Models of Holistic approach to OST patients in Integrated care settings

www.aidsalliance.org.ua

Models of holistic approach to OST patients

in Integrated Care settings

1

Zahedul Islam

ICF “International HIV/AIDS Alliance in Ukraine”

23 May 2012, Kyiv 1

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


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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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OST scale up

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2000

3000

4000

5000

6000

7000

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11 Ap

r. 1

, 2

01

28 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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A model of holistic approach

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Integrated

Care Center

OST TB 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

5


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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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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Medical services

8

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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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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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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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 wereemployed

startededucation/training

patients restoredfamily relationships

set up families patients gave birth tochildren

started to practice anactive social life

6500 patients in the OST program was interviewed in December, 2011

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- 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


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- 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


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Pavel Kutsev

Past life…. 14


Pavel Kutsev

Life has changed ever

since 15


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Thank you!

16

Health & Medicine

Models of Holistic approach to OST patients in Integrated care settings