Modelling the impact and cost-effectiveness of non-governmental organizations on HIV and HCV transmission among people who inject drugs in Ukraine

Jack Stone; Adam J W Trickey; Josephine G Walker; Sandra Bivegete; Nadiya Semchuk; Yana Sazonova; Olga Varetska; Frederick Altice; Tetiana Saliuk; Peter T Vickerman

doi:10.1002/jia2.26073

Modelling the impact and cost-effectiveness of non-governmental organizations on HIV and HCV transmission among people who inject drugs in Ukraine

Jack Stone^*
, Adam J W Trickey
, Josephine G Walker
, Sandra Bivegete
, Nadiya Semchuk
, Yana Sazonova
, Olga Varetska
, Frederick Altice
, Tetiana Saliuk
, Peter T Vickerman

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

10 Citations (Scopus)

Abstract

Introduction
People who inject drugs (PWID) in Ukraine have high prevalences of HIV and hepatitis C virus (HCV). Non-governmental organisations (NGOs) provide PWID with needles/syringes, condoms, HIV/HCV testing, and linkage to opioid agonist treatment (OAT) and antiretroviral therapy (ART). We estimated their impact and cost-effectiveness among PWID.

Methods
A dynamic HIV and HCV transmission model among PWID was calibrated using data from four national PWID surveys (2011-2017). The model assumed 37-49% coverage of NGOs among community PWID, with NGO contact reducing injecting risk and increasing condom use and recruitment onto OAT and ART. We estimated the historic (1997-2021) and future (2022-2030, compared to no NGO activities from 2022) impact of NGOs in terms of proportion of HIV/HCV infections averted and changes in HIV/HCV incidence. We estimated the future impact of scaling-up NGOs to 80% coverage with/without scale-up in OAT (5% to 20%) and ART (64% to 81%). We estimated the cost per disability-adjusted life-year (DALY) averted of current NGO provision over 2022-2041 compared to NGO activities stopping over 2022-2026, but restarting after that till 2041. We assumed average unit costs of US$80-90 per person-year of NGO contact for PWID.

Results
With existing coverage levels of NGOs, the model projects that NGOs have averted 20.0% (95% credibility interval: 13.3-26.1) and 9.6% (5.1-14.1) of new HIV and HCV infections among PWID over 1997-2021, respectively, and will avert 31.8% (19.6-39.9) and 13.7% (7.5-18.1) of HIV and HCV infections over 2022-2030. With NGO scale-up, HIV and HCV incidence will decrease by 54.2% (43.3-63.8) and 30.2% (20.5-36.2) over 2022-2030, or 86.7% (82.9-89.3) and 39.8% (31.4-44.8) if OAT and ART are also scaled-up. Without NGOs, HIV and HCV incidence will increase by 51.6% (23.6-76.3) and 13.4% (4.8-21.9) over 2022-2030. Current NGO provision over 2022-2026 will avert 102,736 (77,611-137,512) DALYs when tracked until 2041 (discounted 3% annually), and cost US$912 (702-1,222) per DALY averted; cost-effective at a willingness-to-pay threshold of US$1548/DALY averted (0.5xGDP).

Conclusions
NGO activities have a crucial preventative impact among PWID in Ukraine which should be scaled-up to help achieve HIV and HCV elimination. Disruptions could have substantial detrimental impact.

Original language	English
Article number	e26073
Pages (from-to)	e26073
Number of pages	12
Journal	Journal of the International AIDS Society
Volume	26
Issue number	4
DOIs	https://doi.org/10.1002/jia2.26073
Publication status	Published - 3 Apr 2023

Bibliographical note

Funding Information:
Harm reduction interventions for PWID are a key component of Ukraine's national HIV strategy; mostly funded by the Global Fund [ 4 ]. This primarily funds non‐governmental organizations (NGOs), whose activities include distributing condoms and needles/syringes, providing HIV and HCV testing, and linkage to antiretroviral therapy (ART) and opioid agonist treatment (OAT). Our previous analyses of national data from five rounds of integrated bio‐behavioural assessment surveys (IBBA, 2009–2017) showed that contact with PWID‐targeted NGOs in Ukraine is associated with better preventive, HIV testing and HIV treatment outcomes [ 3 ]. These associations are heightened with longer contact with NGOs, suggesting a beneficial impact of NGOs [ 3 ].

