Aim: To evaluate the effectiveness of an HIV peer training program conducted in a colony for drug dependent male prisoners in Siberia, Russia.
Method:Questionnaires were used to collect data pre and post peer training sessions. Three peer training sessions were conducted between questionnaires. Fifteen to twenty inmates were trained as peer educators at each week-long health education training session.
Access to hepatitis C virus (HCV) testing and treatment is limited in Myanmar. We assessed an integrated HIV and viral hepatitis testing and HCV treatment strategy. Sofosbuvir/velpatasvir (SOF/VEL) ± weight‐based ribavirin for 12 weeks was provided at three treatment sites in Myanmar and sustained virologic response (SVR) assessed at 12 weeks after treatment. Participants co‐infected with HBV were treated concurrently with tenofovir. Cost estimates in 2018 USD were made at Yangon and Mandalay using standard micro‐costing methods.
803 participants initiated SOF/VEL; 4.8% were lost to follow‐up. SVR was achieved in 680/803 (84.6%) by intention‐to‐treat analysis. SVR amongst people who inject drugs (PWID) was 79.7% (381/497), but 92.5% among PWID on opioid substitution therapy (OST) (74/80), and 97.4% among non‐PWID (298/306). Utilizing data from 492 participants, of whom 93% achieved SVR, the estimated average cost of treatment per patient initiated was $1030 (of which 54% were medication costs), with a production cost per successful outcome (SVR) of $1109 and real‐world estimate of $1250. High SVR rates were achieved for non‐PWID and PWID on OST. However, the estimated average cost of the intervention (under the assumption of no genotype testing and reduced real‐world effectiveness) of $1250/patient is unaffordable for a national elimination strategy. Reductions in the cost of antivirals and linkage to social and behavioural health services including substance use disorder treatment to increase retention and adherence to treatment are critical to HCV elimination in this population.
Russia has experienced a large increase in injecting drug use since the col/apse of the Soviet Union. Injecting drug use is presently attributed with up to 90 perccent of newly acquired HIV. Peer educators of an outreach program conducted a survey of injecting drug users (IDUs) in Moscow. The survey was supplemented by qualitative field notes. Due to differences in settings and methods, the hospital and street survey resufts are presented separately. A total of 298 hospital and 126 street surveys were collected. Resufts showed that IDUs are young (average 20 years), and the majority were studying or working.Needles were rated as easy to get, although police pressure often deters carrying a syringe. Sharing needles was common; IDUs that used only heroin were significantly less likely to share (RR 0.38 to 0.56). IDUs that had spoken to a peer educator were also less likely to share (RR 0.55). Heroin users had lower rates of hepatitis. Self-assessed HIV risk was unclear for many IDUs. HIV prevalence was 3 percent.
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