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Background:
Kyrgyzstan is the country with the high level of injected drugs using and estimated number of PWID (people who inject drugs) is 25,000. Prevalence of HIV among PWID – 16.2%, and Hepatitis C – 62.2%. Although the state started activities to expand viral hepatitis treatment, due to lack of funds, and also stigma and discrimination, PWID have no chance of receiving treatment.
With support of UNITAID, Frontline and the Alliance for Public Health (Ukraine), a model of community-based HCV diagnostics and treatment is being introduced. The model is being introduced in the form of operational study approved by WHO, local Ethics Committee, and 2,200 PWID will receive treatment on the basis of a non-governmental organization. Study results will be the basis for scaling-up the model of simplified access to hepatitis C diagnostics and treatment.
Description of care/intervention model:
1.In order to introduce the model, legislation was revised including orders for hepatitis diagnostics and treatment that include the possibility of community-based testing, diagnostics and treatment of hepatitis C.
2.According to legislation, services of diseases diagnostics and treatment require creating conditions for the provision of services and obtaining a medical license, which was fulfilled.
3.Non-governmental organizations providing harm-reduction services conduct express-tests for hepatitis C among PWID and in case of positive tests accompany them to our organization for diagnostics and treatment.
4.Innovativeness of the model is in the fact that PWID may undergo complete diagnostics and start treatment in three visits. In our organization hepatitis C is confirmed (PCR), all companion diagnostics (hepatitis b, HIV, pregnancy, fibrosis degree etc.) and will receive treatment drugs here as well. In case of HIV, hepatitis B and other diseases detected, a patient will be sent to relevant organizations.
Effectiveness:
More than 8000 PWID will be tested for hepatitis C, 2,200 people will be treated. Hepatitis C prevalence among PWID will be reduced twice. PWID note that they prefer this model as reduced is the number of visits and expenses, no queues, no stigma and discrimination, questions of the disease and treatment are explained in simple language.
Conclusion and subsequent steps:
The model allows extending coverage of at-risk populations with hepatitis C treatment, provide services with low costs and exclude discrimination. The model can be scaled-up to majority of countries and can be used for treating of other diseases including HIV, STDs.
We will present an algorithm of how communities can be integrated into the healthcare system, obtain permission documents for the provision of diagnostics and treatment services, as well as ensure import, procurement, storage of diagnostics means and drugs. Using WHO recommendations and national clinical recommendations, we will talk about the arranging the process of simplified inclusion of drug users into treatment. By the moment of the conference holding, we will have results of community-based treatment and its effectiveness. We will note barriers and methods of their overcoming while arranging community-based treatment model.
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