Eastern Europe and central Asia is the only region globally where HIV incidence and mortality continues to increase, particularly among people who inject drugs (PWID). There is low coverage of opioid agonist therapy (OAT) among PWID, despite overwhelming evidence supporting its effectiveness and cost-effectiveness since the introduction of buprenorphine and methadone in 2004 and 2008, respectively. This modelling study uses a combination of mathematical modelling and real-world regional data from Ukraine. Using HIV epidemic profiles and regional data, including statistics on OAT enrolment and retention, the efficiency of OAT programmes with a linear optimisation model was assessed. The effect of expanding OAT programmes on HIV prevention and mortality over 10 years, were also evaluated.
Under a status-quo scenario the number of new HIV infections among PWID was projected to increase to 58,820 over the next 10 years. Striking regional differences were observed. With optimum allocation of OAT without additional increases in procurement, OAT coverage could increase from 2.7% to 3.3%, by increasing OAT doses to ensure higher retention levels. Scaling up OAT to 10% and 20% over 10 years would, prevent 4368 and 10,864 new HIV infections, and reduce deaths by 7096 and 17,863, respectively, relative to the status quo. OAT expansion to 20% in five regions of Ukraine with the highest HIV burden, would account for the prevention of 56% of new HIV infections, and 49% of deaths over 10 years.
- Current HIV prevention and treatment strategies should be reappraised.
- To improve HIV outcomes OAT must be substantially scaled up in all regions.
- Optimisation of OAT dosing and increasing medication procurement is essential to promote retention.
- Findings may serve as a guide for other countries who have similar HIV epidemics.