Update on DRID among PWID in Romania: focus on recent

institutional response

� 31 December 2014 – 12 886 PLWHA

� “romanian cohort” – high rate of incidence in children infected in the 1990s’

� >90% sub-type F1 (unique in Europe)

� large number of survivors (> 6000) from the 20-29 age group (1987-1990 cohort)

� 2011 – an HIV+ outbreak among PWID from Bucharest was declared (after the risk assessment conducted in November 2011 by the EMCDDA &ECDC)

� 165 PWID(157HIV+ and 8MSM/IDU HIV+) of which :

◦ 135 males &20 females;

◦ 39% use heroine & legal highs, 19% heroin alone and 11 % NPS alone;

◦ 82,2% co-infected with HVC, 22% with TB and 24,24 % with STDs;

◦ 53 in the 25-29 age group & 47 in the 30-34 age group.

◦ 83 HIV+ and 82 with AIDS.

HVB, HVC & HIV prevalence among IDUs in treatment, TDI (PRELIMINARY) Data 2004-2014 (%)

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

HVB+ 3.4 6.9 8.8 10 11.7 10.3 13.1 14.9 24.5 27.7 9.7

HVC+ 47.6 45.8 46.2 65.6 72.6 71.3 63.9 68.5 82.4 74.2 59

HIV+ 0 1.1 1.44 1.6 1.09 3.3 4.1 11.6 24.9 49.2 24

0102030405060708090

100

Source: National Antidrug Agency

HIV+

� 96 PWID HIV+ of which:- 73males & 23 females;

- 90.6% are heroin users & 7.3% NPS users;

- 49% are long-term opiate users (more than 10 years)

- 82,3% co-infected with HVC &21.9% with HVB;

- 42.7% at their first treatment& 50% previously treated.

NEEDLE EXCHANGE PROGRAMMES

HIV Screening tests under needle exchange programmes

Tested HIV+ no. HIV+ prevalence (%)

2012 187 43 22.9

2013 320 33 10.3

2014 671 113 16.8

Source: National Antidrug Agency

HIV + prevalence among IDUs in the NSP, 2012-2014 (%) - preliminary data.

-64,8% males & 35,2% females;-55,7% clients of a fixed site;-56,6 % secondary distributors;-12,3 % sexual workers, 23% homeless persons, 23% street children, 33.6% rroma;-32% from the 30-34 age group.

- heroin is the first drug injected by the IDUs in 2014, but there are significant levels of injecting NSP use (mostly combined with heroin –”speedball for the poors”) and also methadone. This maintains an intensive injecting pattern among IDUs from Bucharest.

- low rates of harm-reductions programmes provision for IDUs caused by the lack of founding (only 2 fixed sites in Bucharest and one outreach programme);

- high level of syringes sharing (27%) was recorded for the IDUs in treatment.

- most of the IDUs infected with HIV comes from the long term users population group (from 5 to 10 years and more)

- low rates of HVC ”classic” treatment provision (new generation ARV therapy available but at prohibitive costs).

- limited access to the public medical &social services for the IDUs, caused by their social vulnerability (economic, education, ethnic discrimination).

• the new GPS 2013 data shows an increased prevalence of any druguse (including NPS) – 6.6% ( 1.7% in 2007 and 4.3% in 2010);• highest LTP in Bucharest/Ilfov – 13.9%;• cannabis is the most prevalent drug (4,6% compared to 1.6% in2010), heroin and NPS remain stable ( 0.3% vs. 2%);

• HRDU estimates about 6000 active drug injectors in Bucharest in2013;

• no. of the IDUs in treatment remains steady in 2014 ( 1261compared to 1054 in 2013, 1110 in 2012, 934 in 2011 and 1233 in2010);

• significant decrease in number of the NSP clients from Bucharest in2014 (2694 compared to 5148) – NGOs reports’ hypothesis refer tothe large number of their clients who went to prison, havedeceased/migrated.

- 8 providers (5 public, 2 private &1 NGO) and 13 sites

- 1225 slots available only in Bucharest

- 785 slots free of charge & 440 payed

- setting up a common, standardized WAITING LIST for all OST providers is in the process

0 100 200 300 400

NAA

Sf. Stelian/MS

ANP

ANIT

NAA CSM/MSSf.

