Ukraine Expands Opioid Substitution Therapy to Reduce HIV

The Ukrainian government is increasing the scope of the country’s state-funded opioid substitution therapy (OST) programme – a harm reduction tool which reduces the risk of overdose and disease transmission, TalkingDrugs reports.

Ukraine has provided free OST to around 8,000 people since the beginning of 2017, and now authorities have made the treatment accessible for even more people. As of this year, Ukraine is now fully funding OST for over 10,000 patients at 178 healthcare facilities around the country – “a 100 fold increase in the number of OST patients in Ukraine since 2005”, according to the World Health Organisation (WHO).

OST involves people who use illicit opioids, such as heroin, being provided with prescribed opioid medicines, such as methadone or buprenorphine, for administration in supervised clinical settings. OST is a method of harm reduction for people who use opioids; due to the sterile and clinical nature of the opioid provisions, OST reduces people's risk of overdose, and cuts the transmission of infectious diseases, such as Hepatitis C and HIV. It also provides an opportunity for patients to engage with related health services – for some people, this may be their only regular interaction with a health professional. For patients who stop using illegal opioids outside of their therapy, OST means they may no longer have to engage with the illegal market altogether.

OST pilot programmes first began in Ukraine in 2004, and grew in prevalence during the following years. Prior to 2017, Ukraine’s OST programmes were primarily funded by the Global Fund to fight AIDS, Tuberculosis, and Malaria, but an increase in the country's income status in 2016 resulted in a drop in financing from the Global Fund. This change in financial contributions led to the government pledging support for this harm reduction measure by opting to fully fund the initiative, TalkingDrugs has previously reported.

According to 2015 data from international HIV and AIDS charity Avert, around 1 per cent of Ukraine's adult population - or 346,000 people - inject drugs. Seeing as almost one quarter of new HIV infections in Ukraine are caused by injecting drug use - often through the use of non-sterile needles in non-clinical settings - the need for OST is abundantly clear to health experts. The government’s recent decision to expand access to OST has, therefore, gained praise from health experts for countering the potential harms of drug use and infectious diseases.

Martin Donoghoe, senior advisor on TB, HIV and Viral Hepatitis at the WHO's Ukraine office in Kiev, described this development as “an important milestone for public health in Ukraine. WHO and partners have been working together with the government for many years to finally see OST accepted and financially supported. This shows that Ukraine is fully committed to respond to HIV.”

The government’s support for this measure was also met with support from patients who use OST.

“OST has saved my life. It has returned me to my family, I have married my girlfriend and we are planning to have children,” Anton Basenko, a Ukrainian OST patient, described. “OST has made me what I am, an employee of an international organisation and a representative of the community of people who inject drugs and OST patients at the National Council to Fight Tuberculosis and HIV/AIDS”

“We should not forget that all these lives were saved through the financial support of international donors. However, this funding cannot be provided forever, and without state support, all these people are doomed.”

While people in the majority of Ukraine are able to benefit from the government’s financial support for OST, the same cannot be said for those who live in Crimea. The Crimean peninsula, recognised by most countries as Ukrainian territory, was taken over by the Russian state in 2014. Under Russian law, OST is illegal – meaning that around 800 patients who had accessed this treatment for years were suddenly denied access to it. While the extent that this change has affected people who inject drugs in the region is difficult to ascertain, it has undoubtedly contributed to deaths.