Funding Information:
NS, TS, YS and OV work for the Alliance for Public Health (APH), Ukraine, which is a non‐governmental organization. The Global Fund to fight AIDS, tuberculosis, and malaria (GF) or other international funders had no role in these analyses or in decisions to publish. APH is one of the largest recipients in Ukraine of funding from the GF, and the salaries of YS and TS are funded through GF grants. JGW, FLA and PV report research grants from Gilead unrelated to this work.

Publisher Copyright:
© 2023 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.

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SDG 3 Good Health and Well-being

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Cite this

Stone, J., Trickey, A. J. W., Walker, J. G., Bivegete, S., Semchuk, N., Sazonova, Y., Varetska, O., Altice, F., Saliuk, T., & Vickerman, P. T. (2023). Modelling the impact and cost-effectiveness of non-governmental organizations on HIV and HCV transmission among people who inject drugs in Ukraine. Journal of the International AIDS Society, 26(4), e26073. Article e26073. https://doi.org/10.1002/jia2.26073

@article{2f22fd081da54870a2d46c73c7d9615e,

title = "Modelling the impact and cost-effectiveness of non-governmental organizations on HIV and HCV transmission among people who inject drugs in Ukraine",

abstract = "Introduction People who inject drugs (PWID) in Ukraine have high prevalences of HIV and hepatitis C virus (HCV). Non-governmental organisations (NGOs) provide PWID with needles/syringes, condoms, HIV/HCV testing, and linkage to opioid agonist treatment (OAT) and antiretroviral therapy (ART). We estimated their impact and cost-effectiveness among PWID. Methods A dynamic HIV and HCV transmission model among PWID was calibrated using data from four national PWID surveys (2011-2017). The model assumed 37-49\% coverage of NGOs among community PWID, with NGO contact reducing injecting risk and increasing condom use and recruitment onto OAT and ART. We estimated the historic (1997-2021) and future (2022-2030, compared to no NGO activities from 2022) impact of NGOs in terms of proportion of HIV/HCV infections averted and changes in HIV/HCV incidence. We estimated the future impact of scaling-up NGOs to 80\% coverage with/without scale-up in OAT (5\% to 20\%) and ART (64\% to 81\%). We estimated the cost per disability-adjusted life-year (DALY) averted of current NGO provision over 2022-2041 compared to NGO activities stopping over 2022-2026, but restarting after that till 2041. We assumed average unit costs of US\$80-90 per person-year of NGO contact for PWID. Results With existing coverage levels of NGOs, the model projects that NGOs have averted 20.0\% (95\% credibility interval: 13.3-26.1) and 9.6\% (5.1-14.1) of new HIV and HCV infections among PWID over 1997-2021, respectively, and will avert 31.8\% (19.6-39.9) and 13.7\% (7.5-18.1) of HIV and HCV infections over 2022-2030. With NGO scale-up, HIV and HCV incidence will decrease by 54.2\% (43.3-63.8) and 30.2\% (20.5-36.2) over 2022-2030, or 86.7\% (82.9-89.3) and 39.8\% (31.4-44.8) if OAT and ART are also scaled-up. Without NGOs, HIV and HCV incidence will increase by 51.6\% (23.6-76.3) and 13.4\% (4.8-21.9) over 2022-2030. Current NGO provision over 2022-2026 will avert 102,736 (77,611-137,512) DALYs when tracked until 2041 (discounted 3\% annually), and cost US\$912 (702-1,222) per DALY averted; cost-effective at a willingness-to-pay threshold of US\$1548/DALY averted (0.5xGDP). Conclusions NGO activities have a crucial preventative impact among PWID in Ukraine which should be scaled-up to help achieve HIV and HCV elimination. Disruptions could have substantial detrimental impact. ",

author = "Jack Stone and Trickey, \{Adam J W\} and Walker, \{Josephine G\} and Sandra Bivegete and Nadiya Semchuk and Yana Sazonova and Olga Varetska and Frederick Altice and Tetiana Saliuk and Vickerman, \{Peter T\}",

