Development of Combination HIV Prevention Programs for People Who Inject Drugs through Government and Civil Society Collaboration in the Russian Federation

Population Services International (PSI) has worked collaboratively with several government institutions of the Russian Federation to develop and implement a model program to access health services for individuals who are opioid dependent, including those with HIV infection. Through the development of partnership agreements between government organizations (GOs) and non-government organizations (NGOs), a model of the continuum of care has been developed that identifies a Recommended Package of HIV Prevention Services for Injecting Drug Users (RPS-IDU). The implementation of the RPS-IDU in the Russian Federation offers a model for other countries with HIV epidemics associated with injection drug use. This paper will describe the model program and its implementation in one of the pilot program regions. 1. Introduction Globally, the trafficking and subsequent use of addictive substances is widespread [1, 2]. Vulnerability to drug dependence, particularly heroin, can occur rapidly for injection drug users and is behaviorally complex as a function of biological, psychological, and environmental interactions and influences. In the Russian Federation heroin, trafficked from Central Asia, is readily available for use with dependence manifested as a chronic relapsing brain disease [2]. The clinical diagnosis of opioid dependence, according to the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10), is not based on the quantity of drug used, but the maladaptive patterns of drug use, as well as cognitive, behavioral, and physiological symptoms including any significant consequences related to drug use [3]. International treatment guidelines promote effective treatment programs that have multiple components offering an array of services and pharmacotherapies that address the cognitive, behavioral, physiological, and social aspects of opioid dependence [4]. Opioid treatment programs also need to address the medical comorbidities associated with injection drug use, most significantly Human Immunodeficiency Virus (HIV). The World Health Organization (WHO) has identified a comprehensive set of interventions for HIV prevention, care, and treatment for injection drug users [5]. They include needle and syringe programs; drug dependence treatment; targeted information, education, and communication for people who use drugs; HIV testing and counseling; HIV care and treatment; safe and effective condom use; detection and management of sexually transmitted infections; prevention and treatment of viral hepatitis;