Until the mid-1990s, opioid use was rare in the post-Soviet countries of Eastern Europe and Central Asia. Opioid users now represent 80-90% of the registered drug users seeking medical care. In most of the Former Soviet Union countries, drug dependency treatment is government-funded. The treatment systems include inpatient and outpatient care facilities, data collection and administrative functions. Most centers focus their treatment efforts on total abstinence. Some centers also have harm reduction programs, including needle and syringe exchange programs and methadone substitution therapy. Over the last several years, HIV infection has been on the rise among injecting drug users in Eastern Europe and Central Asia. In 2005, the WHO added methadone and buprenorphine to the WHO Model List of Essential Medicines for opioid addiction treatment. In all the countries where opioid substitution therapy was introduced, program effectiveness evaluations were completed or are now underway. The most detailed study was in Lithuania and Ukraine under the WHO Collaborative Study on Substitution Therapy of Opioid Dependence and HIV/AIDS and ICAP Study in Kyrgyzstan, Kazachstan and Tadjikistan. The primary achievements of opioid substitution therapy programs have been obtaining government funding (Lithuania and Georgia), an opioid substitution therapy program launch in a prison system (Kyrgyzstan). The primary challenges encountered during the introduction and rollout of opioid substitution therapy involved complications in the paperwork required for methadone procurement and importation. Other problems encountered during opioid substitution therapy program implementation were poor levels of awareness among specialists and the general public at program start time, and negative reactions on the part of some law-enforcement authorities. There is a real shortage of Russian-language literature about opioid substitution therapy. The primary responses required to improve the opioid substitution therapy situation are to relax the opioid substitution therapy eligibility requirements, improve physician education and public awareness about opioid substitution therapy, make opioid substitution therapy available to general practitioners, incorporate opioid substitution therapy into undergraduate and postgraduate medical curricula, and campaign to de-stigmatize drug dependent patients.
The relevance of Training Needs Assessment among SUD specialists is connected with the increasing prevalence of substance use in Ukraine, HIV epidemic, the insufficient number of SUD doctors and the lack of accreditation of non-medical SUD specialists. The aim of the project was to study the current needs of SUD specialists in professional education on personal level (according to subjective opinion) for further provision of additional training support to specialists in various spheres, who provide addiction counseling, treatment or rehabilitation services. The survey “Training Needs Survey for SUD specialists”, provided by Substance Use Disorder Advisor SAMHSA, was used in the study. The survey was translated and adapted by the Ukrainian team of researchers and included the following sections: general information, work experience, frequency and ease of use of knowledge and skills, need for knowledge and skills, desired training mode. The survey was conducted among 1008 specialists. An assessment of the training needs among SUD specialists showed a strong interest in new knowledge and skills in SUD assessment and treatment. Existing training courses and programs often do not cover complex issues that are of interest to specialists and do not reflect multidisciplinary approach, and, therefore, require changes in accordance with modern concepts of addiction treatment.
With the ultimate goal of building a sustainable partnership focused on reducing the individual and societal impacts of HIV and substance use disorders in Ukraine consistent with the PEPFAR, SAMHSA and ATTC Network mission, the International ATTC-Ukraine is dedicated to building and supporting a well-trained, recovery-oriented, diverse workforce in order to improve outcomes of substance use disorders treatment and reduce substance-related problems in the country.
The primary mission of the International PEPFAR Addiction Technology Transfer Center – Ukraine
is to assist the government and people of Ukraine
in building competencies and capacities in responding to the HIV epidemic among people with substance use disorders and other key populations. For 1,5 years of operating ATTC Ukraine conducted 26 trainings, which involved more than 844 participants from allover Ukraine with different background and specialization. Training topics included current science on addictions and evidence-based treatment strategies, screening and brief intervention, motivation enhancement, multidisciplinary work with MAT clients, work with specific populations (HIV, LGBT). Training impact was assessed by repeated knowledge tests, attitude measurements, and skills evaluation during supervision. Also we had continued contacts with each organization, involved in trainings, regarding their perception of trainings and further support. Specialists demonstrated improvement in skills and knowledge in 1 and 3 months after the trainings and change in attitude towards people with HIV and SUDs. Due to follow up specialists found easier to talk with clients and work with doubting ones, also they noticed, screened and referred more cases of SUD and substance use. Majority of organizations found training useful with respect to their goals and half of them requested continuous technical assistance. According to prior results, ATTC Ukraine demonstrated its effectiveness in addiction workforce development in Ukraine, but further evaluation is needed.
This symposium will give an overview about the present status of opiod abuse in eastern Europe. Also the first experiences of the PEPFAR Addiction Technology Transfer Center in Ukraine will be demonstrated.