The Global HIV Epidemics among People Who Inject Drugs

scale-up is cost-effective even at moderate levels of intervention impact, and very cost-effective at higher levels of effectiveness. This study corroborates finding from other modeling studies for Ukraine which adopted a different methodology and found the scale-up of MAT alongside ART at very high levels to be very cost-effective in Ukraine (Alistar, Owens et al. 2011).

Our model shows that if Ukraine increases coverage for NSP to 75 percent and HCT for PWID to 60 percent, with proportionate provision of ART to PWID and 15 percent coverage of MAT among opiate-dependent PWID, then it can reduce new infections in this group by 34 percent compared to status quo at 2011 levels of coverage. This depends on the interventions being highly effective—a requirement that Ukrainian implementers can meet, but not without some change to the overall policy environment. This reduction is in the range established for Ukrainian cities by other studies modeling similar scale-up of NSP, MAT, and equitable access to ART (Strathdee, Hallett et al.

2010).

While we do not model structural factors, other studies have done so (Strathdee, Hallett et al. 2010), and they suggest that removal of punitive provisions against PWID in Ukrainian cities such as Odessa can ameliorate the risk environment, diminish stigma, and reduce the risk of HIV acquisition.

Besides such benefits in epidemic control, reducing problematic police practices related to PWID is an important human rights issue.