1-Mar-2011 - Effectiveness and cost effectiveness of expanding harm reduction and antiretroviral
therapy in a mixed HIV epidemic: a modeling analysis for Ukraine
A new study from Stanford researchers published in PLoS Medicine makes the case that a combination
of methadone substitution therapy and anti-retroviral treatment would have the greatest effect on reducing new
infections and improving quality of life in a region where HIV is spreading rapidly among intravenous drug users.
In the past decade, an epidemic of HIV has swept through Ukraine, fueled mostly by intravenous
drug use. Of Ukraine's approximately 390,000 intravenous drug users as many as half are HIV-infected. Researchers at
Stanford and Veterans Affairs Palo Alto Health Care System have demonstrated, using a cost-effectiveness modeling
study, that the most effective way to combat the spreading disease is a combined program of drug
substitution - providing methadone for opiate users, for instance - and anti-retroviral
therapy for those already infected with HIV.
"HIV is spreading in Eastern Europe more quickly than in any other part of the world," said
Margaret Brandeau, the Coleman F. Fung Professor of Engineering at Stanford University and senior author of the study. "Our
study shows that substitution therapy for injection drug users is an inexpensive and effective means of curbing HIV
transmission in the region."
With no further intervention, the study predicts that HIV prevalence will reach 67.2 percent in intravenous drug users in
20 years. The authors further show that providing drug-substitution to just 25 percent of intravenous drug users today
could lower that figure considerably.
"Providing effective drug substitution therapy and HIV antiretroviral therapy together to the injection-drug-using
community protects the entire population - it actually prevents more infections in non-drug users than in the
drug-using community," said Douglas K. Owens, co-author and a senior investigator at the VA Palo Alto
Health Care System and professor of medicine at Stanford University.
Funding: This research was supported by Grant Number R01DA15612 from the National Institute on Drug Abuse. Sabina S.
Alistar is also supported by a Stanford Graduate Fellowship. Dr. Owens is supported by the Department of Veterans
Affairs. The funders had no role in study design, data collection and analysis, decision to publish, or
preparation of the manuscript.
Competing Interests: DKO received an honorarium from Quintiles to prepare a continuing medical education lecture about
HIV screening. No other competing interests have been declared.
Citation: Alistar SS, Owens DK, Brandeau ML (2011) Effectiveness and Cost Effectiveness of Expanding Harm Reduction
and Antiretroviral Therapy in a Mixed HIV Epidemic: A Modeling Analysis for Ukraine. PLoS Med 8(3): e1000423. doi:10.1371/journal.pmed.1000423
Margaret Brandeau is Coleman F. Fung Professor of Management Science and Engineering, Stanford University: 650.725.1623, firstname.lastname@example.org
Douglas K. Owens, MD, MS, is a senior investigator at the VA Palo Alto Health Care System and a Professor of Medicine and of Health Research and Policy at Stanford University, email@example.com
Sabina S. Alistar, MS, is a PhD candidate in the Department of Management Science and Engineering, firstname.lastname@example.org
Contact: Katie Hickling
Public Library of Science