The impact of disruptions to services for people who inject drugs in Ukraine: Modelling the potential impact of Russia’s invasion

Author: Jack Stone Adam Trickey Tetiana Salyuk Nadiya Semchuk Yana Sazonova Olga Varetska Frederick Altice Peter Vickerman

Theme: Epidemiology & Public Health Research Year: 2022

People who inject drugs (PWID) in Ukraine have high HIV and HCV prevalence. We estimated the
impact of likely disruptions to non-governmental organizations (NGO) activities, opioid agonist
therapy (OAT) and anti-retroviral therapy (ART) following Russia’s invasion of Ukraine.
A dynamic HIV/HCV transmission model among PWID in Ukraine was calibrated using data from four
national surveys of PWID (2011-2017). The model assumed 37-49% NGO coverage, with NGO contact
reducing injecting risk and increasing condom use and OAT/ART recruitment, 4-5% OAT coverage and
35-48% ART coverage in 2017. We estimated the 1 and 10-year impact of ceasing NGOs, OAT and/or
ART from March 2022 for 3, 6 and 12 months in terms of additional HIV/HCV infections and deaths
and impact per person-year (pyr) of closure.
Ceasing all services for 1 year would result in an additional 2,939 (95% credibility interval: 1,954-
4,112) new HIV infections, 2,501 (1,668-3,578) new HCV infections and 3,051 (2,346-4,264) deaths.
Even if services reopened after that year, the one-year closure would have long-term detrimental
impact, with an additional 19,057 (13,449-25,938) new HIV infections, 9,409 (6,134-14,290) new
HCV infections and 9,080 (7,104-11,834) deaths over 2022-2032, equivalent to increases of 39.6%,
6.1% and 2.7% respectively. For each 100pyrs of missed interventions (e.g. an intervention serving
100 PWID closed for 1 year), there would be an additional 3.6 (2.5-4.9) new HIV infections, 1.8 (1.2-
2.7) new HCV infections and 1.7 (1.3-2.2) deaths and 15.6 (12.3-21.1) life-years lost over 2022-2032,
with disruptions to ART having greatest impact on HIV transmission and mortality (Figure). Impact
per person-year of closure is similar irrespective of duration of closure.


Interruptions to services in Ukraine could have a substantial detrimental impact. Russia currently bans OAT and opposes needle and syringe provision. It is essential that Ukraine continues to be able to provide services to PWID.

Disclosure of Interest Statement:

NS, TS, YS, and OV work for the Alliance for Public Health (APH), Ukraine, which is a non-governmental organisation.

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