Monday, July 27, 2009

Update on the situation in Uzbekistan regarding the suspension of substitution treatment

Dear Colleagues:

I am passing on a thank you to those of you who signed on to the attached letter to the President of Uzbekistan regarding the suspension of substitution treatment in that country. The list of signatories is an impressive group of professionals from around the world. There is also an update about the situation there and what people might do to support the improvement of treatment for opiate dependent people in that nation.

I think it is very important that American professionals participate in international efforts to improve the treatment of substance using patients as well as contribute to such efforts at home. I thank you for your efforts as well. Andrew Tatarsky, PhD Harm Reduction Psychotherapy and Training Associates


Dear colleagues,

EHRN is thankful for your support to substitution treatment in Uzbekistan, and for your help to its initiative aiming to inform the President and Government of Uzbekistan about the negative consequences of closing the OST program. EHRN sent the attached letter to its addressees, and we will inform you once we receive feedback.

Meanwhile, we thought we should provide a brief update based on our discussions with local specialists and EHRN Director Raminta Stuikyte's visit to the country:

According to the Ministry of Health of Uzbekistan, the opioid substitution therapy program there was a pilot program which had come to conclusion and which had been evaluated. Following the evaluation, the pilot program was not extended and no new ‘non-pilot’ program is set up. According to information gathered through a series of meetings with local stakeholders, international organizations and local NGOs were not consulted and the decision was made without them. Local NGOs and international organizations recognize that the pilot program had to address quality issues, including illegal drug use by clients, however, general appreciation of the substitution pilot was expressed during the EHRN’s Director visit to Uzbekistan last week. According to anecdotal information, the program's 200 patients are currently undergoing other treatment options or have ceased to have contact with health settings.

Although the Ministry of Health communicated openness to gathering further evidence around substitution therapy, it is unlikely that their decision to fend the pilot and not to start implementing substitution therapy in the health system can be reversed in the near future. One opportunity to return to this discussion is to conduct an assessment of OST implementation in Uzbekistan, demonstrating that the problems were related to the particular program rather than the method itself.

AIDS NGOs and other stakeholders met by the EHRN Director during her visit to Uzbekistan last week are rather pessimistic about the future of OST and also about other harm reduction services in the country. Current funding for low threshold programs is coming to end and the last three attempts to get support from the Global Fund were not successful. Additionally, a national program around spiritual and moral values which was recently approved by the Uzbek AIDS Commission might have impact on harm reduction developments and operations of more than 200 low threshold sites for drug users operating in the country. Two major harm reduction NGOs: the local branch of World Vision running one service site; and CARHAP providing methodological, technical and other support, are both closing their operations around harm reduction. However, an Uzbek NGO consortium is planned to be a principal recipient in a new RCC application to the Global Fund (to extend the current GF-funded program with similar or larger levels of funding) and take over responsibility for all services and advocacy work around vulnerable groups, including injecting drug users. The draft proposal excludes OST. Some problems of existing low threshold programs exist and, for example, a service site visited in Tashkent did not have needles for the last one or two months and as waiting for procurement from the GF project management. Thus more investment into the Uzbekistan’s harm reduction with a solid capacity building element is needed. The governmental commission is currently doing some review of data on low-threshold programs.

The country is closed and rather isolated. There is a need for more support for harm reduction capacity on the ground, however this should be implemented through a dialogue with governmental institutions, respecting their competence and understanding limited role of international agencies.

Thank you again, and we hope that you will continue to support EHRN initiatives and public health programs in the region of Central and Eastern Europe and Central Asia. Best regards, Alec Khachatrian EHRN consultant

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