HIV treatment access and scale-up for delivery of opiate substitution therapy with buprenorphine for IDUs in Ukraine--programme description and policy implications.
BACKGROUND
Injection drug use (IDU) accounts for 70 percent of HIV cases in Ukraine. Until buprenorphine maintenance therapy (BMT) was introduced, few effective strategies aimed at achieving reduction in illicit drug use were available as a conduit to anti-retroviral therapy (ARV) among IDUs.


METHODS
In October 2005, BMT was scaled-up using Global Fund resources in six regions within Ukraine. Entry criteria included opioid dependence, HIV-1 seropositivity, age >or=18 years and reported interest in BMT. All sites included a multidisciplinary team. To date, 207 patients have been initiated on BMT.


CONCLUSIONS
The existing infrastructure allows for further scale-up of and administration of BMT and the possibility of co-administration with ARV. The process for prescription and administration of buprenorphine and ARV is at times cumbersome and constrained by current regulations.


CONCLUSIONS
More IDU need BMT to improve overall health outcomes. Central to expanding access will be legislative changes to existing drug policy. Moreover, the cost of buprenorphine is prohibitively expensive. Sustainable substitution therapy in Ukraine requires lower negotiated prices for buprenorphine, the addition of methadone, or both to the existing formulary for HIV+ drug users.
Bruce
R Douglas
RD
Yale University AIDS Program, New Haven, CT 06510-2283, United States. robert.bruce@yale.edu <robert.bruce@yale.edu>
Dvoryak
Sergey
S
Sylla
Laurie
L
Altice
Frederick L
FL
D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000517:prevention & control* / Q000635:transmission; D006679:HIV Seropositivity; D015497:HIV-1; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008297:Male; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D018671:Needle-Exchange Programs; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000534:rehabilitation; D010865:Pilot Projects; D011050:Policy Making; D016730:Program Development; D016320:Substance Abuse Treatment Centers; D015819:Substance Abuse, Intravenous / Q000188:drug therapy* / Q000534:rehabilitation; D014455:Ukraine / Q000453:epidemiology
D009292:Narcotic Antagonists; D002047:Buprenorphine
Am J Addict. 2004;13 Suppl 1:S17-28
15204673
AIDS. 2006 Nov 14;20(17):2217-23
17086062
J Acquir Immune Defic Syndr. 2006 Apr 15;41(5):563-72
16652030
Clin Infect Dis. 2006 Mar 1;42(5):716-21
16447120