AEGiS-15IAC: The impact and cost of expanding harm reduction activities in Odessa, Ukraine.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

The impact and cost of expanding harm reduction activities in Odessa, Ukraine.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. TuOrC1114)

Vickerman PT, Kumaranyake L, Watts C, Guinness L, Balakireva O, Artyukh O, Yaremenko A
London School of Hygiene and Tropical Medicine, London, United Kingdom

BACKGROUND: There are ~25,000 injecting drug users (IDUs) in Odessa. In 2000 the IDU HIV prevalence was 64%. A harm reduction project started in Sept 1999. It reached 7524 IDUs and distributed 71,273 syringes in its 1st year. The percentage of reached IDUs not sharing syringes doubled in 2 years. We estimate the cost-effectiveness of the project for Sept 1999 to Aug 2000, and forecast the cost of scaling it up to achieve greater reductions in HIV incidence.

METHODS: The economic costs of the project were collected for its 1st year. Epidemiological and behavioural data were compiled from project records and behavioural surveys. The project's impact on risk behaviour was estimated from this data. A mathematical model was used to estimate the impact of the project among the IDUs and their sexual partners. An uncertainty analysis was undertaken around the model's inputs. The impact and costs of scaling up activities were also modelled.

RESULTS: The annual economic cost of the project was $76,797 and the cost per syringe distributed was $1. The model estimated the project caused a 20% decrease in IDU HIV incidence to 20 infections per 100 person years (20%). The unit costs and the estimated cost effectiveness of the project is shown in Table 1. For the project to reduce the HIV incidence to below 15%, three times as many IDUs need to be reached with an estimated cost of $80,000-228,086 depending on the nature of expanding services. For the project to reduce the HIV incidence further, to levels similar to IDU populations in industrialised countries (<10%), greater reductions in syringe sharing are required. [table: see text]

CONCLUSIONS: Harm reduction projects can be cost-effective when the IDU HIV prevalence is high. However, substantial reductions in HIV incidence can only be achieved if IDU projects achieve high coverage. Given that 3% of the adult population in Odessa are IDUs, this requires mobilising resources to deliver harm reduction services more broadly to the population in order to control the epidemic.

Keywords: AEGIS, Substance Abuse, Intravenous, Needle Sharing, Harm Reduction, Acquired Immunodeficiency Syndrome, Incidence, Prevalence, Risk-Taking, Costs and Cost Analysis, HIV Infections, Syringes, HIV Seropositivity, HIV Seroprevalence, Cost-Benefit Analysis, Disease Outbreaks, Ukraine, Adult, economics

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