Implementation of the Substitution Maintenance Therapy in the framework of the Programme...

Implementation of the Substitution Maintenance

Therapy in the framework of the Programme “Overcoming

HIV/AIDS Epidemics in Ukraine”

Stakeholders meetingKyiv, 14 February 2006

Sergiy Dvoryak, MD, PhD

Ukrainian Institute on Public Health Policy

Previous projects’ outcomesFebruary-December 2005 (1)

• The Expert commission has been formed, which implemented assessment of legislative base and have produced recommendations on improvement.

• Order of the Ministry of Healthcare № 161 have been issued to allow organization of buprenorphine pilot projects with attached schedule of drug administration.

• A strategy for procurement, administration, transporting and distribution of the drug has been developed.

• A joint survey with the Ministry of Healthcare and WHO was conducted to assess the readiness of the regions for the SMT.

Український інститут досліджень політики щодо громадського здоровУкраїнський інститут досліджень політики щодо громадського здоров’’я я

Ukrainian Institute on Public Health PolicyUkrainian Institute on Public Health Policy


1. Development of the multidisciplinary team concept.2. Search of partners in the narcological institutions.3. Selection of models for SMT implementation:

narcological insitution based, AIDS Center based, municipal clinic based, or NGO Rehab Centers.

4. Staff training for the SMT projects. Development of the training programmes. Six trainings conducted, seven MDT formed.

5. Preparation and printing of the 3 manuals on SMT for doctors, social workers and counselors, and patients.

6. Translation and printing of the manual on cognitive behavioral therapy model for clients and staff.




1. Monitoring visits and evaluation of regional projects’ activities in Donetsk, Simferopol, Odesa, Mykolaiv, Dnipropetrivsk and Kyiv (18 visits)

2. Web-based resource center on SMT created, allowing to inform on current state of the projects and provide help to MDT in the regions

3. Monitoring and evaluation plan developed in cooperation with WHO.

4. Work underway on the development of SMT scale-up plan for Ukraine.



Ednok procurement

• Drug administration schedule outlined by the order of the Ministry of Healthcare

• Documents to support purchase of the drug as humanitarian aid prepared

• Respective licenses on procurement and sale acquired («Ліки України»)

• Procurement monitoring and control mechanism developed (“Соціотерапія”)

• Protocol for drug administration control in the narcological institutions developed

• Ednok distribution control forms developed



SMT Project in the framework of the Programme “Overcoming HIV/AIDS Epidemics in Ukraine“,

as at 01.26.2006

Kyiv (AIDS

Centre)

Kyiv (Sociotherapy)

Donetsk KhersonDnipropetr

ovskOdesa Simferopol Mykolaiv TOTAL

SMT commencement date

16.11.200510.10.20

057.10.2005 15.05.2005 07.11.2005 27.10.2005 14.10.2005 1.11.2005

Number of clients 18 31 30 22 23 23 27 23 197

male / female 15 / 3 21 / 10 27 / 6 16 / 6 20 / 3 21 / 2 20 / 7 18 / 5

Average age / average drug use experience

34/16,5 yr 28 / 9 yr 30 / 12 yr 32 / 8 yr 36/13 yr 32 /12,5 yr 37/17 yr 40/18 yr

HIV+ clients 18 16 20 8 12 23 27 23 147

Hepatitis В or С 7 24 6 16 1 14 0 0 68

Tuberculosis 0 1 0 1 0 4 3 0 52

Clients on HAART 17 3 4 2 4 10 12 0 5752

Clients in prep for HAART

1 0 5 0 0 13 15 23 57

Average dosage 14 mg 10 mg 12 mg 3-4 mg 8 mg 10 mg 5 mg 8 mg

min/max dosage 8 / 16 mg12 /13

mg4 / 22 mg 0,8 / 7,2 mg 2 / 12 mg 4 / 12 mg 2 / 8 mg 2 / 10 mg 0,8/22

Number of clients that terminated the programme

0 4 2 0 7 5 2 5 25



Programme “Overcoming HIV/AIDS

Epidemics in Ukraine“ 2006 TOTAL %

Number of clients 197 100

male / female 157/40 80/20

Average age / average drug use experience 31/12,5

HIV+ clients 147 75

Hepatitis В or С 61 31

Clients on HAART 52 26

Clients in prep for HAART 57 29

Average dosage, mg ~10

min/max dosage, mg 0,8/22

Number of clients that terminated the programme 25 12,7



Scaling up the SMT in Ukraine in accordance with the Programme «Overcoming HIV/AIDS Epidemics in

Ukraine» (2006) (1)• Ongoing collaboration with MoH and

corresponding healthcare institutions aimed at the further development of functional networking in the framework of SMT infrastructure (narcological institutions+AIDS Centers+NGO+family doctors+WHO Technical Assistance )

• Development of a database of scientific, methodical, regulatory materials on SMT; maintenance of the web-based resource center and its usage for interactive communication among experts and project staff and to facilitate the access to information on SMTУкраїнський інститут досліджень політики щодо громадського здоровУкраїнський інститут досліджень політики щодо громадського здоров’’я я


Scaling up the SMT in Ukraine in accordance with the Programme «Overcoming HIV/AIDS Epidemics in

Ukraine» (2006) (2)• Systematic consulting and assistance

to MDT • Conducting Monitoring and Evaluation

of SMT projects• Development and dissemination of a

licensed study course on pscycho-social support of SMT clients and a study course on SMT for family doctors

• Fostering access to SMT of HIV-negative IDUs



Primary tasks

• Complete and acquire approval for national SMT development plan in Ukraine;

• Work out a cooperation mechanism with appropriate governmental agencies through NCC on HIV/AIDS in order to mobilize political element of SMT development in the country;

• Enlarge the number of SMT clients through diversification of Ukrainian buprenorphine market (finding another manufacturer);

• Launch methadone pilot projects;• With the assistance of MoH create the mechanism

of drug purchasing at own costs;• Together with WHO initiate the Monitoring and

Evaluation Project.



Main obstacles

• The poor cooperation between narcological institutions and AIDS Centers

• The little interest of local healthcare institutions in SMT implementation

• The insufficient professional level of NGOs, that cooperate with narcological institutions

• Obsolete drug circulation control system and disinclination to change it in order to adapt SMT

• Lack of purchasing mechanism at personal expense, through charity organizations, local and national budget expense.

• Stigma associated with HIV/AIDS and drug abuse.



CONCLUSIONS

First steps of SMT implementation in Ukraine show:

• SMT is an effective treatment method• Existing infrastructure allows for further

development and scale-up• There is an acute necessity for legislation change

regarding drug substance administration• More efforts needed to lower the cost of

treatment. Methadone is an alternative, that will broaden the access to SMT treatment

• Advocacy should be continued as political opposition to SMT programmes remains stiff.



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