On 20 December 2017, a press briefing and field visit to a substitution maintenance therapy (SMT) site took place on the occasion of state’s undertaking the responsibility for funding the program which has for 12 years been funded exclusively by international donors. The visitors had a unique opportunity to learn about the activities of the first SMT site in Ukraine, talk to doctors, social workers, and patients, and see with their own eyes how the patients receive SMT drugs are medical and social support. They could also hear opinions of representatives of the Ministry of Health of Ukraine and civil society organizations with regard to the future of development of this important program as a component of HIV prevention for people who inject drugs.

In 2018, the SMT program that will be funded largely from the state budget will remain the largest program of the kind in Eastern Europe and Central Asia. While at the beginning, in 2005, it reached less than 100 patients, next year it will be covering over 10 thousand patients at 178 healthcare facilities throughout Ukraine. The dry numbers belie more than 12 years of hard work of international and domestic NGOs, the Ministry of Health of Ukraine and healthcare facilities: awareness raising, training staff, engaging patients, procurement, distribution and delivery of the medications to the regions, and protection of the rights of patients.  First patients have recently begun receiving medications paid for by the state, which is a good precondition for the transition to state funding to be gradual and smooth.

Michel Kazatchkine, the UN Special Envoy for HIV/AIDS in Eastern Europe and Central Asia, welcomes the move: “Today’s announcement is great and, certainly, has an important political meaning for the whole of Eastern Europe where HIV epidemic has been and remains connected will illegal drug use. With the support of the Global Fund, the Alliance have for many years supported the largest substitution therapy program in the region. The Government of Ukraine is now taking the leadership in the program acknowledging that no-one must be denied access to healthcare”

The Government understands its responsibility before patients and assumed the responsibility to purchase medications for opioid substitution therapy in order to ensure its sustainability and further development, – said Iryna Chybisova chief specialist of the State Institution “Ukrainian Center for Social Disease Control of the Ministry of Healthcare of Ukraine during the briefing.

“Alliance is transferring to the Government the OST program currently providing services to over 10 000 patients. This program has been implemented according to the highest international standards ensuring high treatment adherence. 10 years ago Alliance had transferred to the Government responsibility another program – antiretroviral treatment. Since that time ART coverage increased by several times, and we expect that it will be the same with OST program as the real need in Ukraine exceeds 50 000”, – highlighted Andriy Klepikov, Executive Director of Alliance for Public Health.

The event took place at the Kyiv City Narcological Hospital “Sociotherapy”, one of the 178 healthcare facilities, serving 775 patients as of 01.11.2017. This is a facility with the highest number of SMT patients in Ukraine! Behind each patient is his or her own story, problems, path to socialization and overcoming dependency from illegal drugs. Anton Basenko, a patient, tells about his experience on the program: “Just saying that SMT has changed my life is saying nothing. SMT has saved my life and returned me to my family, I have married my girlfriend and we are planning to have children; finally, SMT has made me what I am, an employee of an international organization, public activist and representative of the community of people who inject drugs and SMT patients at the National Council to Fight Tuberculosis and HIV/AIDS. And trust me, every one of more than 10,000 patients can tell his own positive story.

Yet we sometimes forget that all these lives were saved only through financial support of international donors that cannot be provided forever and would simply end one day. And without a state support, all these people are doomed.  Today, we are really happy that the government have finally turned their attention to the drug-dependent people and for the first time provided funds to procure SMT medications, but we are still worried about whether this is a final decision and whether they are ready to ensure secure and stable procurement of medications as well as provision of the complex of necessary psychosocial support of the patients”.

Effective response to HIV/AIDS epidemic, which includes SMT program as an efficient component, demands united efforts of government agencies and non-government organizations. And it is very good that this process is characterized by mutual understanding and cooperation.

Substitution maintenance therapy is a globally recognized method of treatment of people who inject drugs (PWID) aiming at prevention of spreading of HIV/AIDS among PWID. It also facilitates re-socialization of PWID, returning them to living full life in the society. In Ukraine, implementation of the SMT program started in 2005, and legislative support for the program was provided in 2008. SMT is implemented at healthcare facilities (narcological dispensaries, AIDS centers, TB dispensaries, city and rayon hospitals, primary healthcare facilities). Overall, there are about 180 HCFs in Ukraine providing services to about 10 thousand patients of whom 42% are HIV-positive. All patients receive integrated services of medical (diagnostics and treatment of HIV/AIDS, TB, hepatitis, or other somatic diseases) and psychosocial support (employment, restoring interpersonal relations, creating families, having children, reintegration to the social life). In 2017, for the first time SMT medications for the amount of UAH 13 mln were procured using state budget funding, the medications are being delivered to HCFs and issued to the patients. Bidding procedures to procure the next batch of SMT medications with the funds of the State Budget of Ukraine for 2018 are going on.

Growing coverage of SMT program in Ukraine and growing share of public funding (2005-2018):