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Overview

Data use for planning, implementation and evaluation of prevention, care and treatment programs for PWID in Ukraine Pavlo Smyrnov International HIV/AIDS Alliance in Ukraine. Overview. Background on HIV epidemic in Ukraine Data  Action examples Peer-driven intervention (PDI)

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Overview

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  1. Data use for planning, implementation and evaluation of prevention, care and treatment programs for PWID in Ukraine PavloSmyrnov International HIV/AIDS Alliance in Ukraine

  2. Overview • Background on HIV epidemic in Ukraine • Data  Action examples • Peer-driven intervention (PDI) • Risk network PDI, Outreach testing • Medication-assisted therapy (MAT) • Community-initiated treatment intervention (CITI) • Integrated care • Conclusion

  3. HIV epidemic among PWID in Ukraine • Estimated # of PWID in Ukraine is 310,000 • Main injectable drug of abuse – home-made acetylated poppy straw extract (opioid) • Home-made methamphetamine-type drugs are also prevalent • HIV epidemic started in 1995 among PWID in southern and eastern regions Kyiv Dnipropetrovsk Donetsk Lviv Odesa Mykolaiv AR Crimea

  4. New cases according toAEM and Spectrum models

  5. Data: Integrated Bio-Behavioral Surveys (IBBS) and Program data Comparison of IBBS and syringe exchange programs (SEP) data showed that not all PWID have equal access to services • Only 20% clients of syringe exchange programs (SEP) were women • Only 30% were teenagers and youth < 25 y.o • Only 1.5% were stimulant users

  6. Action: Peer Driven Intervention (PDI) • Outreach model for reaching and educating PWID from hidden subpopulations using existing peer networks • Recruiting coupons are used to invite peers for intervention • IDUs are taught to share knowledge and can earn rewards for educating peers with bonuses for recruiting young IDUs and women-IDUs • Results • Starting from 2007 ~30 000 new PWID were reached; coverage increased up to 10 times at some sites • For most of the clients this was the first contact with harm reduction services • Worked best with young PWID

  7. Data: Program testing results on all PWID clients in 2011-2013 Testing data show low yield of HIV+ in PWID clients % positive at first test is 4.6% (Overall prevalence is 18.6%) Also: Preliminary data from TRIP project in Odesa suggest that in high prevalence settings up to 40% of high risk partners of HIV positive people are also HIV positive and might not be aware about their HIV status.

  8. Action 1: Outreach testing • In the situation of radical decrease of the unit cost the scope and attractiveness of services will also decrease and may negatively affect number of people who approach services including testing. To deal with this we prioritize outreach by social worker. • We also propose that social workers will carry rapid tests in outreach routes and assist client in testing. This will greatly increase screening capacity (HIV detection sensitivity) of the projects as tests will be provided at time and location convenient to a client. • In previous period the testing was limited to time schedule and physical location of doctor and nurse, many doctors were only working between 3 and 6 PM and only at NGO office location, which greatly limited accessibility of HIV testing.

  9. Action 2: Risk Network PDI (RNPDI) • Active recruitment of HIV positive and their risk networks. In addition to usual post-test counseling routine and referral social/outreach worker will distribute coupons and invite to take part in a survey for a small reward. • Provide coupons to other positive clients and also for some negative at higher risk. The coupon distribution will stop once we have no more positive participants. • This will allow actively recruit immediate risk network members of the HIV positive clients, increase screening yield and focus prevention efforts on most at risk for acquiring HIV or most likely transmitting HIV to their partners. • This approach may increase finding of HIV cases from 4,6% up to 10% of all tested in high prevalence setting (based on data from Odesa pilot). This approach should have maximum effect in high and medium priority regions and may help to identify majority of HIV cases among high risk groups.

  10. Data: MAT effectiveness studies Schaub M, Chtenguelov V, Subata E, Weiler G, Uchtenhagen A (2010) Feasibility of buprenorphine and methadone maintenance programmes among users of home made opioids in Ukraine. Int J Drug Policy 21: 229-233.

  11. Action: MAT scale-up in Ukraine Crimea annexation Estimated # of injecting opioid users is ~250,000 MAT covers about 3.4% of them

  12. Data: HIV care and treatment program PWID have disproportionately low access to treatment and care *no ART retention data on PWID

  13. Action: Community initiated treatment intervention (CITI) • Short term rapid linkage to treatment intervention which facilitates early treatment access for active drug users. • locate HIV positive clients in harm reduction and link them to HIV treatment using a case management approach. • support HIV positive clients up to 6 months into ART (if no support provided through other projects - care and support, ST, integrated services) • refer to care and support projects or other available resources for long term treatment support. CITI is mostly focused on linkage to ART with build-in short term adherence support.

  14. CITI preliminary data During first 3 months of CITI implementation in 2014: • 884 clients were involved • 429 clients registered in AIDS clinics • 380 clients started ART • 30 clients started MAT

  15. Conclusion:Prevention effectiveness • All data sources confirm inverse correlation between increasing coverage of prevention programs and number of new cases among PWID; • RNPDI, rapid testing in outreach settings, CITI, and other approaches aimed at increasing the service coverage, improving PWID retention in services, and their access to care are key to the success of prevention program in Ukraine • The effectiveness of prevention programs among PWID in reducing HIV incidence could be easily undermined in case of decreasing coverage or limiting the service package for PWID, which are inevitable in case of the anticipated decline in funding of services for PWID in Ukraine

  16. Thank you for attention!

  17. Data: MAT retention study Positive TB test is increasing dropout from MAT programs due to legislative requirement for inpatient treatment of active TB cases

  18. Action: Integrated Care • 6 sites working in TB dispensaries • 2 sites in narcological clinics pilot TB-DOTS • 1 site in narcological clinics provides ART • Implementation guidelines developed Narco TB STI HIV Public Health Tertiary Secondary • Challenges: • Rigid vertical health care structure • No financial incentives for providers • Restrictive legislature Primary

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