More than four and a half years have passed since Russia launched its full-scale invasion of Ukraine in February 2022. Since then, continuous shelling has damaged or destroyed 2,698 healthcare facilities across the country, leaving dozens of communities without health centres, medical staff or a reliable supply of medicines. Amid the wider emergency created by the war, Ukraine is working to prevent the collapse of care for two public health challenges that predated the invasion, HIV and tuberculosis.
In one community in the Kharkiv region, just a few kilometres from the Russian border, a doctor visited only once during the seven months following the liberation of the area. Electricity and food aid had returned, but medicines had not. “People have nowhere to turn,” a former local official lamented at the time.
Today, care travels directly to the patients. A network of Alliance for Public Health mobile clinics visits hundreds of frontline settlements across eight regions of Ukraine, where health centres have been destroyed, few medical professionals remain and reaching the nearest hospital requires travelling along roads that are damaged or exposed to attack. The vans carry rapid tests, portable X-ray equipment and laboratory supplies. The teams bring together professionals in family medicine and nursing, laboratory personnel and social workers, with TB specialists, gynaecologists or dentists joining depending on local needs.
Each route is coordinated with local authorities, community leaders and, when necessary, the military. Once a visit is confirmed, residents receive notice by phone, through social media or by word of mouth. The itinerary can change on the spot if shelling, drone activity or curfew restrictions prevent teams from continuing.
The first mobile units began operating in December 2022. By June 2026, they had reached more than 38,000 people across 599 communities in eight regions. What began as an emergency response has become one of the few points of access to healthcare for many people.
“Our mobile clinics deliver lifesaving care to frontline, hard-to-reach villages where medical services no longer exist. This is about survival, not just medicine,” says Anna Korobchuk, Head of the Mobile Health Programmes Department at Alliance for Public Health.
The war hit a country that already recorded one of the largest HIV epidemics in Eastern Europe alongside a high incidence of tuberculosis, including drug-resistant strains. Both conditions require continuous treatment. Maintaining it becomes far more difficult when pharmacies close, healthcare centres come under attack or patients are forced to flee without identification or medical records.
New HIV diagnoses recorded in Ukraine fell from 15,360 in 2021 to 8,024 in 2025. There is no certainty as to how much of this drop reflects a real decline in infections and how much is linked to the obstacles to testing and registering cases during the war. What is clear is who finds the cases that are detected: since 2022, Alliance for Public Health and its partners have identified 17,426 new HIV cases, representing 42% of all new diagnoses in the country.
Another key figure helps put this decrease in context. In 2024, nearly two out of three people newly diagnosed reached healthcare services only after HIV had already weakened their immune systems. In four out of ten cases, the deterioration was even more advanced. Alliance for Public Health points out that the proportion of late diagnoses has increased steadily since 2020.
Tuberculosis shows a similar pattern. A large share of new cases among internally displaced populations has been identified through direct screening in the street or in temporary shelters. To avoid losing track of patients, medications are sent by post to safer areas, longer supplies are provided in case of evacuation and clinical histories are stored on secure remote digital servers so they are not lost if a centre is destroyed.
In 2025, programmes run by Alliance for Public Health and its partners screened 75,000 highly vulnerable people. They identified 1,159 cases, and all patients started treatment. Among internally displaced people across Ukraine, 279 cases were detected, compared with just 13 recorded by these programmes in 2021. This increase reflects, at least in part, the expansion of screening within a hard-to-reach population. Cases identified by Alliance for Public Health represented 68% of all tuberculosis diagnoses confirmed among displaced people that year.
Diagnostic efforts have also had to move into the front lines. Mobile units have carried out radiological screenings on tens of thousands of soldiers in combat areas, where prolonged cold, damp trenches and overcrowded underground bunkers multiply respiratory infections. Detecting these cases early has allowed supervised treatments to begin before the disease undermines physical health or spreads among other soldiers.
Completing a treatment that lasts several months is extraordinarily difficult in such precarious conditions. Adherence is hard to maintain when someone has been forced from their home, has lost their papers while fleeing or lacks a regular income.
To keep people in care wherever they are, the Alliance has moved part of its work online. Its Help24 service has provided more than 210,000 telemedicine consultations, and its AI assistant TWIIN, available around the clock, has been used by more than 73,000 people. Between 2022 and 2025, the Alliance distributed more than 160,000 HIV self-tests, many of them delivered by post. Stable patients receiving opioid agonist therapy can take home up to 30 days of medication, so a move or an evacuation does not interrupt treatment.
Alliance for Public Health, which turns 26 on 1 December 2026, did not emerge with the war. Together with its network of partner organisations, it had spent more than two decades working with people living with HIV and tuberculosis and with other groups facing barriers to accessing healthcare. When the invasion began, the organisation drew on that experience to meet needs that went far beyond clinical care. Since February 2022, APH and its partners have supported more than 2.2 million people.
In Lviv, in the west of the country and far from the shelling at the front, APH ran Safe Space, a project geared towards women and children fleeing the war. It was coordinated by Viktoria Bobrinok, who was also displaced at the start of the conflict and set up a heated facility with play areas to ease the impact of evacuation. The project also supported people who often fall through the cracks of mainstream care, such as older people on their own or patients with chronic conditions who face stigma linked to their illness.
The Alliance created HelpNow in 2022 to help refugees maintain their treatment for HIV and tuberculosis or access opioid agonist therapy. Until 2024, its teams retrieved medical records, translated documents and located healthcare services in host countries. The work now continues through Fundacja HelpNow HUB in Poland.
According to one of its volunteers, requests regarding social issues were twice as common as those directly related to medical treatment. A call could begin with an inquiry about where to pick up antiretrovirals and continue with questions about temporary protection, housing or school enrolment for children. “You cannot separate all these problems,” she explains.
Maintaining this coverage is becoming increasingly complex. Work takes place under constant strain. Some APH teams require helmets and bulletproof vests to travel, staff and volunteers carry more than four years of exhaustion and some programmes rely on temporary funding. Since June 2026, APH’s mobile clinics have held a Ministry of Health licence for medical practice and record patient data in the national eHealth system. Mobile clinics cover urgent gaps, but they do not replace destroyed facilities or the medical staff who have left the most exposed areas.
Since the start of the invasion, the Global Fund has mobilised 275 million dollars. These funds allow the Ministry of Health and community organisations to secure antiretrovirals, diagnostic tests and operational costs such as fuel for mobile clinics or generators for laboratories. These allocations, backed by donors such as Spain, also finance local networks that coordinate with public authorities to track displaced patients so their treatments are not interrupted.
The Global Fund remains one of the largest donors supporting Ukraine’s HIV and tuberculosis response.
“Since the first day of the full-scale war, the Global Fund has responded quickly, and that shows what reliable funding makes possible: our teams keep working without a break. But every gap in funding has a human cost. For people on the front line, a delayed contribution means a missed test or an interrupted treatment,” says Inna Gavrylova of Alliance for Public Health.
Alliance for Public Health and other organisations working on the ground are demanding that donor countries disburse pledged funds in full and within planned timeframes. Purchasing medicines, hiring personnel and mapping clinic routes require advance planning. After more than four and a half years of war, sustaining care near the front lines depends on sufficient funding arriving on time.
