Facilitator’s Guide Breaks New Ground in Ukraine

Posted on June 30, 2016May 2, 2023

Dr. Chris Behrens (center) and participants at a pilot training event in Uzhgorod.

In June 2016, the academic and professional communities involved in training family physicians and general practitioners in Ukraine received another valuable guide to a highly sensitive topic.

The International Training and Education Center for Health (I-TECH) in Ukraine, the Ukrainian Family Medicine Training Center (UFMTC) at the Bogomolets National Medical University (NMU), and the International Renaissance Foundation, all under the auspices of the Ministry of Health (MoH) of Ukraine, published “Use of Narcotic, Psychotropic Substances and their Precursors in the Practice of Family Medicine.” This facilitator’s guide (published in Ukrainian) was developed by Ukrainian and international experts in the fields of palliative care, controlled drug use, and pain management.

“The uniqueness of this publication is its extremely topical and, until recently, understated issue in Ukraine: provision of medical care with the use of controlled drugs, including opioid analgetics,” said Kateryna Amosova, Rector of the Bogomolets NMU.

The guide incorporates recent, groundbreaking updates in Ukrainian legislation. Resolution #333 of the Cabinet of Ministers of Ukraine and Order #494 of the MoH legitimize primary health care providers to prescribe and manage opioids for pain management in palliative care and opioid substitution therapy (OST).

“I-TECH Ukraine was honored to be able contribute to the development of the in-service training course that promotes most progressive principles of palliative care and OST provision for patients, including those with HIV, tuberculosis, and other HIV-associated diseases,” said Anna Shapoval, Country Representative for I-TECH Ukraine. “As always, we express our profound gratitude to the Ministry of Health of Ukraine, HRSA of the U.S. Department of Health and Human Services, CDC in Ukraine, and the International Renaissance Foundation for supporting this project.”

The goal of this training curriculum is to provide participants with the skills and knowledge required to form competencies in applying narcotic, psychotropic substances, and their precursors in the practice of family medicine, specifically in combination with treatment of drug addiction, tuberculosis, and hepatitis.

Participants work at the pilot training in Uzhgorod.

The guide is based on the results of three pilot training events that took place in October through December 2015 in Uzhgorod and Kyiv. Dr. Chris Behrens, Clinical Associate Professor in the University of Washington’s Department of Global Health, co-facilitated the first event in Uzhgorod. Dr. Behrens also co-authored the guide, along with leading experts from the Bogomolets NMU, the Ministry of Internal Affairs of Ukraine, the National Police of Ukraine, the State Service of Ukraine for the Drug Use Control, the Ivano-Frankivsk Oblast Clinical Center for Palliative Care, the Kyiv and Kryvyi Rih City AIDS Centers, and the International Renaissance Foundation.

The course covers such essential themes as:

The role of family physicians and primary health care facilities in using narcotic and psychotropic drugs and their precursors;
Legal and organizational principles of applying narcotic and psychotropic drugs and their precursors in primary health care practice in Ukraine;
Mental health; pre-conditions and types of opioid addiction; HIV/AIDS and other infectious diseases in IDUs; palliative and hospice care;
Principles and use of opioid maintenance therapy in primary health care, including the patients living with HIV/AIDS; and
Principles and use of narcotic and psychotropic drugs and their precursors in provision of palliative and hospice care, including patients living with HIV/AIDS.

The MoH of Ukraine recommends this guide as a tutorial for clinical interns and doctors enrolled in in-service or continuous medical education training programs, as well as for faculty of the Ukrainian medical universities and colleges that train doctors and nurses as general practitioners and family doctors. The guide has been already disseminated to about 60 medical universities and the largest medical colleges in Ukraine.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under U91HA06801, the International AIDS Education and Training Center (IAETC). The content of this post is the author’s and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

Ukraine Formally Adopts ClASS Methodology

Health Systems Strengthening Ukraine

Posted on February 25, 2016May 2, 2023

Anna Shapoval, Country Representative, and Iryna Yuryeva, Senior Training Developer, with the National ClASS Guidelines.

On January 26, the Ministry of Health (MOH) of Ukraine formally adopted the national guidelines on Clinical Assessment for Systems Strengthening (ClASS) and approved ClASS as a formally recommended national qualitative methodology/tool. The ClASS Guidelines were developed by a team of 10 experts from the International Training & Education Center for Health (I-TECH) and the Ukrainian Center for Socially Dangerous Diseases of the MOH of Ukraine (UCDC).

The ClASS methodology in Ukraine offers four key modules/tools: Clinical, VCT, Administrative, and Financial. Two additional modules that will help assessing HIV/TB integrated services and HIV labs are in the process of development with input from the national and international experts. They are expected to be formally approved later this year.

