As part of the regional information and advocacy campaign EECA Voices at AIDS 2026, implemented by VirusOFF with support from the UNAIDS EECA and Asia-Pacific Office, we continue to look at the key messages emerging from AIDS 2026 through the lens of Eastern Europe and Central Asia.
This conversation focuses on Moldova’s experience in sustaining HIV prevention and care through national ownership, domestic financing and community trust. At a time when the global HIV response is facing changes in financing and growing pressure on prevention systems, Moldova offers an important example of how transition can become not only a financial process, but a health-system transformation.
We spoke with Lucia Pirtina, Director of the Infectious Disease Hospital and of the National HIV/Viral Hepatitis Programme in Moldova, about what sustainability means in practice, why prevention and community-based services must be protected, and how trust, integration and national responsibility can keep people connected to care.
In the context of the global discussions around AIDS 2026, what do you see as the most urgent priority for Moldova’s HIV and viral hepatitis response today?
The most urgent priority is to ensure that the progress Moldova has achieved over the past two decades becomes irreversible. We are entering a new phase of the national response, where sustainability is no longer defined by donor support but by the strength of our own health system.
Over the last several years, Moldova has made remarkable progress in increasing domestic ownership. Today, antiretroviral treatment and HIV testing are fully financed from public resources, and national investment in prevention services continues to expand. In 2025, nearly 68% of the national HIV response was financed from public domestic resources, reflecting our country’s increasing commitment to long-term sustainability.
However, sustainability is not simply about replacing external resources with domestic funding. It is about institutionalizing the entire response. This means integrating HIV and viral hepatitis services into the health system and ensuring that prevention, testing, treatment, laboratory services, community engagement, monitoring systems and procurement mechanisms are supported through strong national institutions and sustainable financing mechanisms.
Ultimately, our goal is both to sustain services and to ensure that every person, especially those from the most vulnerable populations, continues to receive timely, high-quality and people-centred care. That is how Moldova will move closer to ending AIDS and eliminating viral hepatitis as public health threats by 2030.
Moldova is working to sustain HIV prevention, testing, treatment and care through stronger national ownership. What does national ownership mean in practice — beyond policy language — for people who need services every day?
For people living with HIV or those who depend on prevention services, national ownership should never be an abstract policy concept. It should be experienced through uninterrupted access to quality services every single day. National ownership means that prevention programmes continue to reach communities, HIV testing remains easily accessible, treatment is consistently available, and care is delivered without interruption regardless of changes in external financing.
Achieving this requires much more than financial resources. It requires strong public institutions capable of planning, procuring, financing, delivering and continuously improving services. It also means close collaboration between the Ministry of Health, the National Health Insurance Company, healthcare providers, public health institutions and civil society organizations. This approach is at the core of Moldova’s National Programme on HIV, STIs and Viral Hepatitis for 2026–2030 and of the Transition and Sustainability Plan, which Moldova’s team developed to ensure systemic, comprehensive and structured national ownership.
Ultimately, national ownership is measured not by who finances the services, but by whether every person can access high-quality, people-centred care whenever they need it.
From your perspective as both Director of the Infectious Disease Hospital and Head of the National HIV/Viral Hepatitis Programme, where has Moldova made the strongest progress in ensuring continuity of HIV services?
I believe Moldova’s greatest achievement has been the gradual transition from a donor-supported HIV response to one that is increasingly embedded within national systems and financed through domestic resources.
One of the most significant milestones has been treatment sustainability. Today, 100% of antiretroviral treatment is financed through the state budget, ensuring uninterrupted access to life-saving medicines.
A second major achievement has been the institutionalization of HIV prevention services. Since 2018, the National Health Insurance Company has progressively contracted HIV prevention services delivered by civil society organizations through its Prevention Fund. What began as a pilot mechanism has evolved into a sustainable national model supported by quality standards, standardized service packages, costed interventions, strengthened procurement mechanisms and, more recently, multi-year contracting arrangements.
This progress is reflected in the overall financing of the national HIV response: in 2025, domestic public resources accounted for nearly 68% of total HIV expenditures, compared to 65% in 2024, while 34% of all programme expenditures were invested in prevention, demonstrating Moldova’s commitment not only to sustaining treatment but also to preventing new HIV infections.
A third important milestone has been the integration of innovation into routine health services. Since introducing PrEP in 2018, Moldova has progressively institutionalized this intervention. Today, oral PrEP medicines are procured from the state budget, community-based PrEP has become part of the national service model, and the country is preparing for the introduction of long-acting PrEP as the next step in strengthening HIV prevention.
