Effectiveness And Cost Effectiveness Of Expanding Harm Reduction And

Antiretroviral Therapy In A Mixed HIV Epidemic: A Modeling Analysis For

Ukraine

A new study from Stanford researchers published in PLoS Medicine makes the

case that a combination of methadone substitution therapy and

anti-retroviral treatment would have the greatest effect on reducing new

infections and improving quality of life in a region where HIV is spreading

rapidly among intravenous drug users. 

In the past decade, an epidemic of HIV has swept through Ukraine, fueled

mostly by intravenous drug use. Of Ukraine's approximately 390,000

intravenous drug users as many as half are HIV-infected. Researchers at

Stanford and Veterans Affairs Palo Alto Health Care System have

demonstrated, using a cost-effectiveness modeling study, that the most

effective way to combat the spreading disease is a combined program of drug

substitution - providing methadone for opiate users, for instance - and

anti-retroviral therapy for those already infected with HIV. 

"HIV is spreading in Eastern Europe more quickly than in any other part of

the world," said Margaret Brandeau, the Coleman F. Fung Professor of

Engineering at Stanford University and senior author of the study. "Our

study shows that substitution therapy for injection drug users is an

inexpensive and effective means of curbing HIV transmission in the region." 

With no further intervention, the study predicts that HIV prevalence will

reach 67.2 percent in intravenous drug users in 20 years. The authors

further show that providing drug-substitution to just 25 percent of

intravenous drug users today could lower that figure considerably. 

"Not only does drug substitution therapy work, but it is remarkably

cost-effective when you consider total costs of treating and caring for a

growing HIV-infected community," said lead author Sabina Alistar. 

"Providing effective drug substitution therapy and HIV antiretroviral

therapy together to the injection-drug-using community protects the entire

population - it actually prevents more infections in non-drug users than in

the drug-using community," said Douglas K. Owens, co-author and a senior

investigator at the VA Palo Alto Health Care System and professor of

medicine at Stanford University. 

Funding: This research was supported by Grant Number R01DA15612 from the

National Institute on Drug Abuse. Sabina S. Alistar is also supported by a

Stanford Graduate Fellowship. Dr. Owens is supported by the Department of

Veterans Affairs. The funders had no role in study design, data collection

and analysis, decision to publish, or preparation of the manuscript. 

Competing Interests: DKO received an honorarium from Quintiles to prepare a

continuing medical education lecture about HIV screening. No other competing

interests have been declared. 

Citation: Alistar SS, Owens DK, Brandeau ML (2011) Effectiveness and Cost

Effectiveness of Expanding Harm Reduction and Antiretroviral Therapy in a

Mixed HIV Epidemic: A Modeling Analysis for Ukraine. PLoS Med 8(3):

e1000423. doi:10.1371/journal.pmed.1000423 

Source: 

PLoS Medicine