Combating HIV through integrated care for drug users in Ukraine

August 2012

Within one programme, Ukraine is providing treatment to patients who are HIV positive and inject drugs. The impact has been remarkable: improving HIV treatment outcomes and reducing illicit drug use.

Oleg and Oxana, programme participants in Kriviy Rig

Oleg, now in his forties, started injecting heroin in 1990. One day in 2008, he found himself in a wheelchair being pushed down a gloomy hospital corridor by his wife. He was diagnosed with several health problems, including severe pneumonia, brain disorder, and HIV. The outlook seemed grim. Against all odds, Oleg survived and was transferred home – HIV positive and still dependent on heroin.

WHO-supported methadone programme

Soon after he got home, Oleg heard about methadone, a medication to help treat opoid addiction. “I had tried many other ways to quit, going to detox, religious institutions and other methods, but nothing worked. I am convinced that methadone is the only way to help people stop taking street drugs.” Oleg was accepted in a WHO-supported methadone programme. At the clinic where he received methadone each day, he was also given the HIV treatment he needed.

HIV and drug dependence: Ukraine’s integrated model of care

Oleg’s story is not unique. Ukraine has been innovative in the approach to treating HIV and drug addiction, including the development of programmes through which people who inject drugs can receive health and social services and exchange used syringes for clean ones. In 2008, Ukraine introduced programmes providing HIV services and drug dependence therapy in an integrated manner for the first time. Each day, patients receive a combination of methadone for their drug dependence, medication to treat HIV and medication to prevent or treat TB.

This integrated model of care is proving highly successful in a country with one of the highest and fastest growing HIV rates in Europe, and with the largest concentration of people living with HIV found among injecting drug users. In 2010, the rate of newly diagnosed HIV infections was around 45 per 100 000 population. Almost one third of these cases were caused by contaminated needles.

Injecting drug users: improving access to treatment

Injecting drug users in Ukraine face a host of issues that increase their risk of HIV. Many are still unable to access treatment for drug dependency. Ukraine also has a major tuberculosis epidemic that disproportionately affects injecting drug users living with HIV.

The simple step of reorganizing health services around the needs of the people who inject drugs is making it easier for people with drug dependence to access the HIV and TB treatment that they require. The challenge now is to make integrated treatment available to all people who need it.

WHO’s role in expanding integrated care services

WHO has played a key role in establishing and expanding integrated care services in Ukraine, by providing technical support and guidance to national partners. In 2008, pilot sites providing methadone were established in the Dnipropetrovsk, Mykolaiv and Odessa regions and in Kiev city. About twenty sites now provide integrated HIV and drug dependency treatment along with primary health care, TB services, and sexual and reproductive health services for women. WHO has also supported integrated care training for multidisciplinary teams from 18 regions of Ukraine.

Improved HIV treatment and decreased drug use

The impact of these efforts has been remarkable. Recent analysis of integrated care in Ukraine found that it not only resulted in improved HIV treatment outcomes but also in significantly decreased illicit drug use. Clients of the pilot sites are more aware of their needs of certain medical services, use medical and psycho-social services much more often, have lower average alcohol consumption, and are more aware about safe sex.

“When we first started integrated care with methadone, we were all very worried,” says Dr. Dimitri Valentinovich Shaposhnik from Kriviy Rig City Narcological Dispensary. “But the positive effects of methadone were soon evident: improved social life, better family life, employment, greater access to health care and better health.”

Substitution therapy has changed my life

Oleg was finally able to reduce and ultimately completely stop his heroin use. Through the medicines, his immune system had become strong again and he was able to live an almost normal life. "Substitution therapy has changed my life! Improved my family relationships, my health and most importantly, my financial situation,” says Oleg. “I am celebrating my 10th wedding anniversary, my son is in second grade, plays piano, and enjoys computers and English. And my wife smiles a lot more than she used to.”