note = "Funding Information: Harm reduction interventions for PWID are a key component of Ukraine's national HIV strategy; mostly funded by the Global Fund [ 4 ]. This primarily funds non‐governmental organizations (NGOs), whose activities include distributing condoms and needles/syringes, providing HIV and HCV testing, and linkage to antiretroviral therapy (ART) and opioid agonist treatment (OAT). Our previous analyses of national data from five rounds of integrated bio‐behavioural assessment surveys (IBBA, 2009–2017) showed that contact with PWID‐targeted NGOs in Ukraine is associated with better preventive, HIV testing and HIV treatment outcomes [ 3 ]. These associations are heightened with longer contact with NGOs, suggesting a beneficial impact of NGOs [ 3 ]. Funding Information: NS, TS, YS and OV work for the Alliance for Public Health (APH), Ukraine, which is a non‐governmental organization. The Global Fund to fight AIDS, tuberculosis, and malaria (GF) or other international funders had no role in these analyses or in decisions to publish. APH is one of the largest recipients in Ukraine of funding from the GF, and the salaries of YS and TS are funded through GF grants. JGW, FLA and PV report research grants from Gilead unrelated to this work. Publisher Copyright: {\textcopyright} 2023 The Authors. Journal of the International AIDS Society published by John Wiley \& Sons Ltd on behalf of the International AIDS Society.",

year = "2023",

month = apr,

day = "3",

doi = "10.1002/jia2.26073",

language = "English",

volume = "26",

pages = "e26073",

journal = "Journal of the International AIDS Society",

issn = "1758-2652",

publisher = "John Wiley \& Sons, Inc",

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Stone, J , Trickey, AJW , Walker, JG, Bivegete, S, Semchuk, N, Sazonova, Y, Varetska, O, Altice, F, Saliuk, T & Vickerman, PT 2023, 'Modelling the impact and cost-effectiveness of non-governmental organizations on HIV and HCV transmission among people who inject drugs in Ukraine', Journal of the International AIDS Society, vol. 26, no. 4, e26073, pp. e26073. https://doi.org/10.1002/jia2.26073

Modelling the impact and cost-effectiveness of non-governmental organizations on HIV and HCV transmission among people who inject drugs in Ukraine. / Stone, Jack ; Trickey, Adam J W ; Walker, Josephine G et al.
In: Journal of the International AIDS Society, Vol. 26, No. 4, e26073, 03.04.2023, p. e26073.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - Modelling the impact and cost-effectiveness of non-governmental organizations on HIV and HCV transmission among people who inject drugs in Ukraine

AU - Stone, Jack

AU - Trickey, Adam J W

AU - Walker, Josephine G

AU - Bivegete, Sandra

AU - Semchuk, Nadiya

AU - Sazonova, Yana

AU - Varetska, Olga

AU - Altice, Frederick

AU - Saliuk, Tetiana

AU - Vickerman, Peter T

N1 - Funding Information: Harm reduction interventions for PWID are a key component of Ukraine's national HIV strategy; mostly funded by the Global Fund [ 4 ]. This primarily funds non‐governmental organizations (NGOs), whose activities include distributing condoms and needles/syringes, providing HIV and HCV testing, and linkage to antiretroviral therapy (ART) and opioid agonist treatment (OAT). Our previous analyses of national data from five rounds of integrated bio‐behavioural assessment surveys (IBBA, 2009–2017) showed that contact with PWID‐targeted NGOs in Ukraine is associated with better preventive, HIV testing and HIV treatment outcomes [ 3 ]. These associations are heightened with longer contact with NGOs, suggesting a beneficial impact of NGOs [ 3 ]. Funding Information: NS, TS, YS and OV work for the Alliance for Public Health (APH), Ukraine, which is a non‐governmental organization. The Global Fund to fight AIDS, tuberculosis, and malaria (GF) or other international funders had no role in these analyses or in decisions to publish. APH is one of the largest recipients in Ukraine of funding from the GF, and the salaries of YS and TS are funded through GF grants. JGW, FLA and PV report research grants from Gilead unrelated to this work. Publisher Copyright: © 2023 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.

