Integrated HIV Care for Injection Drug Users in Ukraine
In September 2015, a group of family doctors and primary care clinic staff gathered in the southern Ukranian city of Kriviy Rih to attend a provider support group-sponsored training on integrated HIV care for injection drug users at the Center of Excellence Psychiatric Dispensary. Here in Kriviy Rih, a city with an injection drug user population twice the national rate, HIV patients normally attend these support groups as part of the integrated care program for injection drug users living with HIV, but today providers are the target audience. They hear from addiction treatment specialists, including Dr. Solonskyy, Director of the Center of Excellence’s Psychiatric Clinic, and Svitlana Osipova, Director of the NGO Public Health of Kriviy Rih, as well as AIDS specialists, public health professionals, and social workers on the importance of an integrated approach to HIV care. The providers participate in workshops, learn theoretical principles of diagnosis and treatment of opioid addiction and methadone substitution therapy, and discuss social support and case management.
Ukraine is one of the leading countries in Europe in new HIV infections. The country’s HIV epidemic is driven by needle sharing associated with injection drug use. With a lack of early interventions, blood-born diseases are rampant among the injection drug user population, including HIV, Hepatitis, and TB. The rate of HIV infection among injection drug users in Ukraine is extremely high, measured at 19.7% in 2013 by the Ukraine Harmonized AIDS Response Progress Report.
Effective drug treatment in the form of opiate substitution therapy is fundamental to the success of an integrated care approach for HIV patients in Ukraine. Since 2006, CHAI has supported opiate substitution therapy—the long-term use of methadone, a synthetic drug, as an opioid substitute to replace heroin—by first providing technical support for the registration of methadone as legal medicine in Ukraine and later by supporting opiate substitution therapy introduction on a national scale in 2008.
With CHAI’s support, the Center of Excellence Psychiatric Dispensary was launched in 2009 following a World Health Organization assessment of opiate substitution therapy in Ukraine recommending further integrated care for injection drug users, including training programs for providers, such as the one that occurred in September 2015. Comprehensive training for integrated care providers is critical to the success of patient treatment. Integrated care for HIV patients includes a coordinated set of methods and principles encompassing all aspects of treatment, service delivery, and clinical provision. This care seeks to connect, align, and collaborate within and between sectors, taking into account medical, social, and psychological concerns in order to create maximum system efficiency for patients with treatment cutting across multiple services, providers, and settings.
In 2012, the Kriviy Rih Center of Excellence Psychiatric Dispensary became the first fully-operational antiretroviral therapy site in Ukraine. Since then, 100% of opiate substitution therapy patients at the Center are informed of their HIV status and those who are HIV-positive are encouraged to initiate on antiretroviral treatment. In addition to clinical services, the site provides social support, case management, and peer education. For those who test negative for HIV, follow-up tests are performed every six months.
Kriviy Rih Center of Excellence Psychiatric Dispensary
Today, the Center of Excellence Psychiatric Dispensary is one of the largest opiate substitution therapy site in Ukraine, providing integrated HIV care services to over 300 patients including opiate substitution therapy, antiretroviral treatment, voluntary counseling and testing, rapid HIV testing, TB screening including x-ray examinations, and consultations with infectious disease specialists, as well as social support including social worker consultation, peer support groups, peer education groups, self-help groups, programs for drug-addicted pregnant women, and case management in partnership with local organization, Public Health of Kriviy Rih.
A nurse at a methodone treatment site, Kriviy Rih Psychiatryc Dispensary
In addition, CHAI currently supports the two opiate substitution therapy sites in Kriviy Rih that offer integrated care family clinics for HIV-positive injection drug users. Eduard, a patient at Center for Excellence, says, “methadone is a life buoy for me. My wife and I completely changed our lifestyle including starting antiretroviral therapy and getting healthy.”
As of March 2016, CHAI has supported the training of 45 doctors and nurses and 18 medical interns specializing in family medicine on providing comprehensive integrated care at the primary level, including extensive training in HIV diagnostics and treatment.
Moving forward, CHAI, in partnership with the Kriviy City Administration, plans to share the experience of The Center for Excellence to expand the integrated care provider network. Improved access to integrated treatment services will further destigmatize drug users and people living with HIV to create a more sustainable continuum of care for this vulnerable population in Ukraine.
CHAI Ukraine continues to seek partner support in 2017 to maintain and scale up this work.