Facilitating access to testing and treatment for HIV and hepatitis for Ukrainian refugees in the Czech Republic
Spolecnost Podane ruce o.p.s., Brno, Czech Republic (www.podaneruce.cz)
Doc. MUDr Viktor Mravcik, Head of Research, Czech National Monitoring Centre for Drugs and Addiction; and Spolecnost Podane ruce, Czech Republic
Injecting drug use and associated drug-related infections (HIV and viral hepatitis) have been a major public health challenge in Ukraine for several years. There are an estimated 350 000 people who inject drugs (PWID) in the country; including approximately 20% women. Estimated 21% of PWID are infected with HIV and 64% with HCV. The disruption of health services caused by the armed conflict, including provision of drug treatment and harm-reduction services, is likely to increase the risk of HIV and HCV transmission. The Czech Republic had registered over 300 000 Ukrainian refugees as of May 2022, the majority of them being women. A number of NGOs offering services to drug users have reported increasing numbers of drug- and alcohol using females coming from Ukraine, with approximately half having tested positive for HIV and all being found to experience great distress, trauma and disorientation.
The project seeks to provide access to testing and subsequent treatment to the refugees coming to Podane ruce’s centres, with the support of a team of 10-15 Russian and/or Ukrainian speaking peers. The project aims to reach some 3000 people from the refugee community, test at least 100 people who use drugs (PWUD) and other people at risk for HIV and HCV and link them to treatment and follow-up services as needed, including methadone substitution therapy. The project will also explore risks factors for HIV and HCV transmission and map needs and gaps in current health service for Ukrainian refugees, with a main focus on PWUD.
The study population will be reached through a combination of information and awareness campaigns aimed at refugees (using printed and electronic materials in Russian and Ukrainian). The main counselling centre for Ukrainian refugees will offer counselling for somatic and mental health problems and ensure linkage to testing, treatment and care, including referral to methadone substitution therapy. A total of 15 centres of Podane ruce (including two methadone centres, the outreach programme and drop-in centres) will offer HIV and HCV testing to refugees with risk behaviour (particularly PWUD) as well as referral to treatment and follow-up monitoring. Ukrainian and/or Russian speaking medical students will be available to support all centres. In addition, Ukrainian and/or Russian peers will be trained to accompany and support clients through the testing and treatment follow up processes. Lastly, a survey will be conducted among Ukrainian clients to assess HIV and HCV transmission risks factors and map health service provision needs and gaps. Semi-structured interviews and focus group discussions will be conducted with a minimum of 30 people to provide additional insights regarding the preparedness of the Czech Republic to respond to crisis situations and the adequacy of the services provided.
The project will increase the number of refugees at risk of, or living with, HIV and/or HCV in the Czech Republic who have access to testing and treatment and other health support services (e.g. mental health care or harm reduction). In close cooperation with the Czech National Monitoring Centre for Drugs and Drug Addiction the project will provide a) insights on possible needs for adjusting existing national surveillance systems for HIV and HCV, b) recommendations to improve service provision for refugees and c) input into developing revised national policies and guidance for the management of HIV and co-infections among migrants. It will further empower a team of 10 peer educators to provide services for migrants at risk of HIV/HCV and help document lessons learned for the provision of care in similar emergency situations.