Support from the Global Fund has been instrumental in increasing the availability of harm reduction services and supplies, such as clean needles and syringes. However, harm reduction organizations in the region are confronting an influx of poor quality supplies that threatens the success of their programs. Improving the quality of supplies is an important step toward an effective and sustainable HIV response. This report, by the Open Society Institute’s Public Health Program, evaluates Global Fund grants and procurement practices in Armenia, Georgia, Russia, and Tajikistan. In each country, needles and syringes have been procured that drug users do not find usable because, for example, they may be the wrong size or type. NGOs also experience delays or interruptions in receiving supplies. This report highlights good procurement practices and provides recommendations for countries to improve the quality of harm reduction supplies and services.