Assessment of health services for people who use drugs in Central Asia: findings of a quantitative survey in Kazakhstan and Kyrgyzstan.

BACKGROUND: In Central Asia, there is a need to update information about the situation of people who use (opioid) drugs (PWUD), especially regarding their access to and utilization of health care services. The aim of the study was to gather information about two different groups of drug users in Kazakhstan and Kyrgyzstan. METHODS: In 2013, two groups of PWUD were recruited in Kazakhstan and in Kyrgyzstan in order to gather quantitative data via interviewer-administered questionnaires. PWUD registered with the Narcological Register were allocated to group A while non-registered PWUD were allocated to group B. Interviews were conducted in the office of the Narcological Register as well as in low-threshold facilities. Participants reported about their drug use patterns, health status, and utilization of health services as well as barriers to utilization. RESULTS: The sample consisted of N = 600 PWUD (301 registered and 299 non-registered PWUD) from Kazakhstan and N = 900 PWUD (450 registered and 450 non-registered PWUD) from Kyrgyzstan. Both groups-registered (group A) and non-registered (group B)-consisted of mainly male long-term intravenous opioid users. We found high rates of current (last 30 days) opioid use (group A up to 70%; group B up to 84%). Most PWUD were burdened with poor physical and mental health. The prevalence of infectious diseases added up to 19% (group A) or 13% (group B) regarding HIV, 56% (group A) or 30% (group B) regarding HCV, and 24% (group A) or 20% (group B) regarding tuberculosis. Registered and non-registered PWUD reported high rates (95 or 82%) of lifetime use of health services for PWUD. Drug-related services were utilized less often, especially among the non-registered PWUD (13%). The most important barriers preventing PWUD from accessing services were the belief not to need treatment, doubts about the effectiveness of treatment, mistrust of treatment regime/staff, and fear of being registered with the Narcological Register (mainly group B). CONCLUSIONS: Results show that access to the health care system for non-registered PWUD is realized mainly through low-threshold facilities. Opioid substitution treatment, which is an important pillar in the treatment of PWUD, is normally only available for those registered with the Narcological Register. Instead, access to opioid substitution treatment (especially in Kazakhstan) should be expanded and granted without prior registration, as this poses an important barrier for PWUD's utilization of drug treatment services. Further, there seems to be a need for the provision of specific and target group-related information about drug treatment services in order to reduce existing reservations among PWUD as to the necessity and effectiveness of modern drug treatment.

A review of medical and substance use co-morbidities in Central Asian prisons: implications for HIV prevention and treatment.

BACKGROUND: HIV incidence in Central Asia is rising rapidly. People who inject drugs (PWIDs) contribute greatest to the epidemic, with more than a quarter of all HIV cases being in the criminal justice system (CJS). This review assembled and aggregated recent data on drug-related health problems and respective healthcare services in the CJS of Central Asia and the Republic of Azerbaijan. METHODS: Online databases and published literature (peer-reviewed and gray) were reviewed. Additionally, prison officials in the 6 countries were invited to participate in a survey and prison administrators from Kazakhstan, Kyrgyzstan and Tajikistan completed it. RESULTS: The data on conditions and healthcare in Central Asian prisons are inconsistent and lack unbiased details. Reporting is primarily based on "official" disease registries, which markedly underestimate prevalence. Even these limited data, however, indicate that HIV prevalence and drug-related health problems are high, concentrated and, in some countries, rising rapidly in CJS. Only some of the range of HIV prevention interventions recommended by international organizations have been implemented in the region with two of the crucial interventions, needle and syringe exchange programs (NSP) and opioid substitution therapy (OST), only available in prisons in Kyrgyzstan, with Tajikistan implementing a pilot NSP and contemplating introduction of prison-based OST. CONCLUSIONS: Despite deficiencies in routine health reporting and insufficient HIV sentinel surveillance undertaken in prisons, the data available on the concentration of HIV within at-risk populations in prisons indicate a necessity to broaden the range and increase the scale the scale of HIV prevention and treatment services.