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Model of HIV Prevention and Care Among Chronic Substance Abusers

The use of injection drugs is the main cause of HIV transmission in Russia. An important part of the fight against the HIV epidemic is preventing substance abuse and risky behavior by substance abusers. The aim of this program is to build a social support system for substance abusers and people living with HIV that will give clients access to high-quality care from different types of specialists and will help ensure that they participate in psychological, rehabilitative, and preventive activities.

Key components: 

Statistics on Russian HIV prevalence clearly indicate that the main factor in HIV infection is injection drug use; an estimated 80% of all new cases of HIV infection from 1987 to 2008 were associated with injection drug use and opioid dependence, and the number of HIV+ women is also increasing.

This makes efforts to address the interconnected problems of HIV and injection drug use a critical element of measures aimed at improving the health of this at-risk population, and keeping the target audience informed and connected to a multi-sectoral medical and social support network and system of care.

HIV/AIDS and injection drug use are closely linked health problems in the Russian Federation; government statistics estimate that approximately 80% of all new cases of HIV infection from 1987 to 2008 were associated with injection drug use and opioid dependence.

Nonetheless, in a post-Soviet health care system run by the state, and focused on curative rather than preventive care, substance abuse and HIV treatment and prevention centers operate independently and with minimal communication or collaboration.

The Health and Development Foundation created this model of care in order to assist in the integration and colocation of the treatment of these two health crises, and build an integrated support network for clients. This model has a multifaceted approach, and addressed two target audiences: substance abusers, and a particularly vulnerable subset, women with substance abuse or HIV in their medical history.

In 2010, the Health and Development Foundation launched a pilot version of an mHealth initiative aimed at the latter group in St. Petersburg. Clients who came to St. Petersburg Maternity Hospital No. 16, a hospital for high-risk patients, during pregnancy or for delivery were invited to join the program based on the following criteria: injection drug use in their medical history, experience as a commercial sex worker, or HIV+ status (169 women total). Female clients were selected for the same criteria at St. Petersburg State Narcological Hospital (86 total).

Selected clients received individual counseling, and upon release from the hospital, these women received text messages, developed by relevant health care specialists, with content related to counseling topics: encouraging adherence to substance abuse treatment, the prevention and treatment of HIV and other infectious diseases, reproductive health, information on childcare and more.

This mHealth pilot program was part of the larger comprehensive initiative in St. Petersburg intended to create a support system to ensure the most effective care for HIV and substance abuse risk groups through interagency and intersectoral collaboration, training of health care providers, utilization of NGO peer counselors, and HIV/substance abuse counseling for clients.

Both the initiative as a whole and the mHealth component showed positive results, with a high percentage of clients willing to participate, and M+E data show positive outcomes in terms of behavior change (more HIV tests and treatment received, a higher willingness to continue substance abuse treatment) and attitude of clients towards the text message service (the amount of clients who actively used text message information or saved them as reference material)