Drugs In Ukraine Research Articles

Судова фармація, організація фармацевтичної справи, технологія ліків, медичне, фармацевтичне та кримінальне право: державна система боротьби із незаконним обігом наркотичних засобів і психотропних речовин та зловживання ними в умовах пандемії

In the context of the COVID-19 pandemic, the burden on the sphere of health care, pharmacy, finance, economy, industry, and law enforcement are increasing. The level of the state system regarding the effectiveness of the criminal and legal struggle against the illegal circulation of narcotics (narcotic drugs and psychotropic substances) and their abuse by improving the legislation and normative legal acts of Ukraine in the conditions of the pandemic on the basis of forensic pharmacy, drug technology, the organization of the pharmaceutical case, medical and pharmaceutical law. Scientific information sources were studied, taking into account the recommendations of the WHO and the Cochrane Society for PICO from 25 disciplines that have interdisciplinary connections. The forensic and pharmaceutical practice in criminal proceedings regarding the illegal circulation of psychoactive substance of various classification and legal groups were analyzed. Proven that the abuse and uncontrolled intake of psychoactive substances causes manifestations of a person's hidden predisposition to mental illnesses according to the ICD-11 codes. The forensic and pharmaceutical characteristics of the "drug business" market were summarized according to the data of law enforcement agencies. The provisions of the State Policy Strategy on Drugs in Ukraine were analyzed. Normative proposals for improving the legislation on measures to counter the illegal circulation of narcotic drugs, psychotropic substances and precursors and their abuse in order to protect the rights and freedoms, life and health of drug addicts were presented.

A BAYESIAN HIERARCHICAL MODEL FOR COMBINING MULTIPLE DATA SOURCES IN POPULATION SIZE ESTIMATION.

To combat the HIV/AIDS pandemic effectively, targeted interventions among certain key populations play a critical role. Examples of such key populations include sex workers, people who inject drugs, and men who have sex with men. While having accurate estimates for the size of these key populations is important, any attempt to directly contact or count members of these populations is difficult. As a result, indirect methods are used to produce size estimates. Multiple approaches for estimating the size of such populations have been suggested but often give conflicting results. It is, therefore, necessary to have a principled way to combine and reconcile these estimates. To this end, we present a Bayesian hierarchical model for estimating the size of key populations that combines multiple estimates from different sources of information. The proposed model makes use of multiple years of data and explicitly models the systematic error in the data sources used. We use the model to estimate the size of people who inject drugs in Ukraine. We evaluate the appropriateness of the model and compare the contribution of each data source to the final estimates.

Analysis of the domestic market of 1,2,4-triazole-containing drugs

The modern market of medicines in Ukraine has the dynamics of constant development. At the same time, the dynamics of the pharmaceutical market depend entirely on the welfare of the population. Current features of quarantine restrictions have caused a number of distortions in drug consumption. Thus, after the introduction of quarantine in March 2020, part of the population panicked, which forced them to stockpile vital goods. At this time, there was a significant increase in sales of drugs, including antiviral, antiseptic, and disinfectant activity. The dynamics of drug balances on the shelves reached +50 %. However, there was a sharp decline in consumption between June-October 2020 and April 2021 due to the full effect of quarantine restrictions and March-April 2022 due to martial law in Ukraine. Today, the rate of purchases and balances of medicines on the shelves of pharmacies exceeds the rate of growth of their sales. The aim of the work is to conduct research and provide a description of the range of the national market of domestic 1,2,4-triazole-containing drugs. Materials and methods. The following methods were used in the work: analytical, information retrieval, descriptive, and generalization. The materials of the research were literature sources that contain information on the registration of domestic 1,2,4-triazole-containing drugs in Ukraine at present. Results. The search, analysis, characterization, and generalization of domestic drugs – derivatives of 1,2,4-triazoles were carried out. It was established that the Ukrainian market was moderately saturated with 1,2,4-triazole-containing drugs of domestic production based on the study of available information and scientific research. The drugs have a fairly wide range of applications in medicine, have different mechanisms of action, belong to different pharmacotherapeutic groups, and were used in veterinary practice and the agro-industrial economy. Conclusions. Elaboration, analysis, systematization, comparison, and generalization of modern sources of information indicated a fairly high biological activity of 1,2,4-triazole derivatives, a wide range of applications, and moderate saturation of the national market with 1,2,4-triazole-containing drugs.