“This is a significant accomplishment and the product of a very small team who put tremendous efforts, time, and energy to develop national guidelines in the course of just few months,” says Anna Shapoval, Country Representative for I-TECH Ukraine. “We are extremely proud and humbled by the fact that our joint efforts of promoting ClASS in Ukraine in the past two years are sustained in the form of this publication.”

On February 2-3, I-TECH and UCDC conducted the national dissemination workshop in Kyiv. ClASS Guidelines were presented to the group of the national ClASS reviewers, representatives of the eight Oblast AIDS Centers (OACs) from the regions that participated in the assessment to date, as well as OACs from the three new regions interested in applying ClASS. Along with local partners, I-TECH and UCDC discussed potential benefits that participation in ClASS could offer, just some of which include:

A positive platform for mentorship and sharing experience with the national ClASS reviewers, most of whom represent various health facilities and work in various regions of Ukraine;
Sound, evidence-based assessment findings, which may be successfully used for development of the strategic and working action plans and for attracting additional financing from budget and off-budget sources, donors including additional technical assistance; and
Preparation for accreditation and compulsory certification.

The future plans in regard to ClASS promotion in Ukraine include assessments of additional regions, development of at least two additional modules, training of the second group of the national ClASS reviewers, and applying ClASS toward at least two OAC as part of their preparation for the accreditation or mandatory certification.

Following the workshop, over 100 copies of the publication were immediately sent out to the U.S. Centers for Disease Control and Prevention (CDC) office in Ukraine, other international agencies, the MOH, all Health Departments of all Oblast State Administrations, all Oblast AIDS centers, scientific medical libraries, libraries of the Ukrainian medical universities, and continuous medical education academies.

“These guidelines open new opportunities for applying ClASS methodology and tools in Ukraine in different contexts and, most importantly, upon request from specific health care facilities or regions,” says Ms. Shapoval. “This differentiates ClASS from other top-down evaluations or approaches.

“The level of enthusiasm about ClASS among our national and local partners is inspiring, and with the additional modules on labs and HIV/TB co-infection being finalized and plans to train and certify the new group of national reviewers, we hope I-TECH will continue expanding its work around ClASS in Ukraine in the coming years.”

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under U91HA06801, the International AIDS Education and Training Center (IAETC). The content of this post is the author’s and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

New HIV Training Guide Geared Toward Family Physicians in Ukraine

Health Systems Strengthening HIV and STI Prevention Human Resources for Health Ukraine

Posted on June 5, 2015May 2, 2023

Pilot Training Ukraine — Participants, experts, developers, and trainers of the pilot training event that took place in October 2014 at the UFMTC at NMU.

The International Training and Education Center for Health (I-TECH) Ukraine, in close partnership with the Ukrainian Family Medicine Training Center (UFMTC) at Bogomolets National Medical University (NMU), and under the auspices of the Ministry of Health (MoH) of Ukraine, has published a new facilitator guide, Modern Technologies for the Organization of Prevention of HIV/AIDS Transmission and Drug Use: The Role of Family Medicine Based Primary Health Care.

“This publication is a product of creative collaboration by a united team of experts in the areas of family medicine and HIV,” said Olga Vysotska, Director of the UFMTC at NMU. “It is a unique gift to the faculty of all departments at medical schools and colleges all over Ukraine that train medical doctors and nurses.”

The MoH of Ukraine recommends the guide as a tutorial for clinical interns and doctors enrolled in in-service or continuous medical education training programs, as well as for faculty of the Ukrainian medical universities and colleges that train medical doctors and nurses as general practitioners and family doctors.

The goal of the course is to provide participants with skills and knowledge in the early diagnosis, care, social adaptation, treatment, and early prophylaxis of HIV, specifically in combination with drug addiction, tuberculosis, and hepatitis, as well as to form the proper attitudes necessary for family physicians in Ukraine to provide effective services to HIV patients, and patients of at-risk groups.

The guide is based on the results of a pilot training event that took place in October 2014 at the UFMTC at NMU. Dr. Chris Behrens from I-TECH facilitated the event, along with nine leading national experts from NMU, the Ukrainian Center of Diseases Control (UCDC), the Ivano-Frankivsk Oblast Clinical Center for Palliative Care, and the Kiev City AIDS Center.

“It is the first of its kind in Ukraine; no such publications existed prior to this one,” said Dr. Vysotska. “In addition to their work on the most up-to-date clinical content, we really valued the methodological support provided by I-TECH during the training process and development of the guide, as well as the application of contemporary tools and approaches to adult education.”

