Partnering with the Ministry of Justice (MOJ) to launch and scale Ukraine's first-ever medication-assisted treatment (MAT) as part of comprehensive HIV prevention services for prisoners with opioid dependency

BACKGROUND: HIV prevalence in prisons in Ukraine is 8.9% (2019), and 90% of prisoners incarcerated for drug crimes continue using drugs while in prison. Access to harm reduction services in prison settings is critical to prevent HIV transmission while addressing substance use disorders. However, no drug-related harm reduction programs existed in Ukrainian prisons before 2019. The USAID/PATH Serving Life project partnered with the MOJ to launch and scale the first MAT pilot in prisons.
DESCRIPTION: Serving Life and the MOJ undertook the following steps to pilot MAT: 1. Advocated to integrate MAT into the comprehensive care package in penal settings; 2. Developed standard operating procedures to guide MAT program enrollment, provision of psychosocial support, and MAT adherence counseling by project-supported social workers, offering of HIV testing as part of MAT services, and linkage to civil-sector MAT programs for prisoners being released; 3. Created a medical advisory board and multidisciplinary care team to manage medical and social services for MAT clients; 4. Established a MAT room at pilot sites equipped with required commodities. MAT was first piloted in Bucha Prison Colony #85 (male prison) in 2019, and in four additional prisons (male and female) in 2021.
LESSONS LEARNED: Among the 144 prisoners enrolled in MAT from December 2019 through December 2021, 123 (85%) are continuing therapy. As of December 31, 2021, 100 prisoners received daily MAT in prisons. Procedures established to transition MAT clients to civil-sector MAT programs upon release were effective, with 23 former prisoners linked to community-based MAT services. No overdoses have been reported. Prisoners are reporting health benefits of MAT, and no longer buy illegal drugs or share injecting equipment, decreasing HIV and viral hepatitis risk.
CONCLUSIONS: Providing MAT services in Ukrainian prison settings is feasible and acceptable. As part of a comprehensive HIV prevention package, MAT enabled prisoners to decrease HIV risk and improve health outcomes. Close partnership with the MOJ was critical to obtaining political will to launch MAT. Serving Life and the MOJ plan to open MAT sites in three additional prisons in 2022; and the MOJ plans to scale MAT at all penal settings in 2023.

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