Together, these achievements demonstrate that continuity of care is never the result of a single intervention. It is achieved through sustained investment in financing, governance, service delivery, laboratory capacity and strong partnerships with communities.
When HIV programmes face funding changes or transition processes, what are the biggest public health risks: interruptions in prevention, delayed testing, treatment adherence challenges, weakened referral pathways or loss of community trust?
These risks are closely interconnected. If I had to identify the greatest public health risk, I would say it is fragmentation of the continuum of care. When prevention, testing, treatment, community support and referral pathways are no longer well coordinated, people are more likely to be diagnosed late, discontinue treatment or be lost to follow-up. This affects not only individual health outcomes but also increases HIV transmission at the population level.
This is precisely why Moldova’s transition is focused not simply on replacing one source of financing with another. Our Transition and Sustainability Plan prioritizes the protection of prevention services, community-based testing, treatment adherence, laboratory systems, strategic information and community partnerships, ensuring that these essential components remain fully integrated as national ownership continues to grow.
What must be protected first to ensure that HIV services remain accessible, confidential, people-centred and trusted by people living with HIV and key populations?
If I had to identify one priority, it would be trust. People seek testing, initiate treatment, remain in care and use prevention services only when they know they will be treated with dignity, their confidentiality will be protected and their individual needs will be respected without stigma or discrimination. Trust is not built by medicines alone; it is built through respectful healthcare professionals, strong community partnerships, reliable referral pathways and services that are truly centred around people.
This is why, as Moldova strengthens the sustainability of its HIV response, protecting community-based services remains essential. Civil society organizations, peer counsellors and outreach workers are often the first, and sometimes the only, trusted point of contact for people who may otherwise never enter the healthcare system. Sustaining these partnerships alongside high-quality clinical services is fundamental to ensuring equitable access, continuity of care and long-term public confidence in the national HIV response.
One of the key messages in the global HIV discussion is that innovation alone is not enough if it does not reach people. In Moldova, what helps turn prevention tools — including PrEP, testing, harm reduction and differentiated service delivery — into real access?
Innovation has value only when it reaches the people who need it most. In Moldova, our approach has been to design services around people’s realities rather than expecting people to adapt to the health system.
Over the past years, HIV prevention has evolved far beyond traditional healthcare facilities. Today, services are delivered through community organizations, outreach teams, mobile interventions, prisons, community-based HIV testing and PrEP, HIV self-testing, and innovative approaches such as confidential access to prevention commodities through vending machines. These differentiated service delivery models reduce barriers created by stigma, geography and concerns about confidentiality.
Equally important, innovation is not limited to new technologies. It also means new ways of working. Communities actively participate in designing, evaluating and improving services, while digital solutions, including community-led monitoring, provide real-time evidence that supports better decision-making and accountability.
By combining community leadership, digital innovation and strong integration within the national health system, Moldova is transforming effective prevention tools into equitable access and measurable public health impact.
How can domestic financing strengthen the sustainability of Moldova’s HIV response while also protecting the elements that are often most vulnerable: prevention, outreach, peer support, community-led services and referral pathways?
Domestic financing strengthens sustainability when it goes beyond financing medicines and healthcare facilities: it must also protect the services that keep people connected to the health system. In Moldova, this has been a deliberate policy choice. Since 2018, the National Health Insurance Company has progressively contracted HIV prevention services delivered by civil society organizations, creating a sustainable mechanism to finance outreach, peer support and community-based prevention.
Today, prevention represents 34% of all HIV programme expenditures, demonstrating that preventing new HIV infections remains a strategic investment alongside treatment.
However, financing alone is not enough. Sustainability also depends on good governance, transparent financing mechanisms and shared accountability. Governments must honour their commitments, financing models must evolve as programme needs change, and civil society must remain an equal partner — not only in service delivery, but also in monitoring implementation, identifying service gaps and ensuring that programmes continue to respond to the needs of people living with HIV and key populations.
Community trust is central to this conversation. In Moldova, what builds trust between health services and people living with HIV, people who use drugs, sex workers, men who have sex with men, migrants and other key or vulnerable groups?
Trust is built when people consistently experience respect, confidentiality and high-quality care. Moldova implements programmes to improve that.
For people living with HIV and key populations, trust means knowing that they will not be judged because of who they are, that their personal information will remain confidential, and that they will receive timely, professional and people-centred services.
