This was presentation made at the OST conference in May 2012 to demonstrate different models of Integrated care that has been implemented by Alliance Ukraine in the country.

1. www.aidsalliance.org.ua
Models of holistic approach to OST patients
in Integrated Care settings
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Zahedul Islam
ICF “International HIV/AIDS Alliance in Ukraine”
23 May 2012, Kyiv
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2.  WHO estimates, 53000 IDUs need OST in Ukraine and only
12,6 % of them are receiving it. Opioid Substitution treatment
(OST) is an effective tool to prevent HIV/AIDS epidemic.
 Estimated over 98 000 IDU’s are HIV positive
 GFATM target under R6 11300 patients by end of 2012 vs
national program target 20000
 No national budget committed to implement OST so far at the
same time R10 HIV program intend to handover all OST patients
gradually to MoH starting from 2014.
Background
www.aidsalliance.org.ua
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3. www.aidsalliance.org.ua
Current status of OST implementation
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 As of April 1, 2012 6783 patients are receiving OST in Ukraine
 34 NGOs in 27 regions of Ukraine implement projects on medical,
psychological and social support of OST clients with financial support
from Alliance Ukraine
 138 healthcare institutions (HCI) provide OST in all regions of Ukraine.
35 out of them operate as integrated care centers
 3008 (45%) OST clients are HIV positive
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4. www.aidsalliance.org.ua
OST scale up
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0
1000
2000
3000
4000
5000
6000
7000
December31,
2005
December31,
2006
December31,
2007
December31,
2008
December31,
2009
December31,
2010
December31,
2011
Apr.1,
2012
8 10 10 55 102 124 133 137
160 436 547
2202
5078
6025
6632 6783
Number of healthcare institutions ST-providers
Number of patients on ST
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5. www.aidsalliance.org.ua
A model of holistic approach
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Integrated
Care Center
OSTTB
diagnosis and
treatment
HIV/AIDS
diagnosis and
treatment
NGOs
working in
prevention,
harm
redaction
State bodies
and institutions
(Social centers
for youth, job
centers etc.)
Other
HCIs/services
(surgery,
stomatology,
gynecology…
.)
Hepatitis
diagnosis and
treatment
NGO working
on MPSS for
OST
case
manager
HR
NGO’s
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6. www.aidsalliance.org.ua
Goal
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The aim is to provide extend possible all needed services in
one place – center of integrated support “under one
roof”(“one-stop-shop”)
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7. www.aidsalliance.org.ua
Integrated Care
centers: structure and overall services
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Through a multidisciplinary team
approach this clinics are ensuring
access to:
OST
Diagnosis and treatment of HIV
Diagnosis and treatment of TB
Psychosocial services
Other medical services in
accordance with client’s needs
Support in social reintegration
NGO
HCI,
Providing OST
Specialists of other HCIs
and state services
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8. www.aidsalliance.org.ua
Medical services
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 Includes:
-Consultation, diagnosis, treatment (drug addiction, HIV/AIDS,
STI, TB, hepatitis) - in house or co-located
-If needed: referral and support of patients to other medical
institutions for medical support e.g. surgery, obstetrician-
gynecology service, etc.
-Some specific services for clients are arranged by reference to
relevant Harm Reduction or care and support projects, PSS of
ART, home care, ART adherence and DOTS for PLWH with triple
diagnosis – HIV/IDU/TB
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9. www.aidsalliance.org.ua
Psychosocial support
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Includes:
-Dedicated case manager
-Provide guidance to new comer to navigate through complicated
health care systems
-Counseling on social issues, support and help in employment
(education/training) for patients, including re-socialization and re-
integration:
-Support in restoring of documents, stabilization of family
relations and emotional condition, personality, formation of safe
behavior
-Formation of adherence to OST, ART other medical support e.g.
TB treatment
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10. Narcology
clinic
NGO
General clinic
NGO
NGO NGO
TB dispensary Psychiatric clinic
OST, HIV, TB, PSS, STI, referral
(reproductive health, surgery,
pediatrician)
OST, HIV, TB, PSS, referral
(reproductive health, STI, pediatrician,
surgery, neuropathologist)
OST, HIV, TB, PSS, reproductive
health, STI, referral (surgery)
Models of Integrated care centers
OST, HIV, TB, PSS, reproductive
health, STI, referral (surgery,
neuropathologist)
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11. www.aidsalliance.org.ua
Improving life of patients
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29,17%
2,75%
16,63%
5,05%
2,55%
17,00%
0,00%
10,00%
20,00%
30,00%
40,00%
50,00%
60,00%
70,00%
80,00%
90,00%
100,00%
patients were
employed
started
education/training
patients restored
family relationships
set up families patients gave birth to
children
started to practice an
active social life
6500 patients in the OST program was interviewed in December, 2011
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12. - OST is (MMT, BMT) proven effective for opioid dependency
however, Ukraine still remain cautious
- Complicated and control legislative mechanism pose threat
to successful operation
- Ensuring appropriate dosage of ST drugs
- Absence of established system on issuance of ST drugs
under prescription
- Access to alternative formulation of methadone (liquid)
- Lack of National system of staff education in ST sphere
(medical staff, social workers, case-managers, psychologists)
- Sustaining social support for the clients
Challenges to overcome
www.aidsalliance.org.ua
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13. - To seriously consider integration of services in to different model
of health care systems for Most at Risk populations including
psychosocial support.
- Apply more public health approach to drug treatment (individual
prescriptions)
- To introduce a post-graduate training module on the National
level for the medical staff who can function as integrated care
service provider.
- National and regional budget should be allocated to further
sustain donor funded program
Conclusions
www.aidsalliance.org.ua
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14. www.aidsalliance.org.ua
Pavel Kutsev
Past life…. 14

15. www.aidsalliance.org.ua
Pavel Kutsev
Life has changed ever
since 15

16. www.aidsalliance.org.ua
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Thank you!
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