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Provision of Substitution Maintenance Therapy Combined with the Antiretrovial Therapy in the Frames of the ‘Overcoming HIV/AIDS Epidemics in Ukraine’ Programme supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria Elena Gulevich, Infectious Disease Specialist Odessa Oblast AIDS Prevention Center 1 The Group of Patients 25 patients are enrolled to the ST program in Odessa region as of 11.02.2006. Out of those 25: 11 – PLHA enrolled to ART 14 – PLHA getting ready to start ART 25 – immunosuppression of different level (CD4 less then 250) 2 The Group of Patients (II) Patients with opportunistic infections (candidosis, chronic herpetic infection, etc.) Opiates consumption during 5 – 10 years 23 patients have co-infection of Hepatitis В and С 7 patients are also diagnosed tuberculosis 3 The Process of ST Provision - Selection of the potential patient (from the AIDS Center register, through the Community Center, etc.) by the NGOs’ social workers - Directing the patient to the infectious disease specialist at the AIDS Center - Clinical and immunological inspection, consultations of the infectious disease specialist - Re-directing of the patient to the narcological dispensary 4 The Process of ST Provision (ІІ) • Multidisciplinary approach (team work: infectious disease specialist – social worker – narcologist) provides for more qualified provision of ART combined with ST • Continuous medical observation of the patients by the infectious disease specialists and narcologists • Peer counseling, consultations of the TB specialists, surgeon, other doctors and a lawyer when required • Psychological and social support (social workers, NGO) 5 Clinical Observations • Improved health status (lower sickness rate) • Improvement of tuberculosis treatment, no tuberculosis relapse during the period of ST provision • Stabilization of psychological and emotional status (in particular, adequate perception of the HIV-status, socialization, desire to find work, etc.) • Increased ART adherence, motivation to treatment 6 Perspectives for ST Scaling-up • Enrollment of more IDUs to the ART (ST – one of the methods to develop adherence to ART) • Provision of ST combined with ART motivates the patients to go back to healthy, abstinent life style (rehabilitation programmes) • ST – one of the methods to prevent HIV/AIDS epidemics spread 7