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Overcoming double standard policies towards expansion of Opioid substitution treatment (OST) in Ukraine. Authors Oleksandr Lebega, MD* Schedule Islam* Sergey Filippovych, MD* Kostyantyn Talalayev, MD, PhD* *International HIV/AIDS Alliance in Ukraine. 1. www.aidsalliance.org.ua.

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  1. Overcoming double standard policies towards expansion of Opioid substitution treatment (OST) in Ukraine Authors Oleksandr Lebega, MD* Schedule Islam* Sergey Filippovych, MD* Kostyantyn Talalayev, MD, PhD* *International HIV/AIDS Alliance in Ukraine 1 www.aidsalliance.org.ua

  2. Appreciation for OST Partners • Ministry of Health of Ukraine & Ministry of Health of Crimea • State Service of Ukraine on HIV/AIDS and other socially dangerous diseases • Regional Healthcare Administrations • Healthcare institutions which provide OST • Ukrainian Institute on Public Health Policy • Ukrainian medical and monitoring center on alcohol and narcotics MOH of Ukraine. • Ukrainian Center for AIDS Prevention of the Ministry of Health of Ukraine • All-Ukrainian Network of PLWH • Clinton Foundation • State Stock Company “Liky Ukrajiny” • Open Society Institute • WHO Regional office for Europe • UNAIDS • UNODC • Other multiple Domestic and International organizations which are partnering towards development of OST in Ukraine 2 www.aidsalliance.org.ua

  3. Background • WHO estimates 53,000 IDUs need to be placed on OST to provide adequate response to HIV/AIDS epidemic in Ukraine. • There are 6979 OST patients in Ukraine. That means only 13% out of 53,000IDUs are placed on OST in Ukraine. Consequently adequate response to HIV/AIDS epidemic hasn’t been provided yet. • Ukrainian National 2009-2013 HIV/AIDS Prevention Program (NAPP) envisages 20,000 people on OST by the end of 2013. • Ministry of Health (MOH) is the sole executive body regulating number of OST patients. MOH determines exact numbers of OST patients in distribution orders. • OST targets set by MOH distribution orders are much lower than annual NAPP indicators and indicator of GFATM Rd 6 funded Program run by ICF “HIV/AIDS Alliance in Ukraine” (AU) for 2012 as it shown on Diagram #1. www.aidsalliance.org.ua

  4. Diagram #1 Programmatic indicators for OST scale up versus OST expansion targets envisaged by MOH distribution orders 4 www.aidsalliance.org.ua

  5. Methods. Current status of SMT provision. • 6979 patients were getting OST in 140 healthcare institutions in all regions on July 1, 2012. • All patients receive treatment along with psychological and social support for free within GFATM Rd 6 & Rd 10 funded Programs. • Though OST procurement is budgeted in NAPP OST medications have never been bought from state budget. • OST is regulated by MOH and other executive bodies in pretty clumsy manner. • It takes up to 7 months in MOH to issue new OST distribution order. • MOH approved new procedure on OST provision (Order #200 from March 3, 2012) which contradicts to some rules approved by another MOH regulatory act (Order #11 from 21.01.2010) • Cabinet of Ministers allowed importation of only 60% of methadone envisaged by MOH distribution order in 2011. • Importation of methadone needed for SMT continuity and scale up over 2012-2013 is delayed due to organizational problems. 5 www.aidsalliance.org.ua

  6. Results. • Ukrainian State demonstrates double standard policies towards scaling up of OST. • Ambitious OST NAPP targets were proclaimed but MOH and other governmental institutions applies inadequate efforts to achieve those targets. • Diagram#2 shows that OST expanded on 10% only over 2011 comparatively to 303% in 2008 and 131% in 2009. • 8754 patients are to receive OST according to the active MOH order, but there’re only 6979 OST patients in Ukraine now. So, there are 1775 “empty” OST slots. 6 www.aidsalliance.org.ua

  7. Diagram#2 OST scale up in Ukraine over 2005-2011 7 www.aidsalliance.org.ua

  8. Conclusions. • Together with OST Partners AU is trying to overcome double standard policies towards OST scale up. • Due to collaboration among AU, MOH, State Service of Ukraine on HIV/AIDS and other socially dangerous diseases, Ukrainian medical and monitoring center on alcohol and narcotics MOH of Ukraineand Ukrainian Center for AIDS Prevention SMT expansion on 1423 patients is planned for 2013. • AU and Ukrainian Center for AIDS Prevention have established partnership within GFATM Rd 10 supported program. This partnership is aimed to develop capacity of Ukrainian specialized governmental institutions for organizational and methodological support of OST provision, to ensure OST scale up and sustainability. • Following main strategic objectives for OST implementation in frames of GFATM Rd 10 supported program will be pursued over 2012-2013: • Further OST scale up in accordance with realistic OST demand • Handover of OST from AU to the comprehensive stewardship of Ukrainian specialized governmental institutions • Improvement of the quality of treatment, quality of social and psychological services provided, expansion of integrated services. 8 www.aidsalliance.org.ua

  9. Thank You SO MUCH For Your INTEREST and ATTENTION!!! 9 www.aidsalliance.org.ua

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