Todadze K, Lezhava G. Implementation of drug substitution therapy in Georgia. Cent Eur J Public Health. 2008;16(3):121-3.
The geopolitical uniqueness of the regional socioeconomic situation and the existence of territories outside the control of the national government have facilitated the spread of drug use in Georgia. A special problem is injection of opiates, in particular heroin and Subutex (buprenorphine). It has been established that among registered HIV infected individuals the main route of transmission is injecting drug use. Although the prevalence of HIV among people who inject drugs is only 1-3%, the high number of injecting drug users and the high prevalence of hepatitis C in this population creates high risk of dramatic spread of HIV in Georgia. Beginning at the end of 2005, the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria supported methadone substitution programmes in Georgia. At present, three programmes are functioning. At the same time, they involve 230 patients altogether. The studies carried out by the Research Institute on Addiction, with the aim to control the efficacy of pilot programmes have revealed a dramatic improvement of psychophysical state of patients, with very high rate of re-socialization and decriminalization, and significant diminishment of drug-related risky behaviour. Obtained results indicate high efficiency of methadone substitution programmes in Georgia, as an important tool both for treatment of opioid dependence and harm reduction. In order to obtain a more significant impact on public health, substitution therapy programmes have to be further expanded.
Editors’ note: Drug use in Georgia, an important drug transit route from Asia to Europe, escalated in the early 1990s following the breakdown of the Soviet Union, and ensuing unemployment and social pessimism. Despite economic development and crime reduction, drug use has not decreased. The Georgian parliament passed a law in 2002 permitting substitution therapy. This report of improved health and psychosocial patient outcomes from Georgia’s first methadone substitution programme should spur expansion of the programme there and set an example for other Eastern European countries.
Jürgens R, Ball A, Verster A. Interventions to reduce HIV transmission related to injecting drug use in prison. Lancet Infect Dis. 2009;9(1):57-66. The high prevalence of HIV infection and drug dependence among prisoners, combined with the reuse of non-sterile injecting drug equipment, make prisons a high-risk environment for the transmission of HIV. Ultimately, this contributes to HIV epidemics in the communities to which prisoners return on their release. Jürgens and colleagues reviewed the effectiveness of interventions to reduce injecting drug use risk behaviours and, consequently, HIV transmission in prisons. Many studies reported high levels of injecting drug use in prisons and HIV transmission has been documented. There is increasing evidence of what prison systems can do to prevent HIV transmission related to injecting drug use. In particular,
needle and syringe programmes and
opioid substitution therapies have
proven effective at
reducing HIV risk behaviours in a wide range of prison environments,
without resulting in negative consequences for the
health of prison staff or prisoners. The introduction of these programmes in countries with an existing or emergent epidemic of HIV infection among injecting drug users is therefore warranted, as part of comprehensive programmes to address HIV in prisons.
Editors’ note: Although most prisoners living with HIV contract their infections before imprisonment, the risk of acquiring HIV in prison through use of contaminated injecting equipment is high. Prisoners have the right to receive health care, including preventive measures, equivalent to that available in the community. Furthermore, national commitments to universal access to prevention, treatment, care, and support cannot be achieved without introducing and rapidly expanding comprehensive HIV programmes in prisons. Thus, implementation of evidence-informed HIV programming in prisons is an essential component of any national AIDS programme.
Bayoumi AM Md Msc, Zaric GS Phd. The cost-effectiveness of Vancouver’s supervised injection facility. CMAJ. 2008;179(11):1143-1151.
The cost-effectiveness of Canada’s only supervised injection facility has not been rigorously evaluated. Bayoumi and colleagues estimated the impact of the facility on survival, rates of HIV and hepatitis C virus infection, referral to methadone maintenance treatment, and associated costs. They simulated the population of Vancouver, British Columbia, including injection drug users and persons infected with HIV and hepatitis C virus. The model used a time horizon of 10 years and the perspective of the health care system. They compared the situation of the supervised injection facility with one that had no facility but that had other interventions, such as needle-exchange programmes. The effects considered were decreased needle reuse, increased use of safe injection practices and increased referral to methadone maintenance treatment. Outcomes included life-years gained, costs, and incremental cost-effectiveness ratios discounted at 5% per year. Focusing on the base assumption of decreased needle reuse as the only effect of the supervised injection facility, they found that the facility was associated with an incremental net savings of almost $14 million and 920 life-years gained over 10 years. When the authors also considered the health effect of increased use of safe injection practices, the incremental net savings increased to more than $20 million and the number of life-years gained to 1070. Further increases were estimated when they considered all 3 health benefits: the incremental net savings was more than $18 million and the number of life-years gained 1175. Results were sensitive to assumptions related to injection frequency, the risk of HIV transmission through needle sharing, the frequency of safe injection practices among users of the facility, the costs of HIV-related care and of operating the facility, and the proportion of users who inject in the facility. Vancouver’s supervised injection site is associated with improved health and cost savings, even with conservative estimates of efficacy.
Editors’ note: Supervised injecting facilities or SIFs provide a hygienic, safe environment for people to inject their previously obtained illicit drugs under supervision. SIFs reduce overdose mortality, decrease public injecting and discarding of syringes, and increase referrals to social and health services. This computer simulation estimates considerable cost savings and improved health outcomes comparing a supervised injecting facility to standard needle exchange and methadone maintenance treatment. Findings such as these, combined with results from acceptability, feasibility, and anticipated impact studies, support evidence-informed decision-making about the introduction and continued functioning of such programmes.
