title: Assessment of health services for people who use drugs in Central Asia: findings of a quantitative survey in Kazakhstan and Kyrgyzstan.
abstract: BACKGROUND
  In Central Asia, there is a need to update information about the situation of people who use (opioid) drugs (PWUD), especially regarding their access to and utilization of health care services. The aim of the study was to gather information about two different groups of drug users in Kazakhstan and Kyrgyzstan.
  
  
  METHODS
  In 2013, two groups of PWUD were recruited in Kazakhstan and in Kyrgyzstan in order to gather quantitative data via interviewer-administered questionnaires. PWUD registered with the Narcological Register were allocated to group A while non-registered PWUD were allocated to group B. Interviews were conducted in the office of the Narcological Register as well as in low-threshold facilities. Participants reported about their drug use patterns, health status, and utilization of health services as well as barriers to utilization.
  
  
  RESULTS
  The sample consisted of N = 600 PWUD (301 registered and 299 non-registered PWUD) from Kazakhstan and N = 900 PWUD (450 registered and 450 non-registered PWUD) from Kyrgyzstan. Both groups-registered (group A) and non-registered (group B)-consisted of mainly male long-term intravenous opioid users. We found high rates of current (last 30 days) opioid use (group A up to 70%; group B up to 84%). Most PWUD were burdened with poor physical and mental health. The prevalence of infectious diseases added up to 19% (group A) or 13% (group B) regarding HIV, 56% (group A) or 30% (group B) regarding HCV, and 24% (group A) or 20% (group B) regarding tuberculosis. Registered and non-registered PWUD reported high rates (95 or 82%) of lifetime use of health services for PWUD. Drug-related services were utilized less often, especially among the non-registered PWUD (13%). The most important barriers preventing PWUD from accessing services were the belief not to need treatment, doubts about the effectiveness of treatment, mistrust of treatment regime/staff, and fear of being registered with the Narcological Register (mainly group B).
  
  
  CONCLUSIONS
  Results show that access to the health care system for non-registered PWUD is realized mainly through low-threshold facilities. Opioid substitution treatment, which is an important pillar in the treatment of PWUD, is normally only available for those registered with the Narcological Register. Instead, access to opioid substitution treatment (especially in Kazakhstan) should be expanded and granted without prior registration, as this poses an important barrier for PWUD's utilization of drug treatment services. Further, there seems to be a need for the provision of specific and target group-related information about drug treatment services in order to reduce existing reservations among PWUD as to the necessity and effectiveness of modern drug treatment.
authors.affiliation: Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. moritz.rosenkranz@uni-hamburg.de.
authors.forename: Moritz
authors.initials: M
authors.lastname: Rosenkranz
authors.affiliation: Regional Office for Central Asia, United Nations Office on Drugs and Crime (UNODC), 26 Bukeykhan Street, UN House, 010000, Astana, Kazakhstan.
authors.forename: Nina
authors.initials: N
authors.lastname: Kerimi
authors.affiliation: Regional Office for Central Asia, United Nations Office on Drugs and Crime (UNODC), 26 Bukeykhan Street, UN House, 010000, Astana, Kazakhstan.
authors.forename: Madina
authors.initials: M
authors.lastname: Takenova
authors.affiliation: Regional Office for Central Asia, United Nations Office on Drugs and Crime (UNODC), 26 Bukeykhan Street, UN House, 010000, Astana, Kazakhstan.
authors.forename: Antti
authors.initials: A
authors.lastname: Impinen
authors.affiliation: Regional Office for Central Asia, United Nations Office on Drugs and Crime (UNODC), 26 Bukeykhan Street, UN House, 010000, Astana, Kazakhstan.
authors.forename: Mirlan
authors.initials: M
authors.lastname: Mamyrov
authors.affiliation: Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. p.degkwitz@uke.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Degkwitz
authors.affiliation: Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. zurhold@uke.de.
authors.forename: Heike
authors.initials: H
authors.lastname: Zurhold
authors.affiliation: Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. marcus.martens@uni-hamburg.de.
authors.forename: Marcus-Sebastian
authors.initials: MS
authors.lastname: Martens
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D055030:Drug Users / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D007239:Infections / Q000453:epidemiology / Q000209:etiology; D007623:Kazakhstan / Q000453:epidemiology; D007707:Kyrgyzstan / Q000453:epidemiology; D008297:Male; D008603:Mental Health; D015995:Prevalence; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation*
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