In Moldova, trust has been strengthened through long-term collaboration between healthcare institutions and community organizations. Peer counsellors and outreach workers often become the first trusted connection to the health system, helping people navigate services, remain in care and overcome barriers related to stigma and social exclusion.
Equally important, trust grows when communities are not only beneficiaries of services, but also active partners in shaping them. Through continuous dialogue, community-led monitoring and systematic feedback, we are building a health system that people trust: one that is committed and able to provide treatment, and equally prevention, testing and lifelong care.
What role should community-led organizations, peer counsellors and outreach workers play in Moldova’s national HIV response — not as an “additional” layer, but as part of the core system of access and continuity of care?
Community-led organizations are not an additional layer of Moldova’s HIV response; they are an integral part of the national system of prevention and continuity of care. Their role is no longer based solely on projects; it is increasingly supported by a strong national framework.
The HIV/STI/VH National Programme by 2030 places HIV prevention among its strategic priorities, while nationally approved prevention standards define the service packages, quality requirements and delivery models for key populations. These standards also provide the foundation for costing services and for contracting community-based organizations through the National Health Insurance Company, transforming community services into an institutionalized component of the health system rather than a temporary intervention.
At the same time, peer counsellors and outreach workers remain indispensable because they build trust, reach people who are often beyond the reach of traditional health services, support adherence and referrals, and provide continuous feedback through community-led monitoring.
Their greatest contribution extends beyond service delivery. They strengthen equity, improve quality, reinforce accountability and ensure that the voices of communities remain central to policy implementation. This partnership between healthcare institutions and communities is one of the strongest foundations of a resilient, people-centred and sustainable HIV response.
As Moldova continues to strengthen and integrate HIV and viral hepatitis responses, what opportunities does this create for earlier diagnosis, stronger linkage to care and more people-centred services?
Integration allows us to organize services around people rather than around diseases. Through the National Programme for HIV, STIs and Viral Hepatitis 2026–2030, Moldova is bringing together prevention, testing, treatment and long-term follow-up within a single strategic framework. This creates important opportunities for earlier diagnosis through integrated testing, stronger referral pathways between community and clinical services, and more coordinated care for people with HIV, viral hepatitis and other related health needs.
Integration also strengthens the resilience and efficiency of the health system. Shared laboratory infrastructure, coordinated procurement, integrated surveillance and monitoring systems, and harmonized community-based prevention services reduce duplication while improving access, quality and continuity of care.
Ultimately, integration means fewer missed opportunities for diagnosis, faster linkage to treatment, better retention in care and services that are simpler, more accessible and genuinely centred on people’s needs. It is not only a more efficient model; it is a better model of care.
What lessons from Moldova could be useful for other countries in Eastern Europe and Central Asia that are also trying to make HIV prevention and care more sustainable in a changing funding environment?
One of Moldova’s most important lessons is that sustainability should begin long before external funding starts to decline. Transition is not a financial adjustment; it is a long-term process of strengthening health systems, governance and national ownership. Countries need to build the legal, institutional and financing mechanisms that allow HIV services to become part of the national health system rather than remain donor-funded projects.
A second lesson is that prevention and community-based services should be institutionalized, not treated as optional. In Moldova, we have institutionalized these services by developing national prevention standards, defining standardized service packages, introducing cost-based financing mechanisms, progressively contracting community organizations through the National Health Insurance Company and strengthening community-led monitoring as part of programme governance.
Finally, sustainability is strongest when governments, communities and development partners work together with a shared vision and clear responsibilities. That partnership has been one of Moldova’s greatest strengths throughout its transition.
As the global HIV community discusses sustainability, domestic financing and the future of prevention, what message from Moldova should be heard more clearly at the regional and global levels?
Moldova’s experience demonstrates that the true measure of sustainability is not the gradual reduction of external funding; it is whether people continue to receive uninterrupted, high-quality services throughout that transition.
Domestic financing is essential, but it is only one part of the solution. Sustainable HIV programmes are built by investing in prevention, communities, public health institutions and resilient systems that guarantee continuity of care.
Our transition has shown that sustainability is achieved when access to HIV prevention, testing, treatment and care no longer depends on the source of funding, but is guaranteed by the strength of the health system.
This is the message Moldova hopes to share with the region and the global HIV community: the ultimate goal of transition is not simply financial sustainability; it is health-system sustainability. When governments, communities and development partners work together with a shared vision and shared responsibility, transition becomes an opportunity to build stronger, more equitable, more resilient and truly people-centred health systems.
