title: Geographic variability in HIV and injection drug use in Ukraine: implications for integration and expansion of drug treatment and HIV care.
abstract: BACKGROUND
  Ukraine has the highest HIV burden of any European country with much of the current HIV epidemic concentrated among people who inject drugs (PWIDs) and their sexual partners. Opiate substitution therapy (OST) is limited in Ukraine and expansion of OST is urgently needed to help stem the tide of the HIV epidemic.
  
  
  METHODS
  We accessed publicly available data in Ukraine in order to explore geographic variability with respect to prevalence of HIV, PWIDs and OST programmes.
  
  
  RESULTS
  The regions of Ukraine with the largest number of opioid dependent persons (the south and eastern portions of the country) correspond to the regions with the highest HIV prevalence and HIV incidence. The number of opioid PWIDs per 100,000 population as well as the number of all OST treatment slots per 100,000 varied significantly across the three HIV prevalence categories. Overall, the proportion of individuals receiving either methadone maintenance therapy (MMT) or buprenorphine maintenance therapy (BMT) was quite low: average across categories: 7.3% and 0.4%, respectively. Additionally, less than half of OST patients receiving MMT or BMT were HIV positive patients.
  
  
  CONCLUSIONS
  There is significant geographic variability in both numbers of HIV positive individuals and numbers of PWIDs across Ukraine, however, there may be a more concentrated epidemic among PWIDs in many regions of the country. Scale up of addiction treatment for PWID, especially OST, can have a significant impact on preventing injection related morbidity, such as HIV and HCV infection. Ukraine can learn from the mistakes other nations have made in denying critical treatment opportunities to PWID.
authors.affiliation: The Miriam Hospital, Providence, RI, United States; Brown Medical School, Providence, RI, United States. Electronic address: NDZaller@uams.edu.
authors.forename: Nickolas
authors.initials: N
authors.lastname: Zaller
authors.affiliation: The International HIV/AIDS Alliance, Kiev, Ukraine.
authors.forename: Alonya
authors.initials: A
authors.lastname: Mazhnaya
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Larney
authors.affiliation: The International HIV/AIDS Alliance, Kiev, Ukraine.
authors.forename: Zahed
authors.initials: Z
authors.lastname: Islam
authors.affiliation: The International HIV/AIDS Alliance, Kiev, Ukraine.
authors.forename: Alyona
authors.initials: A
authors.lastname: Shost
authors.affiliation: The International HIV/AIDS Alliance, Kiev, Ukraine.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Prokhorova
authors.affiliation: The Miriam Hospital, Providence, RI, United States; Brown Medical School, Providence, RI, United States.
authors.forename: Natasha
authors.initials: N
authors.lastname: Rybak
authors.affiliation: The Miriam Hospital, Providence, RI, United States; Brown Medical School, Providence, RI, United States.
authors.forename: Timothy
authors.initials: T
authors.lastname: Flanigan
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage; D058850:Opiate Substitution Treatment / Q000379:methods*; D015995:Prevalence; D012747:Sexual Partners; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology* / Q000534:rehabilitation; D014455:Ukraine / Q000453:epidemiology
chemical_list: D002047:Buprenorphine; D008691:Methadone
keywords: HIV; Opiate substitution therapy (OST); People who inject drugs (PWID); Ukraine