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HIV and drug prevention in Estonia Harm reduction services

HIV and drug prevention in Estonia Harm reduction services. Aljona Kurbatova National Institute for Health Development Tallinn, Estonia. Republic of Estonia: Population – 1.29 million people 276 newly diagnosed HIV cases per million population in 2011 (n=370)

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HIV and drug prevention in Estonia Harm reduction services

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  1. HIV and drugpreventioninEstoniaHarmreductionservices Aljona Kurbatova NationalInstituteforHealthDevelopment Tallinn, Estonia

  2. Republic of Estonia: • Population – 1.29 million people • 276 newly diagnosed HIV cases per million population in 2011 (n=370) • Decrease in the number of new HIV cases (2012; n=315) • A total of 8 377 HIV-cases in 1988–2012 • Main risk group – people who inject drugs • Highest rate of overdose deaths in EU • All possible comorbidities – HIV/IDU, HIV/TB, TB/IDU, IDU/HIV/TB, IDU/HIV/MDR-TB.

  3. Peoplewhoinjectdrugs • Oldestimate:13 801 IDUs in Estonia in 2004, which translated into a prevalence of 2,4% (95% CI 1,4-5.9)among people 15-44 years. • New estimate: 5 362 IDUs in Estonia in 2009, which translated into a prevalence of 0,9% (95% CI 0,7–1,7%)among people 15-44 years. • Experts’ estimate: around 8 000 – 9 000 • IDU prevalence is mostly confined to two (out of 15) counties – Harjumaa including Tallinn and Ida-Virumaa (North-East). • According to the available data the age and injecting period of IDUs is increasing - the population seems to have stabilized. • Main drug – fentanyl, 3-methylfentanyl • Thereisevidencethatinjecting of amphetamineshasincreased.

  4. Background • First NSP project was launched inMay1997 – needle and syringe exchange was provided from a vehicle (car) in Tallinn (NGO AIDS Support and Information Centre). • In 1998 HIV voluntary testing and counselling centre in Narva started second needle and syringe exchange project. • In June 2000 NSP services were extended to other cities in North-East of Estonia - Narva (4 sites in total), Kohtla-Järve (2 sites in total), Jõhvi, Sillamäe and Kiviõli. • Firstopioidsubstitutionprogrammsin 1997, howeverofficially OST startedin 2002.

  5. Background • In the beginning of 2000-s national government and Tallinn City Government started to support harmreductionprogrammes, however resources allocated were very modest. • In 2003 Global Fund Programme is launched and more systematic development of the harmreductionbecomes possible on national level. • In 2004 European Commission PHARE project in collaboration with Netherlands is launched which allows to establish three new low threshold centres in cooperation with local municipalities – Tallinn, Kohtla-Järve ja Paide. • Fromthe end of 2007 harmreduction programmes are fianncedfromthestatebudget. • 2010-2013 additionalfundingforcounsellingservicesfromEuropeanSocialFund

  6. National HIV Policy Main actionareas: • Harmreductionprogramsforpeoplewhoinjectdrugs • Syringeexchangeprograms • Opioidsubstitutiontreatment • Counselling • Overdoseprevention • HIV testing and counselling (based on risk behaviors and indicatorconditions) and STI testing • Voluntary HIV testing and counselling • PilotingoftheInternet-facilitated STI testingforMSM • Pilotingofthe partner notification and testing (STI servicesfor IDUs and theirsexualpartners • STI testing, treatment and counsellingservicesforCSW • STI testing, treatment and counsellingservicesforIDU • STI testing, treatment and counsellingservicesforuninsuredyoungpeople • HIV-relatedhealthcareservicesincluding ARV treatment (free of chargefor all)

  7. Nationaldrugpolicy Main actionareasrelevanttotheinjectingdruguse: • Drugtreatment and rehabilitation • Detoxification • Long-termmedicalrehabilitation (psychotherapyetc) • Counselling

  8. Basic structureofservicesfordrugusers • Lowthreshold • Establishment of the first contact, provision of motivation for treatment – family physicians, harmreductionsevices, counsellingetc. • Addiction treatment, rehabilitation • Healthcareorganisations, rehabilitation centres. • Aftercare, reintegration • Counsellingservices - social, psychological, peer counselling. • Supportservices and possibilities for the reintegration of former drug addicts in the labour market (limited).

  9. NATIONAL STRATEGY: Long term objectives (united effort of different sectors and organisations) ACTIVITY PLAN OF THE STRATEGY yearly plan – the amount of services targeted atpeoplewhoinjectdrugsisplanned for the whole country ACTIVITY PLANS OF SERVICE PROVIDERS IN THE REGION Yearly plan – the amount of service planned for each organisation (in cooperation of service providers and NIHD). SERVICE DESCRIPTION – the types of services provided, required conditions, safety requirements, etc (in cooperation of service providers and NIHD). Work process

  10. NIHD in national level: • coordinating the general development of the service, • planning the budget and theservice need for the country, • conducting public procurements (syringes, needles, condomsetc) • financing the service, • organising staff trainings, • conducting studies, • analysing the results of the service. • Service providers in regional level: • planning the service and the budget in their organisation, • delivering service to the target group, • participating in preparing service descriptions/standards • Participatinginresearch and development. The roles of differentpartners

  11. Some of thelatestdevelopments • National HIV policyhasbeenintegratedintoHealthActionPlan 2009-2020. • Ministry of Interiorhastakenovercoordination of thenationaldrugpolicy • New national HIV testingguidance • Rapid testingincommunitysettingsincollaboration of NIHD, healthcare and communitybasedorganisations (althoughlegallyrestrictedtohealthcaresettings) • Regionalexpansionof OST • Piloting of thetake-homenaloxone programme in 2013, preparationsunderway

  12. Thankyou!

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