Modelling the impact and cost‐effectiveness of non‐governmental organizations on HIV and HCV transmission among people who inject drugs in Ukraine

Abstract

Introduction People who inject drugs (PWID) in Ukraine have high prevalences of HIV and hepatitis C virus (HCV). Non‐governmental organizations (NGOs) provide PWID with needles/syringes, condoms, HIV/HCV testing and linkage to opioid agonist treatment (OAT) and antiretroviral therapy (ART). We estimated their impact and cost‐effectiveness among PWID. Methods A dynamic HIV and HCV transmission model among PWID was calibrated using data from four national PWID surveys (2011–2017). The model assumed 37–49% coverage of NGOs among community PWID, with NGO contact reducing injecting risk and increasing condom use and recruitment onto OAT and ART. We estimated the historic (1997–2021) and future (2022–2030, compared to no NGO activities from 2022) impact of NGOs in terms of the proportion of HIV/HCV infections averted and changes in HIV/HCV incidence. We estimated the future impact of scaling‐up NGOs to 80% coverage with/without scale‐up in OAT (5–20%) and ART (64–81%). We estimated the cost per disability‐adjusted life‐year (DALY) averted of current NGO provision over 2022–2041 compared to NGO activities stopping over 2022–2026, but restarting after that till 2041. We assumed average unit costs of US$80–90 per person‐year of NGO contact for PWID. Results With existing coverage levels of NGOs, the model projects that NGOs have averted 20.0% (95% credibility interval: 13.3–26.1) and 9.6% (5.1–14.1) of new HIV and HCV infections among PWID over 1997–2021, respectively, and will avert 31.8% (19.6–39.9) and 13.7% (7.5–18.1) of HIV and HCV infections over 2022–2030. With NGO scale‐up, HIV and HCV incidence will decrease by 54.2% (43.3–63.8) and 30.2% (20.5–36.2) over 2022–2030, or 86.7% (82.9–89.3) and 39.8% (31.4–44.8) if OAT and ART are also scaled‐up. Without NGOs, HIV and HCV incidence will increase by 51.6% (23.6–76.3) and 13.4% (4.8–21.9) over 2022–2030. Current NGO provision over 2022–2026 will avert 102,736 (77,611–137,512) DALYs when tracked until 2041 (discounted 3% annually), and cost US$912 (702–1222) per DALY averted; cost‐effective at a willingness‐to‐pay threshold of US$1548/DALY averted (0.5xGDP). Conclusions NGO activities have a crucial preventative impact among PWID in Ukraine which should be scaled‐up to help achieve HIV and HCV elimination. Disruptions could have a substantial detrimental impact.

Early disruptions to syringe services programs during the Russian invasion of Ukraine

“…Furthermore, harm reduction organizations should strive to consistently adhere to data reporting, particularly during periods of crisis, so that allocations and client transfers can be uninterrupted. Non-governmental organizations (NGOs) that provide all of the harm reduction activities in the country have substantially contributed to cost-effective reductions in transmission of HIV and HCV (35). To sustain these gains, NGOs will need to work in concert with each other across the diverse regions of Ukraine to maintain prevention services to control potentially volatile HIV and HCV outbreaks during the war.…”

Evaluation of Process Indicators and Challenges of the Elimination of Mother-to-Child Transmission of HIV, Syphilis, and Hepatitis B in Bali Province, Indonesia (2019–2022): A Mixed Methods Study

“…The involvement of non-governmental organizations (NGOs) in monitoring the treatment of pregnant women with syphilis and hepatitis is required [44]. Currently, the support provided by NGOs has been predominantly directed towards pregnant women with HIV; however, extending this assistance to encompass women with syphilis and hepatitis is required to enhance EMCTC outcomes.…”