1. 1 Provision of Substitution Maintenance Therapy Combined with the Antiretrovial Therapy in the Frames of the ‘Overcoming HIV/AIDS Epidemics in Ukraine’ Programme supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria Elena Gulevich, Infectious Disease Specialist Odessa Oblast AIDS Prevention Center

2. 2 The Group of Patients  25 patients are enrolled to the ST program in Odessa region as of 11.02.2006. Out of those 25:  11 – PLHA enrolled to ART  14 – PLHA getting ready to start ART  25 – immunosuppression of different level (CD4 less then 250)

3. 3 The Group of Patients (II)  Patients with opportunistic infections (candidosis, chronic herpetic infection, etc.)  Opiates consumption during 5 – 10 years  23 patients have co-infection of Hepatitis В and С  7 patients are also diagnosed tuberculosis

4. 4 The Process of ST Provision -Selection of the potential patient (from the AIDS Center register, through the Community Center, etc.) by the NGOs’ social workers -Directing the patient to the infectious disease specialist at the AIDS Center -Clinical and immunological inspection, consultations of the infectious disease specialist -Re-directing of the patient to the narcological dispensary

5. 5 The Process of ST Provision (ІІ) Multidisciplinary approach (team work: infectious disease specialist – social worker – narcologist) provides for more qualified provision of ART combined with ST Continuous medical observation of the patients by the infectious disease specialists and narcologists Peer counseling, consultations of the TB specialists, surgeon, other doctors and a lawyer when required Psychological and social support (social workers, NGO)

6. 6 Clinical Observations Improved health status (lower sickness rate) Improvement of tuberculosis treatment, no tuberculosis relapse during the period of ST provision Stabilization of psychological and emotional status (in particular, adequate perception of the HIV-status, socialization, desire to find work, etc.) Increased ART adherence, motivation to treatment

7. 7 Perspectives for ST Scaling-up Enrollment of more IDUs to the ART (ST – one of the methods to develop adherence to ART) Provision of ST combined with ART motivates the patients to go back to healthy, abstinent life style (rehabilitation programmes) ST – one of the methods to prevent HIV/AIDS epidemics spread