The key areas covered by the course are:

HIV/AIDS epidemiology, both globally and in Ukraine, including the roles of primary health care and family medicine in responding to the HIV/AIDS epidemic
Pathophysiology, pathogenesis, and stages of HIV infection, including key diagnostic methods
Palliative care for HIV/AIDS patients by family doctors.
Antiretroviral therapy (ART)
Diagnosis and management of co-infection (HIV/TB/virus, hepatitis B and C) in family practice
HIV in pregnant women, including prevention of mother-to-child transmission
Management of patients with HIV and drug addiction, including opiate substitution therapy (OST)
Post-contact prophylaxis, including universal precautions (international and Ukrainian standards)

“The process of development of this product by a multicultural, multiprofessional team of experts was vibrant, mutually enriching, and very satisfying,” said Anna Shapoval, Country Representative for I-TECH Ukraine. “We are most grateful to the Ministry of Health of Ukraine, HRSA of the US Department of HHS and CDC in Ukraine for their support and guidance through this project and look forward to new initiatives of this kind together with our national partners.”

For more information about the guide, please visit: http://www.ex.ua/618786634523

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under U91HA06801, the International AIDS Education and Training Center (IAETC). The content of this post is the author’s and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

MOU Signed with the Ukrainian Centre for Socially Dangerous Disease Control

Health Information Systems Health Systems Strengthening HIV and STI Prevention HIV Care and Treatment Ukraine

Posted on March 13, 2015May 2, 2023

From L to R: Igor Kuzin, Head of the National M&E Center at UCDC; Dr. Natalia Nizova, Director of UCDC; Matt Heffron, I-TECH Informatics Implementation Specialist; Anna Shapoval, I-TECH Ukraine Country Director; and Mykhailo Rabinchuk, PR and Event Manager at UCDC.

On March 11, the University of Washington Department of Global Health (DGH) signed a Memorandum of Understanding (MOU) with the Ukrainian Centre for Socially Dangerous Disease Control of the Ministry of Health of Ukraine (UCDC).

This landmark event consolidated cooperation between the International Education and Training Center for Health (I-TECH) — a DGH center — and UCDC. This partnership started in 2013 with the launch of the I-TECH-developed Clinical Assessment for Systems Strengthening (ClASS) tool within a project to build clinical and managerial capacity of HIV/AIDS services in Ukraine.

All parties expressed confidence that this MOU would help foster relationships and the development of possible collaborative projects in capacity building, monitoring and evaluation, and research aimed at quality improvement of health care services in Ukraine.

“I-TECH is very excited about this new development in our collaboration with UCDC,” said Anna Shapoval, Country Director of I-TECH Ukraine. “The MOU will help to formalize, fortify, and, hopefully, expand our partnership with the UCDC in the coming year and beyond — in particular in the area of health systems strengthening through development of human resources for health and supporting strategic information systems.”

UW Physician Delivers Keynote at Groundbreaking Ukrainian Conference

Health Systems Strengthening HIV and STI Prevention Ukraine

Posted on October 24, 2014May 2, 2023

Dr. Joseph Merrill speaks at the Ukrainian National Conference.

Dr. Joseph Merrill (left) speaks through an interpreter at the Ukrainian National Conference.

On Sept. 25-26, Ukraine hosted “The Principles for the Management of Drugs, Psychotropic Substances and Its Precursors in General Practice Settings,” the first national conference of its kind. Initiated and organized by the International Renaissance Foundation (IRF) and other international and national stakeholders, including the International Training and Education Center for Health (I-TECH), the event brought together more than 300 experts, including general practitioners and family physicians, state officials, policy makers, infectious disease doctors, narcologists, psychiatrists, and palliative care providers.

The key goal of the conference was to educate primary health care providers on the application of controlled substances in key areas of their practice – such as medication assisted treatment (MAT), often referred to as opioid substitution therapy (OST); palliative care; and mental health – as well as initiate a dialogue about decentralization of these services through primary health centers (PHC) and coordination with specialized facilities and medical specialists.

Joseph Merrill, MD, MPH, an internal medicine physician and associate professor in the University of Washington’s Department of Medicine, delivered a keynote speech on OST in the practice of the family doctor. He also facilitated a day-long section on OST in partnership with local OST expert Vadim Klorfain, MD, from Poltava.

“Dr. Merrill’s contribution was greatly appreciated by the IRF and other conference organizers,” said Anna Shapoval, I-TECH Ukraine Project Director. “His successful participation in the conference seems to indicate a promising start to expanding I-TECH’s activities in this area in the future.”

