluation also provides ongoing technical assistance to PEPFAR implementing partners and sub-grantees in Ukraine by strengthening their M&E capacity and providing training and tools to ensure that data reported to PEPFAR are of high quality.

Evaluating Impact of Tuberculosis Programs

USAID began supporting tuberculosis prevention and care efforts in 2001 to expand international care standards and improve the quality of tuberculosis care in both the civil and penitentiary health systems throughout Ukraine. In 2012, USAID/Ukraine started work on the Strengthening Tuberculosis Control in Ukraine (STbCU) project with the goal of decreasing the tuberculosis burden, thus helping to reduce the rates of incidence and deaths from the disease.

MEASURE Evaluation is working with the StbCU project, the government of Ukraine, and other stakeholders involved in tuberculosis control, to conduct an impact evaluation. The evaluation helps determine if current strategies and interventions affect key tuberculosis outcomes. Specifically, the evaluation proposes to measure:

• the impact of patient social support on tuberculosis treatment adherence, particularly for high-risk patients
• the effect of treatment adherence on treatment success and failure rates
• the effect of improved collaboration and cross-training among tuberculosis and HIV healthcare workers on tuberculosis testing and referrals for HIV patients and HIV testing and referrals for tuberculosis patients
• the effect of improved early case detection on early initiation anti-retroviral therapy among tuberculosis patients with newly diagnosed HIV and early initiation of tuberculosis treatment among HIV patients with newly diagnosed tuberculosis

“While the Ukraine has made important progress in moving toward internationally recommended approaches that will ultimately reduce tuberculosis-related morbidity and mortality, there remains significant work to implement effective and strategic actions to improve the quality of tuberculosis services,” said Stephanie Mullen, the lead for this activity.