Geographic variability in HIV and injection drug use in Ukraine: Implications for integration and expansion of drug treatment and HIV care

Abstract

Background Ukraine has the highest HIV burden of any European country with much of the current HIV epidemic concentrated among people who inject drugs (PWIDs) and their sexual partners. Opiate substitution therapy (OST) is limited in Ukraine and expansion of OST is urgently needed to help stem the tide of the HIV epidemic. Methods We accessed publicly available data in Ukraine in order to explore geographic variability with respect to prevalence of HIV, PWIDs and OST programmes. Results The regions of Ukraine with the largest number of opioid dependent persons (the south and eastern portions of the country) correspond to the regions with the highest HIV prevalence and HIV incidence. The number of opioid PWIDs per 100,000 population as well as the number of all OST treatment slots per 100,000 varied significantly across the three HIV prevalence categories. Overall, the proportion of individuals receiving either methadone maintenance therapy (MMT) or buprenorphine maintenance therapy (BMT) was quite low: average across categories: 7.3% and 0.4%, respectively. Additionally, less than half of OST patients receiving MMT or BMT were HIV positive patients. Conclusion There is significant geographic variability in both numbers of HIV positive individuals and numbers of PWIDs across Ukraine, however, there may be a more concentrated epidemic among PWIDs in many regions of the country. Scale up of addiction treatment for PWID, especially OST, can have a significant impact on preventing injection related morbidity, such as HIV and HCV infection. Ukraine can learn from the mistakes other nations have made in denying critical treatment opportunities to PWID.

Challenges to implementing opioid substitution therapy in Ukrainian prisons: Personnel attitudes toward addiction, treatment, and people with HIV/AIDS

“…To define the country’s regions, we employ the standard four-region approach (Arel, 1995; Kubicek, 2000; Zaller et al, 2014) that divides the country into west, east, north/center, and south. Ukraine first introduced OST with buprenorphine in 2004 (Bruce et al, 2007), followed by methadone’s introduction in 2007 (Lawrinson et al, 2008), which has since become the primary OST due to cost.…”

“…Ukraine first introduced OST with buprenorphine in 2004 (Bruce et al, 2007), followed by methadone’s introduction in 2007 (Lawrinson et al, 2008), which has since become the primary OST due to cost. Although OST reduces HIV risk behaviors (Altice et al, 2006; Metzger et al, 1993), increases ART access (Altice et al, 2011; Lucas et al, 2010; Uhlmann et al, 2010) and improves retention in HIV care and HIV treatment outcomes (Altice et al, 2011; Palepu et al, 2006), OST coverage in Ukraine remains inadequate, with only 2.6% of the estimated 310,000 PWIDs receiving treatment (Degenhardt et al, 2013; WHO, 2013; Zaller et al, 2014). …”

“…Community-based OST (first with buprenorphine and then with methadone) has been available in Ukraine for more than a decade. Expansion of OST, however, has been limited among the estimated 310,000 PWIDs and appears to differ regionally (Zaller et al, 2014). Efforts to improve entry and retention in OST have been thwarted by negative attitudes toward PWIDs, lack of knowledge about HIV and addiction treatment, and absence of integrated care (Degenhardt et al, 2013; Wolfe et al, 2010; Zaller et al, 2014).…”

“…Expansion of OST, however, has been limited among the estimated 310,000 PWIDs and appears to differ regionally (Zaller et al, 2014). Efforts to improve entry and retention in OST have been thwarted by negative attitudes toward PWIDs, lack of knowledge about HIV and addiction treatment, and absence of integrated care (Degenhardt et al, 2013; Wolfe et al, 2010; Zaller et al, 2014). Furthermore, despite 2011 legislation allowing it, OST has not yet been introduced into the Ukrainian criminal justice system (CJS) despite evidence of its benefit to reduce the negative consequences of drug injection within prison (Larney et al, 2012), and to improve transitional care post-release (Kinlock et al, 2009; Springer et al, 2012).…”

A Phylogenetic Analysis of Human Immunodeficiency Virus Type 1 Sequences in Kiev: Findings Among Key Populations

“…Our data are unlikely to be representative of the whole of Ukraine. Transmission patterns may vary in other areas of the country as there is considerable variability in HIV prevalence and population size of different risk groups (35). Differences between sequenced and un-sequenced data is a potential source of bias.…”