how do pwid prevention activities impact the hiv epidemic? case of ukraine
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How do PWID prevention activities impact the HIV epidemic? Case of Ukraine. Olga Varetska International HIV/AIDS Alliance in Ukraine. Background. HIV epidemic among PWID in Ukraine. PLH: 238,000 or 0.9% of estimated adult prevalence (2013) Estimated # of PWID in Ukraine is 310,000 - PowerPoint PPT PresentationTRANSCRIPT
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How do PWID prevention activities impact the HIV epidemic?
Case of Ukraine.
Olga Varetska
International HIV/AIDS Alliance in Ukraine
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BACKGROUND
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HIV epidemic among PWID in Ukraine
Kyiv
Dnipropetrovsk
Donetsk
Mykolaiv
Odesa
Lviv
AR Crimea2007 2008 2009 2011 2013
28.4%
32.8%
21.6% 21.6%
18.1%
HIV prevalence among PWID, mean
• PLH: 238,000 or 0.9% of estimated adult prevalence (2013) • Estimated # of PWID in Ukraine is 310,000
• Main injectable drug of abuse – home-made acetylated poppy straw extract (opioid)• Home-made methamphetamine-type drugs are also prevalent
• HIV epidemic started in 1995 among PWID in southern and eastern regions• Mean HIV prevalence among PWID is 18% (up to 40% in some regions)
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PROGRAM COVERAGE
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SAMPLE SLIDE 2
• Speaking at AIDS 2014• What to think about?
– Keep it simple– Larger text is easier to read– Single words rather than sentences
• Bullet points are there to remind you, not to tell the whole story
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Minimal package for PWID includes clean syringe, condom, information material, consultation, access to HIV testing
Program coverage
6 16 22 28 34 40 46 52 58 64 70 80
Age distribution
72.2%
27.8%Male PWID
Female PWID
20062007
20082009
20102011
20122013
020000400006000080000
100000120000140000160000180000200000
PWID Coverage
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42.2% of clients tested
for HIV in community
settings
27% of clients screened for
TB
13.8% tested for Hep C and 16.3%
for Hep B
25.9% of clients tested for Syphilis,
and up to 7% for other STIs
4.1% of clients on OST
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Distribution of syringes by type of venue
secondary exchange
14%
street outreach
45%mobile clinics
4%
phar-macies
11%
office-based23%
other3%
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RESULTS: HIV AMONG PWID IS DECREASING
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Risky behavior patterns related to drug use
2007 2008 2009 2011 20130%
10%
20%
30%
40%
50%
60%
70%
80%
Needle Sharing, past 30 days Preloaded syringe, past 30 daysContainer sharing, past 30 days
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HIV incidence proxy: case registration
2005 2006 2007 2008 2009 2010 2011 2012 20130
1000
2000
3000
4000
5000
6000
7000
8000
1038 930 771 584 552 461 339 225
6270
7127 7087 7014 7113 69386588
5933 5847
Young PWIDPWID
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HIV incidence proxy: HIV prevalence among young and recent PWID
2007 2008 2009 2011 20130.0%
5.0%
10.0%
15.0%
20.0%
25.0%
Young PWIDRecent PWID
Source: IBBS study reports 2007-2013
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GROWING ROLE OF HETEROSEXUAL TRANSMISSION
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Modes of HIV-transmission: heterosexual share is increasing
Source: L.V. Gromashevsky Institute for Epidemiology and Infectious Diseases of the National Academy of Medical Sciences of Ukraine, HIV infection in Ukraine, Newsletter No. 41, Ukrainian Centre for AIDS Prevention and Control, Ministry of Health, Kiev, 2014, p17.
2005 2006 2007 2008 2009 2010 2011 2012 20130.0
10.0
20.0
30.0
40.0
50.0
60.0
0.1 0.2 0.3 0.3 0.5 0.4 0.7 0.7 1.2
33.3 35.1 38.1
41.6 43.0 44.548.4
50.352.8
45.6 44.340.1
37.0 35.933.9
31.128.6 26.8
18.2 17.6 19.4 19.2 18.9 19.8 18.9 19.5 18.5
2.8 2.8 2.1 1.9 1.8 1.4 0.9 0.8 0.7
HBM HET IDU M-Ch OTH
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Newly registered HIV cases in Ukraine
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
5000
10000
15000
20000
25000
30000
3967 4589 4819 5779 6282 7134 7088 7015 7113 6943 6592 5932 5849
7000
875610009
1249113770
1607817669
1896319840 20489 21177
2074321631
PWID out of Total number Total number of new HIV cases
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Changes in modes of transmission – Spectrum model results
• Spectrum model confirms increasing role of heterosexual transmission
• Who is the “remaining population”?
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
22,557
15,695
1,953 888
IDUs FSW Clients MSM Remaining pop
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Reported HIV cases in PWID and young women infected heterosexually by HIV incidence tercile among PWID
2005 2006 2007 2008 2009 2010 20110
200
400
600
800
1000
1200
• Similar trends are evident among young women infected heterosexually as among PWID in the regions most affected by PWID epidemic
• This suggests that heterosexual transmission is linked to existing HIV cases among PWID, i.e. is happening among sexual partners of PWID
2005 2006 2007 2008 2009 2010 20110
1000
2000
3000
4000
5000
6000
Highest tercile Middle tercileLowest tercile
Reported HIV cases in PWID by PWID incidence tercile
Reported HIV cases in young women by PWID incidence tercile
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Behavioral data: condom use during last sexual intercourse among PWID
• In 50% of cases PWID do not use condoms
• Behavioral data confirms risky sexual practices among PWID
2008 2009 2011 20130
5
10
15
20
25
30
35
40
45
50
55
60
53.8
58.2
47.8 54.1
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Conclusions: prevention proves effective, but more focus on sexual mode of transmission among
PWID needed
2005 2006 2007 2008 2009 2010 2011 2012 -
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
200,000
0
200
400
600
800
1000
1200
Cases among young PWID and coverage by prevention
# PWID covered by prevention# Registered cases among PWID <25 y.o.
• inverse correlation between coverage of prevention programs and number of HIV cases
• decreasing coverage or limited service package for PWID (inevitable in case of anticipated decline in funding of services for PWID in Ukraine)would undermine the success
• need to focus on sexual mode of HIV transmission among PWID and partners to achieve significant results in suppressing HIV rates among general population
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Thank you for your attention!