Stelian/MS

MS

Obregia/se

ctia

XVI/XVII

ANP ARAS ANIT Color Mind

nr slots payed 260 120 60

nr.slots free of charge 200 180 220 60 25 100

nr slots available 200 180 220 60 25 360 120 60

nr sites 3 1 1 2 2 2 1 1

2008 2009 2010 2011 2012 2013 2014number of distributed syringes 1108762 1730776 946820 895160 1074394 2051770 1979259number of IDU 7284 9417 8966 9000 4460 5148 2694

1

10

100

1000

10000

100000

1000000

10000000

Evolution of the number of syringes distributed and beneficiaries in Romania during 2008-2014 (estimate)

- low number of the direct clients of the NSP due to the extensive use of the secondary distribution of injecting paraphernalia.

� some increase of the HIV screening of the IDUs in NSP (about 3000 HIV,HVB&HVC rapid tests were provided by the NAA).

� Consumption rooms – Carusel NGO feasibility study (http://www.ccd.org.ro/wp-content/uploads/2015/04/Carusel-Studiu-fezabilitate-CCM-RAA.pdf)

� > 8000 PLWHA who receive specific ARV therapy (from 10261 in active surveillance at 1st of December 2014)- one of the most effective systems in Europe.

� informal consultation group of experts in harm reduction created in February 2014 on the basis of a specific National Antidrug Strategy’s objective (and after the 2013 EMCDDA&ECDC second risk assessment mission’s recommendations) .

� an working framework for cooperation (expert counselling, monitoring, common and co-financed prevention intervention projects, etc.) set up by NAA, Health Ministry and NGOs partners.

� they met 7 times by now, debating and providing expert recommendations on specific themes like: ◦ assessing the epidemiological figures on DRID;◦ setting up and prioritizing the short term specific goals and measures on

harm-reduction interventions;◦ mediating the partnership between NGOs and the police and custodial services;◦ discussing the opportunity of the consumption rooms now in Romania and the

consequent legal changes needed; ◦ overdoses prevention management and naloxone provision;◦ the assurance of the OST provision for the emprissoned/in custody drug users; ◦ The need for coordinated responses to the OST problems (lack of resources,

waiting lists, preventing the illicit use of methadone and traffic and s.o.)

• HIV trends:• stabilization and slightly decreasing trend for the new diagnosed cases of HIV+ IDUs (from 233 in 2013 to

165 in 2014)• special focus on the newborn children from IDU HIV+HVC+HVB co-infected mothers (from the survivors of

the 20-29 age group belonging to the “romanian cohort”)• significant decrease of the HIV+ prevalence among IDUs in treatment (from 49,5% in 2013 to 24% in 2014)• high rates of HIV (16.8 %) and HVC (43,4%) infections were reported among the IDUs in the Needle &

Syringes Programmes in Bucharest.

• Transmission risks:• an intensive injecting pattern among IDUs from Bucharest is maintained due to the high prevalence of the heroin and

NSP use ( alone or combined) and increasing methadone use.

• low rates of harm-reductions programmes provision for IDUs caused by the lack of founding (only 2 fixed sites in Bucharest and one outreach programme);

• limited access to the public medical &social services for the IDUs, caused by their social vulnerability

• Prevention services coverage:• low provision rate of interventions aiming to reduce the drug infectious diseases risk, caused by insufficient

funding maintained ; • only 1200 slots for OST for at least 6000 active IDUs (estimated in Bucharest)• good provision rates for the syringe distribution (almost 2 mil. In 2014) but the resources for the 2 NSP

available are shrinking ( not enough personnel )- scales up the secondary distribution method . • some increase of the HIV screening of the IDUs in NSP and in the public health surveillance system (

presumed diagnostic confirming testing) ; • high rates of the ARV therapy provision for HIV/AIDS+ (all IDUs confirmed as HIV+ are in treatment, but

shows low adherence to it.)• low rates of HVC treatment provision (new generation ARV therapy available but at prohibitive costs).• monitoring and coordination systems work well ( a new BSS study is expected by the end of 2015), but they

need to be expanded in order to support identify and reach the additional funding to maintain and scale up HIV prevention interventions.

� Thank You!