Assessment of Health Services for People Who Use Drugs in Central Asia: Findings of a Quantitative Survey in Kazakhstan & Kyrgyzstan

BACKGROUND:

In Central Asia, there is a need to update information about the situation of people who use (opioid) drugs (PWUD), especially regarding their access to and utilization of health care services. The aim of the study was to gather information about two different groups of drug users in Kazakhstan and Kyrgyzstan.

METHODS:

In 2013, two groups of PWUD were recruited in Kazakhstan and in Kyrgyzstan in order to gather quantitative data via interviewer-administered questionnaires. PWUD registered with the Narcological Register were allocated to group A while non-registered PWUD were allocated to group B. Interviews were conducted in the office of the Narcological Register as well as in low-threshold facilities. Participants reported about their drug use patterns, health status, and utilization of health services as well as barriers to utilization.

RESULTS:

The sample consisted of N = 600 PWUD (301 registered and 299 non-registered PWUD) from Kazakhstan and N = 900 PWUD (450 registered and 450 non-registered PWUD) from Kyrgyzstan. Both groups-registered (group A) and non-registered (group B)-consisted of mainly male long-term intravenous opioid users. We found high rates of current (last 30 days) opioid use (group A up to 70 %; group B up to 84 %). Most PWUD were burdened with poor physical and mental health. The prevalence of infectious diseases added up to 19 % (group A) or 13 % (group B) regarding HIV, 56 % (group A) or 30 % (group B) regarding HCV, and 24 % (group A) or 20 % (group B) regarding tuberculosis. Registered and non-registered PWUD reported high rates (95 or 82 %) of lifetime use of health services for PWUD. Drug-related services were utilized less often, especially among the non-registered PWUD (13 %). The most important barriers preventing PWUD from accessing services were the belief not to need treatment, doubts about the effectiveness of treatment, mistrust of treatment regime/staff, and fear of being registered with the Narcological Register (mainly group B).

CONCLUSIONS:

Results show that access to the health care system for non-registered PWUD is realized mainly through low-threshold facilities. Opioid substitution treatment, which is an important pillar in the treatment of PWUD, is normally only available for those registered with the Narcological Register. Instead, access to opioid substitution treatment (especially in Kazakhstan) should be expanded and granted without prior registration, as this poses an important barrier for PWUD's utilization of drug treatment services. Further, there seems to be a need for the provision of specific and target group-related information about drug treatment services in order to reduce existing reservations among PWUD as to the necessity and effectiveness of modern drug treatment.

Barriers to utilization of services

	Kazakhstan		Kyrgyzstan
	Group A (reg. PWUD) (%)	Group B (non-reg. PWUD) (%)	Group A (reg. PWUD) (%)	Group B (non-reg. PWUD) (%)
	N = 55	N = 283	N = 8	N = 307
Barriers to utilization of drug-related servicesa
I think I do not need treatment	76.4	60.9*	75.0	62.9
I think that current available treatment is not effective	29.1	29.0	25.0	16.3
I heard stories about the treatment regime that made me dislike it	25.5	19.3	62.5	9.8*
I heard stories about treatment staff that made me dislike it	16.4	15.1	50.0	5.2*
I cannot afford to pay for treatment/treatment is too expensive	14.5	15.5	50.0	17.3*
I do not trust governmental facilities	12.7	21.8	37.5	10.7*
I am afraid of problems with police if they know I was in treatment as a drug user	10.9	41.2*	37.5	19.9
Afraid that then everybody will know I am a drug user	9.1	41.2*	25.0	36.2
I do not want to be registered with narcology	7.3	51.3*	12.5	24.4

PWUD people who use drugs

*Indicates a significant result (p = 0.05 or smaller) between group A and group B in each country

aMultiple response, only people who never received drug-related treatment

Full article at:   http://goo.gl/hQ4R0n

By:  Rosenkranz M1, Kerimi N2, Takenova M2, Impinen A2, Mamyrov M2, Degkwitz P3, Zurhold H4, Martens MS5.

• 1Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. moritz.rosenkranz@uni-hamburg.de.
• 2Regional Office for Central Asia, United Nations Office on Drugs and Crime (UNODC), 26 Bukeykhan Street, UN House, 010000, Astana, Kazakhstan.
• 3Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. p.degkwitz@uke.de.
• 4Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. zurhold@uke.de.
• 5Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. marcus.martens@uni-hamburg.de.
• Harm Reduct J. 2016 Jan 27;13(1):3. doi: 10.1186/s12954-016-0093-2. 

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Tuberculosis Report among Injection Drug Users & Their Partners in Kazakhstan

OBJECTIVES:

Tuberculosis (TB) is a major threat to global public health. Kazakhstan has the second highest percentage of multidrug-resistant tuberculosis (MDR-TB) cases among incident tuberculosis cases in the world (WHO 2013). A high burden of MDR-TB suggests TB prevention, control, and treatment programs are failing. This study provides an epidemiologic profile of TB among injection drug users (IDUs), a high-risk and chronically underserved population, in Kazakhstan.

METHODS:

The authors studied the characteristics and risk environment of IDUs with self-reported previous active TB and their primary sexual partners in Almaty, Kazakhstan. 728 individuals (364 couples) participated in a couple-based study in 2009.

RESULTS:

16.75% of participants reported at least one positive TB test (x-ray) in their lifetime. In a multivariable logistic regression adjusting for couple-based sampling, persons with positive TB test were significantly more likely to be older, male, have a shorter duration of injection drug use, have received high social support from their significant other and more likely (non-significantly) to have been incarcerated.

CONCLUSIONS:

Older men with a history of incarceration and recent injection drug use were more likely to have positive TB test in Kazakhstan. Social network support, while potentially positive for many aspects of population health, may increase risk of TB among IDUs in this context. Public health policies that target high-risk populations and their at-risk networks may be necessary to stem the rise of MDR-TB in Central Asia.

Purchase full article at:  http://goo.gl/1d9CAg

By:  Hermosilla S1, El-Bassel N2, Aifah A2, Terlikbayeva A3, Zhumadilov Z4, Berikkhanova K4, Darisheva M3, Gilbert L2, Schluger N5, Galea S5.

• 1Columbia University Medical Center, USA. Electronic address: sh2405@columbia.edu.
• 2Columbia University School of Social Work, USA.
• 3Global Health Research Center of Central Asia, USA.
• 4Nazarbayev University, Kazakhstan.
• 5Columbia University Medical Center, USA. 

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