Program Scaling up the Response to HIVAIDS in Uzbekistan: a Focus on Vulnerable Populations under th

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Program Scaling up the Response to HIV/AIDS in
Uzbekistan a Focus on Vulnerable Populations
under the Grant of the Global Fund to fight
HIV/AIDS, Tuberculosis and Malaria
(UZB-304-G01-H)

• Substitution therapy pilot project
• the first set of results
• Sergey Kargin
• Project manager
• Tbilisi, 18 September 2007

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Project background

• Tashkent
• Population 2160 ths. people
• 11 districts
• 1 Narcological Dispensary
• IDUs estimation number 17-20 ths. (according to
  UNODC rapid assessment data, 2001)
• Drug Addiction incidence rate (by the first visit
  to the doctor)
• As per official statistics data
  18,5 per 100 ths.
• As per anonymous visit to the
• Narcological Dispensary
  18,3 per 100 ths.
  
  
  
  
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• Total incidence rate
  36,8 per 100 ths .

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Drug addiction prevalence
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Structure of registered drug addicts, by types of
used drugs
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IDUs ratio among registered patients
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Prevalence of HIV-infected persons among IDUs
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Prevalence of HIV-infected among male IDUs and
female IDUs
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Questionnaire analysis

• Type of drug

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Questionnaire analysis

• Way of drugs use

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IDU questionnaires analysis

• Type of the first used
  drug

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According to the questionnaire survey in 2005,
among all the patients who tried intravenous
drugs 28 used a shared syringe or needle 43 -
reported no syringe- or needle-sharing 2 - said
the use of shared syringe or needle is not
acceptable
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IDU questionnaires analysis

• HIV testing

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Substitution therapy on Uzbekistan

• Parliament Recommendations on advisability of
  conducting the pilot project (2000)
• Resolution of the State Drug Control Commission
  on advisability of conducting the pilot project
  in Tashkent (2003)
• Relevant orders of the Ministry of Health

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Substitution therapy in Uzbekistan

• Proposal for the Grant of the Global Fund (2003)
• Program on the Grant of the Global Fund (2004)
• Preparation of the Regulations on the use of ST
  and its approval by the order of the Ministry of
  Health (2005)
• Preparation and Approval of Temporary Manual on
  the use of ST(2005)
• Conference on the use of ST with participation of
  WHO professionals (may 2005)

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• THE LAW
• Of the Republic of Uzbekistan
• About narcotic drugs and psychotropic
  substances
• of 19.08.1999
• Article 45. Drugs and methods not prohibited by
  the Ministry of Health of the Republic of
  Uzbekistan are to be used to diagnose drug abuse,
  toxicomania and for drug users treatment

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Substitution therapy in Uzbekistan

• Trip of professionals to India for adviser
  inspection on the use of substitution therapy
  with buprenorfin (2000, Delhi and Mumbai (India))
  
• Participation of the professionals from
  Uzbekistan in XII International Conference on
  Harm Reduction (2001, Delhi (India))
• Trip of professionals to Vilnius (Lithuania) for
  adviser inspection on the use of substitution
  therapy with methadone (2003 and 2005)

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Substitution therapy in Uzbekistan(the first set
of results)

• The program was started in February, 2006
• Buprenorfin is in use
• Methadone came into use since 13.10.2006
• The number of patients, participating in the
  project - 271 (136 PLWHA)
• 42 people receive ARVT

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Substitution therapy in Uzbekistan(the first set
of results (positive))

• Positive comments on the program from patients
  and their relatives
• Criminal behavior among the project participants
  is not observed (singular events only)
• Improvement in physical condition of the patients
• Multiple services delivery (psychologist, social
  assistance, Friendly Cabinet)
• At present more than 100 patients are on a
  waiting list

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Substitution therapy in Uzbekistan(the first set
of results (positive))
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Substitution therapy in Uzbekistan(the first set
of results (negative))

• Gatherings of drug-users, not participating in
  the project, near dispensary
• Attempts to take the drug out of dispensary

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Problems

• Project orientation towards HIV-positive patients
  only
• Discussion of this limitation with UNAIDS, WHO
  and UNODC representatives
• Joint document on irrationality of this
  limitation
• The personnel is not psychologically ready to
  work with that large number of drug users,
  visiting the dispensary on a daily basis
• Controversial attitude to ST among medical
  community
• Discussion of this matter at the meeting with
  narcology staff at the Ministry of Health
• Discussion of this matter with the board of the
  City Health Administration in Tashkent
• Controversial attitude to ST in the society

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Long-term Prospects

• Preparation of report on the project results and
  its presentation at the meeting of Drugs Control
  Commission
• Removal of methadone from the list of prohibited
  narcotic drugs and its reclassification as
  restrictedly authorized
• Training of the specialists from the other
  regions of the Republic
• Preparation of ST bases in the other regions
• Foundation of one more Center of substitution
  therapy in Tashkent
• ST introduction in the regions (Samarkand,
  Bukhara, Tashkent and others.)

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• Manager of Substitution therapy project
• Oleg Mustafin
• E-mail tshnarcod_at_albatros.uz
• tshnarcod_at_sarkor.com

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Thank you for your attention