PY - 2023/4/3

Y1 - 2023/4/3

N2 - Introduction People who inject drugs (PWID) in Ukraine have high prevalences of HIV and hepatitis C virus (HCV). Non-governmental organisations (NGOs) provide PWID with needles/syringes, condoms, HIV/HCV testing, and linkage to opioid agonist treatment (OAT) and antiretroviral therapy (ART). We estimated their impact and cost-effectiveness among PWID. Methods A dynamic HIV and HCV transmission model among PWID was calibrated using data from four national PWID surveys (2011-2017). The model assumed 37-49% coverage of NGOs among community PWID, with NGO contact reducing injecting risk and increasing condom use and recruitment onto OAT and ART. We estimated the historic (1997-2021) and future (2022-2030, compared to no NGO activities from 2022) impact of NGOs in terms of proportion of HIV/HCV infections averted and changes in HIV/HCV incidence. We estimated the future impact of scaling-up NGOs to 80% coverage with/without scale-up in OAT (5% to 20%) and ART (64% to 81%). We estimated the cost per disability-adjusted life-year (DALY) averted of current NGO provision over 2022-2041 compared to NGO activities stopping over 2022-2026, but restarting after that till 2041. We assumed average unit costs of US$80-90 per person-year of NGO contact for PWID. Results With existing coverage levels of NGOs, the model projects that NGOs have averted 20.0% (95% credibility interval: 13.3-26.1) and 9.6% (5.1-14.1) of new HIV and HCV infections among PWID over 1997-2021, respectively, and will avert 31.8% (19.6-39.9) and 13.7% (7.5-18.1) of HIV and HCV infections over 2022-2030. With NGO scale-up, HIV and HCV incidence will decrease by 54.2% (43.3-63.8) and 30.2% (20.5-36.2) over 2022-2030, or 86.7% (82.9-89.3) and 39.8% (31.4-44.8) if OAT and ART are also scaled-up. Without NGOs, HIV and HCV incidence will increase by 51.6% (23.6-76.3) and 13.4% (4.8-21.9) over 2022-2030. Current NGO provision over 2022-2026 will avert 102,736 (77,611-137,512) DALYs when tracked until 2041 (discounted 3% annually), and cost US$912 (702-1,222) per DALY averted; cost-effective at a willingness-to-pay threshold of US$1548/DALY averted (0.5xGDP). Conclusions NGO activities have a crucial preventative impact among PWID in Ukraine which should be scaled-up to help achieve HIV and HCV elimination. Disruptions could have substantial detrimental impact.

AB - Introduction People who inject drugs (PWID) in Ukraine have high prevalences of HIV and hepatitis C virus (HCV). Non-governmental organisations (NGOs) provide PWID with needles/syringes, condoms, HIV/HCV testing, and linkage to opioid agonist treatment (OAT) and antiretroviral therapy (ART). We estimated their impact and cost-effectiveness among PWID. Methods A dynamic HIV and HCV transmission model among PWID was calibrated using data from four national PWID surveys (2011-2017). The model assumed 37-49% coverage of NGOs among community PWID, with NGO contact reducing injecting risk and increasing condom use and recruitment onto OAT and ART. We estimated the historic (1997-2021) and future (2022-2030, compared to no NGO activities from 2022) impact of NGOs in terms of proportion of HIV/HCV infections averted and changes in HIV/HCV incidence. We estimated the future impact of scaling-up NGOs to 80% coverage with/without scale-up in OAT (5% to 20%) and ART (64% to 81%). We estimated the cost per disability-adjusted life-year (DALY) averted of current NGO provision over 2022-2041 compared to NGO activities stopping over 2022-2026, but restarting after that till 2041. We assumed average unit costs of US$80-90 per person-year of NGO contact for PWID. Results With existing coverage levels of NGOs, the model projects that NGOs have averted 20.0% (95% credibility interval: 13.3-26.1) and 9.6% (5.1-14.1) of new HIV and HCV infections among PWID over 1997-2021, respectively, and will avert 31.8% (19.6-39.9) and 13.7% (7.5-18.1) of HIV and HCV infections over 2022-2030. With NGO scale-up, HIV and HCV incidence will decrease by 54.2% (43.3-63.8) and 30.2% (20.5-36.2) over 2022-2030, or 86.7% (82.9-89.3) and 39.8% (31.4-44.8) if OAT and ART are also scaled-up. Without NGOs, HIV and HCV incidence will increase by 51.6% (23.6-76.3) and 13.4% (4.8-21.9) over 2022-2030. Current NGO provision over 2022-2026 will avert 102,736 (77,611-137,512) DALYs when tracked until 2041 (discounted 3% annually), and cost US$912 (702-1,222) per DALY averted; cost-effective at a willingness-to-pay threshold of US$1548/DALY averted (0.5xGDP). Conclusions NGO activities have a crucial preventative impact among PWID in Ukraine which should be scaled-up to help achieve HIV and HCV elimination. Disruptions could have substantial detrimental impact.

U2 - 10.1002/jia2.26073

DO - 10.1002/jia2.26073

M3 - Article (Academic Journal)

C2 - 37012669

SN - 1758-2652

VL - 26

SP - e26073

JO - Journal of the International AIDS Society

JF - Journal of the International AIDS Society

IS - 4

M1 - e26073

ER -

Modelling the impact and cost-effectiveness of non-governmental organizations on HIV and HCV transmission among people who inject drugs in Ukraine

Abstract

Bibliographical note

UN SDGs

Research Groups and Themes

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