Topics discussed included the basics of addiction and measuring success in addiction treatment; OST with methadone and buprenorphine; co-occurring medical and psychiatric conditions such as HIV infection, depression, tuberculosis, and viral hepatitis; and the advantages of integrating OST into the practice of family doctors.

Dr. Merrill says the last topic is particularly important to ensure increased access to care. “With the current siloed system, specialties have narrowly defined roles, which often has a negative impact on people with co-existing problems, such as HIV, mental health, and addiction,” says Dr. Merrill. “These individuals currently have to access multiple systems to get reasonable care.”

He also cites efforts to integrate HIV specialists into OST sites as a step in the right direction, as the HIV epidemic in Ukraine is driven in large part by injecting drug users and their sexual partners.

Dr. Merrill had the opportunity to visit an overburdened OST site at the City Clinical Hospital #5, next to the Kyiv City AIDS Center. “There were too many patients for the amount of staff, and there wasn’t any onsite counseling or psychosocial treatment when I was there,” he says. “We continue to have the same issues here in the U.S., where it is easier to implement medication than the treatment around the medication.”

To inform efforts to bring this care into family practice, Ukraine hopes to learn from the experiences we’ve had in the U.S., he says.

Recent health care reform, still under way in Ukraine, brought significant changes in legislation and regulations that now enable access to narcotic, psychotropic, and precursor substances at PHC facilities. The 2013-2020 National Drug Strategy of Ukraine envisions development of a humanistic model of drug policy, moving away from law-enforcement approaches to prevention and treatment, including broadening access to controlled substances – such as OST – to those patients in need.

“Ukraine is in a crisis situation, and that is both an obstacle to change and an opportunity for change,” says Dr. Merrill. “They are making a really strong effort to change their health care systems for the better, and they seem to really rally around each other and try to move forward in spite of the challenges they face.”

Ukrainian Medical University Delegation Visits I-TECH HQ

Health Systems Strengthening HIV and STI Prevention HIV Care and Treatment Human Resources for Health Nursing/HCW Cadres Quality Improvement Ukraine

Posted on July 8, 2014May 2, 2023

Ukraine_MOU_image

From L to R: Dr. King Holmes, Dr. Olga Vystoska, and Dr. Ann Downer present the signed MOU.

On June 12 and 13, representatives from Ukraine’s Bogomolets National Medical University (NMU) visited I-TECH HQ offices at Harborview Medical Center and the University of Washington (UW) Department of Family Medicine.

NMU is the leading medical school in Ukraine, with more than 150 years of history. This visit formally launched the partnership between NMU and the UW’s I-TECH, Department of Global Health, School of Nursing, School of Medicine, and Family Medicine Department. Steps toward partnership began this spring, with a Memorandum of Understanding (MOU) signed by all parties.

The visit started off with a two-hour planning meeting, during which Dr. King Holmes, chair of the UW Department of Global Health (DGH), gave an introduction to the department. This was followed by presentations by Olga Vystoska, Director of the Ukrainian Family Medicine Training Center at NMU, and other UW department representatives, who explored possible areas of collaboration. The meeting wrapped up with the exchange of signed originals of the MOU.

The Ukrainian delegation particularly appreciated the opportunity to meet I-TECH’s Executive Director, Dr. Ann Downer, and staff; learn about I-TECH’s activities; and tour the UW’s Family Medicine Clinic and Harborview Madison Clinic, which provides medical care and social services for persons living with HIV/AIDS. The group was especially impressed by a tour of the UW Institute for Simulation and Interprofessional Studies (ISIS) lab at Harborview, and Dr. Vystoska expressed interest in starting a similar lab at NMU.

The delegation also had a working meeting with Dr. Chris Behrens to discuss next steps in developing an HIV in-service training curriculum for family practitioners that I-TECH plans to pilot in Kyiv in October with Dr. Behrens’s co-facilitation.

The new Project Director of I-TECH Ukraine, Anna Shapoval, was a driving force behind this collaboration and visit.

“The I-TECH Ukraine team is excited to promote the HIV response and health care reform in Ukraine,” said Ms. Shapoval, who added that she was very pleased with how the meetings went. “We look forward to growing I-TECH’s presence in country, focusing on the most urgent issues of streamlining HIV into primary health care, advancing quality assurance and quality improvement models — as continuation of its unique experience with CLASS.”

Other potential areas of collaboration include joint research activities, publications, and library exchanges; the exchange of faculty members and students for study, teaching, and research; and joint hosting of distance education broadcasts and online courses and seminars.

Julie Stein, Technical Officer for Training Development on the I-TECH Ukraine team, expressed enthusiasm as well. “This visit was incredibly fruitful,” said Ms. Stein. “The meetings and tours generated a lot of excitement from everyone about possible future collaboration.”