Ensuring sustainable psychosocial services and comprehensive HIV, tuberculosis (TB), and hepatitis C virus (HCV) care package to detainees in Ukrainian pre-trial detention centers

BACKGROUND: Ukraine has the second'largest HIV epidemic in Eastern Europe, and HIV prevalence in Ukrainian penal settings is 8.9%. Since 2017, the USAID/PATH Serving Life project has implemented a comprehensive HIV, TB, and HCV care package for people in penal settings across 12 regions in Ukraine. In 2021, Serving Life, together with the Ministry of Justice of Ukraine's Center of Health Care (MOJ/CHC), implemented the first pilot to provide sustainable psychosocial and HIV services to detainees in a pretrial detention center (SIZO).
DESCRIPTION: A Serving Life-supported NGO hired and trained a social worker for HIV/TB/HCV prevention, HIV rapid testing, and treatment adherence in Poltava SIZO's health care unit. Serving Life financed the social worker''s activities during the one-year pilot, while advocating for staffing changes to add this position as regular SIZO staff. As a result of this advocacy, the MOJ/CHC granted approval to officially employ the NGO social worker in the SIZO using state funds, and as of January 2022, the first social worker was officially included in the SIZO's health care unit staff, employed and paid through MOJ/CHC.
LESSONS LEARNED: In 2021, the NGO social worker conducted counseling and motivational interviewing sessions for SIZO detainees (222 on HIV/TB/HCV prevention; 250 on HIV index case testing (ICT) and ART adherence; 663 on HIV pre- and post-testing; 31 on drug dependency). He also counseled 37 HIV-positive detainees (index clients), who accepted ICT services and provided contact information for their 72 index partners. Seventy index partners were tested for HIV and 9 new HIV-positive cases were identified and linked to treatment, a 12.9% case yield from the social worker's efforts. Daily provision of psychosocial services to detainees by a trusted, trained social worker, without stigma and discrimination, was key to the pilot's success.
CONCLUSIONS: The successful pilot in Poltava SIZO showed the value of counseling and motivational interviewing to provide comprehensive HIV/TB/HCV care in penal settings, and provided an opportunity to ensure sustainability of psychosocial services for detainees using state funds beyond the Serving Life project. The MOJ plans to expand this approach to all SIZOs in Ukraine in 2023.

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