Piloting viral hepatitis B (HBV) vaccination as part of comprehensive harm reduction package in injecting drug users (IDU) and men having sex with men (MSM) in Ukraine
T. Deshko, S. Filippovych, T. Perepelytsia, O. Savenko
International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine
Issues: WHO recommends HBV vaccination as part of comprehensive HIV prevention in concentrated epidemic. In Ukraine IDU and MSM are groups vulnerable to both HIV and HBV: according to 2006-07 research, HBsAg is found in 13,6% IDU and 9,8% MSM. Although HBV vaccination is recommended by national regulations to IDU and MSM, only newborns get systematically vaccinated, starting several years ago. Several publicly debated child deaths after regular measles vaccination built vaccination skepticism.
Description: International HIV/AIDS Alliance in Ukraine is running HIV prevention program targeting vulnerable populations with GFATM support. Comprehensive package of services is provided annually to 150000 IDU and 13000 MSM. Late 2009 Alliance with WHO consultative support developed pilot initiative on HBV vaccination as part of HIV prevention package for MSM and IDU. A model intervention was developed for NGO IDU and MSM clients basing vaccination in polyclinics where local AIDS centers have HIV testing facilities. Alliance procured vaccines, provided grants to 5 NGOs to manage vaccination in 4 regions based in 7 polyclinics, conducted training for multidisciplinary teams, developed motivational IEC and monitoring framework. 470 IDU and 255 MSM will get 3 doses of vaccine through March-October 2010.
Lessons learned: Medical institutions demonstrated low interest in initiating vaccination for vulnerable groups discouraged by heavy paperwork and reporting, previous vaccination scandals. Only medical institutions regularly contacting vulnerable groups and collaborating with NGOs – AIDS centres – got involved. Adding vaccination to prevention package doubled initial client coverage cost (IDU – $39 and MSM – $42) for clients who get vaccinated.
Next steps: Pilots will provide information about HBV vaccination demand in IDU and MSM, vaccination adherence, and will help correct the initial intervention model with perspective of its broader application. In future vaccination effectiveness research is planned to estimate the number of HBV cases prevented by vaccination program within harm reduction.