Ukraine

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Focus: HIV prevention and treatment in prison populations

Affiliation: The Ukrainian Institute on Public Health Policy (UIPHP); Yale Schools of Public Health and Medicine

Contacts: Dr. Frederick Altice, MD, MA frederick.altice@yale.edu; Sergii Dvoriak, M.D., Ph.D. dvoryak@uiphp.org.ua

Projects: The training site will include the Ukrainian Institute on Public Health Policy (UIPHP), which has ongoing relationships with the country’s two largest NGOs that provide HIV prevention and treatment in Ukraine - Alliance Ukraine and the All Ukrainian Network of People Living with HIV - the Ministry of Health, Ministry of Prisons, WHO, USAID and CDC.  Drs. Altice and Dvoryak have collaborated together since 2005 in these sites, which have served as training sites for numerous pre- and post-doctoral fellows.  In 2005 alone, Drs. Altice and Dvoryak were among the first to train 32 Ukrainian physicians and administrators on the treatment of HIV and opioid dependence when they first introduced buprenorphine into the country as primary and secondary HIV prevention.  Many of these trainees have moved to important positions in the Ministry of Health, Clinton Foundation and professional societies within Ukraine.  Since then, the team has continued to train individuals both from Ukraine and the United States on issues related to urban health, HIV, tuberculosis, health services research and addiction medicine.  Drs. Altice and Dvoryak collaborate on two active R01 grants from the National Institutes on Drug Abuse.  The first is to conduct research in collaboration with the criminal justice system. This grant collaborates with the United Nations Office of Drug Coordination for Central Asia and with collaborators in Georgia. This grant is to conduct intervention research with prisons primarily in Ukraine, but also has been extended through funding from UNODC to include prison-related research in the five countries of Central Asia (Kazakhstan, Kyrgystan, Uzbekistan, Turkmenistan, Tajikistan) and Azerbaijan.  The second NIH grant is to conduct implementation research to expand methadone and buprenorphine treatment for HIV prevention and treatment in Ukraine and to use health services research methods to introduce the integration of extended-release naltrexone into HIV clinical care settings. All of this work has mathematical modeling approaches to support the findings.  In addition, Drs. Altice and Dvoryak have been funded by numerous other international agencies, including USAID, CDC, UNAIDS, Open Society Institute and the Global Fund to conduct research on healthcare delivery systems for people who use drugs, including the development of the first integrated healthcare systems.  On-going projects for fellows include:

  1. A NIDA-funded (R01-DA-029910) research program designed to address the linked epidemics of HIV, injection drug use, and the criminal justice system among states of the former Soviet Union. This multi-phase investigation is focused on: (a) evaluating the prevalence of chronic infectious diseases, mental illness, and substance use disorders among soon-to-be-released prisoners with HIV or at risk for HIV; (b) disseminating research findings with criminal justice officials and stakeholders to establish research priorities and plan interventions; and (c) conduct pilot studies to develop and evaluate effective strategies for reducing HIV transmission among IDUs.   
  2. A NIDA-funded (R01-DA-033679) project aimed at expanding access to and retention on medication-assisted therapies (opioid substitution therapy including methadone, buprenorphine and extended-release naltrexone) for the treatment of opioid dependence through the use of an evidence-based intervention program, NIATx (Network for the Improvement of Addiction Treatment). Specifically, this research will: (a) evaluate the individual- and organization-level facilitators and barriers to entry into and retention in MAT in Ukraine; (b) train experts in the use of the NIATx model; and c) To develop a new healthcare delivery model, using XR-NTX, to increase access to MAT by integrating XR-NTX directly into HIV clinical care settings, including health services research and implementation science methods. 

Webpages for sites and research programs:
Yale:    http://medicine.yale.edu/intmed/people/frederick_altice-3.profile
http://cira.yale.edu/people/frederick-l-altice-md