On the eve of the World AIDS Day, on November 30th researchers met in Kyiv with heads of Ukrainian city and region Departments of Health to discuss urgent public health issues and possible routs of scaling up opioid agonist therapy (OAT) in Ukraine. The meeting was organised by the Ukrainian Institute on Public Health Policy, Public Health Centre (MoH), and the Yale School of Medicine.
In Ukraine injecting drug use now account for more than half of all HIV transmission cases. International medical community presently views OAT as the most effective means of treating opioid related disorders which not only serves to fully re-integrate the drug abuse patients back into society but also significantly thwarts the development of socially hazardous disease (e.g., HIV infection, viral hepatitis, TB, and so on) among the general population.
Is the public in Ukraine ready to entirely rid itself of the existing attitude towards drug abuse as a behavioural disorder, an idea stemming from its Soviet past and look at it as a disease which could be effectively treated? Are the public health professionals at all levels including medical nurses and top decision makers ready to contribute to the development of a new system of treating substance disorders and make a significant contribution to combatting the spread of HIV in Ukraine?
These questions were discussed on the on the eve of the World AIDS Day which is marked annually on December 1st during the National Meeting “Problems of Public Health and the HIV Epidemic in Ukraine”. Leading professionals representing state agencies, public health organisations, and civil society associations which are engaged in supporting studies in the field of combatting socially hazardous diseases met with heads of city and region Departments of Health to discuss this most urgent subject matter specific to Ukraine in relation to fighting HIV.
Results of scientific studies supporting the efficiency of opioid agonist therapy and up to date statistics on OAT coverage in Ukraine were presented by professor Sergii Dvoriak (UIPHP), Ezra Barzilay (Centres for Disease Control and Prevention Office in Ukraine), Zahedul Islam (Public Health Alliance), professor Frederic Altice (Yale School of Medicine, USA), doctor Olga Morozova (Yale School of Public Health, USA) and Taras Grytsenko (Public Health Centre, MoH of Ukraine).
Domestic and international experts emphasise that OAT is an internationally recognised method of treating substance disorders which among other things aims to prevent HIV infection among vulnerable populations. Currently Ukraine has approximately 200 clinics with operating OAT sites which deliver services to almost 11,000 patients; out of this number 41% are HIV positive out of which around 85% are taking ART. OAT is provided with Methadone and Buprenorphine.
However, taking into account the menacing scale of HIV epidemic in Ukraine the current coverage of injecting drug users with substitution therapy is at the moment insufficient. Scale up of OAT services in Ukraine is significantly hindered by the public’s prejudicial attitude towards this type of treatment also primary care doctors lack practical skills in providing services to patients with substance abuse issues.
Professor Frederic Altice of the Yale School of Medicine believes that Ukraine should adopt advanced medical practices and places his hopes on the current medical reform: “Years back we together with our Ukrainian colleagues worked on launching OAT at specialised health care facilities in Ukraine such as Narcological Dispensaries and AIDS Centres. The current health care reform underway in Ukraine allows to scale up this network of health care facilities which offer OAT services: now the patients could access treatment at Primary Care Clinics. So far we have been successful in introducing a training programme for family doctors and GPs on how to manage patients with substance disorders. At the health care facilities under the umbrella of the pilot project on OAT service delivery we notice positive changes in doctor-patient relations as well as in the patients’ health".
The event organisers note that despite a number of achievement in introducing OAT at primary care level the researchers and drug abuse specialists cannot always find support among the decision makers managing the health care field at the city and region level. They hope that today’s meeting between the academics and heads of Departments of Health will have a positive impact on scaling up regional integrated care programmes for people who use drugs which in turn will improve the quality of life of the patients and their families as well as the population as a whole.
Frederic Altice. The Public Health Burden of Addiction Impact on Ukraine (UA)
Taras Grytsenko. Development of OAT Programmes in Relation to Strengthening Public Health Care System (UA)