Comparative analysis of drug consumption for the treatment of epilepsy in Ukraine, Kazakhstan and Belarus

The aim to conduct a comparative analysis of the population's consumption of antiepileptic drugs in the retail pharmaceutical markets of developing countries, including Ukraine, Kazakhstan and Belarus in the period 2016-2020.
 Materials and methods. The objects of the research were the data of marketing agencies that monitor the domestic pharmaceutical market in the countries under study. In particular, the range of AED in Ukraine was determined using the market research system «Pharmstandard» of the company «Morion». Analytical-comparative, systematic, graphical, logical, mathematical-statistical research methods were used.
 Results. The results of the study show that the market of antiepileptic drugs in Ukraine, Kazakhstan and Belarus mainly depends on foreign manufacturers, in particular by 60 %, 92 % and 46 % respectively in 2020, and does not meet the needs of the population in accordance with WHO recommendations. It is established that in the market of Ukraine, Kazakhstan during 2016-2019 there is a general trend of increasing retail sales of antiepileptic drugs, which are not included in the WHO Basic List of Essential Medicines, both in natural and in monetary terms. The results of the analysis of retail sales of drugs in the Belarusian market in quantitative and monetary terms indicate an increase in sales of drugs for the treatment of epilepsy, which are included in the WHO Basic List of Essential Medicines.
 Conclusions. The presence in Ukraine of a difficult situation with the consumption of antiepileptic drugs in comparison with other countries of the reference group indicates the need to implement comprehensive programs to combat the spread of epilepsy and the introduction of models for the rational use of limited health resources

Analysis of antiasthmatic drugs for inhalation in the pharmaceutical market of Ukraine and dynamics of their consumption

Bronchial asthma (BA) is a common disease, as today the world suffers from about 300 million people. The number of patients with severe and complicated forms of BA is growing every year due to untimely diagnosis of the disease and late appointment of basic therapy. Complications cause disability in patients and increase mortality.
 The purpose of this work was to study the range and consumption in Ukraine of antiasthmatic drugs for inhalation (ADI), intended for the treatment of BA for the period 2018–2020.
 The analysis of the range and volumes of consumption of ADI was carried out according to the system of research of the market of medicines «Pharmstandard» of the company «Morion». Consumption estimates were made using the ATC/DDD methodology. DDDs/1 000 inhabitants/day (DID, DDDs per 1 000 inhabitants per day) was used as a unit of measurement.
 The results showed that in the pharmaceutical market of Ukraine during 2018–2020 used 61–64 trade names (TN) ADI, of which 11–13 TN were domestically produced and 50–51 TN – foreign manufacturers. Retail prices for ADI during 2018–2020 varied widely and increased slightly each year, due to economic instability in the pharmaceutical market of Ukraine. It was found that the consumption of ADI in the period 2018–2019 increased slightly by 1.03 times – from 7.00 DID in 2018 to 7.24 DID in 2019. In 2020, the consumption of this group of drugs decreased 1.1 times – to 6.60 DID. The undisputed leader in consumption in Ukraine was salbutamol (3.53–3.56 DID), which is probably due to the clinical efficacy and sufficient safety of the drug, greater availability of salbutamol for the population due to the wide range of generic drugs in Ukraine. market and the state program «Affordable Medicines». The second place was taken by the combination of fenoterol + ipratropium bromide (0.81–0.85 DID), which is used in adults and children for the immediate treatment of sudden attacks of bronchospasm in BA. The third place in terms of consumption in Ukraine was occupied by the combination of salmeterol + fluticasone (0.52–0.54 DID), which is mainly prescribed to patients with moderate and severe asthma.

Police abuse and care engagement of people with HIV who inject drugs in Ukraine

ABSTRACT Police abuse affects people who inject drugs (PWID), including those with HIV, and negatively impacts care engagement. This cross-sectional study evaluated police abuse among PWID receiving MOUD (medication for opioid use disorder) living with HIV and associations with HIV treatment adherence and receipt of NGO services. We assessed lifetime and past six-month rates of police abuse among a cohort of Ukrainian PWID with HIV receiving MOUD (n = 190) from August to September 2017. Logistic regression models evaluated associations between past six-month police abuse and past 30-day antiretroviral therapy (ART) adherence, and past six-month NGO service receipt. Almost all (90%) participants reported lifetime police abuse: 77% reported physical violence and 75% reported paying the police to avoid arrest. One in four females (25%) reported police-perpetrated sexual violence. Recent police abuse was reported by 16% of males and 2% of females and was not associated with ART adherence (aOR: 1.1; 95% CI:0.3–5.0) or NGO service receipt (aOR: 3.4; 95% CI:0.6–18.3). While lifetime police abuse rates were high, few participants reported recent police abuse, which was not linked to care engagement. These trends should encourage the Ukrainian government for public health-public safety partnerships and legal interventions to eliminate human rights violations against PWID living with HIV.

Marketing analysis of the pharmaceutical market of antidiabetic drugs in Ukraine

Diabetes mellitus is an important public health issue. Statistics show a rapid growth in the number of patients each year, which increases the financial burden on the state’s economy. Therefore, systematic marketing monitoring of the pharmaceutical market of drugs for diabetes is appropriate and permanently relevant. The aim of the research was to study the pharmaceutical market of antidiabetic drugs in Ukraine as of the first quarter of 2022. Materials and methods. The nomenclature range of drugs was analyzed in accordance with the State Register and the Anatomical-Therapeutic-Chemical Classification. The objects of research were information on synthetic hypoglycemic drugs registered in Ukraine, as well as herbal medicines belonging to the category A10 “Antidiabetic drugs”. Analytical and comparative methods, as well as marketing analysis and generalization of information were applied. Results. The structure of the pharmaceutical market of medicines from category A10 “Antidiabetic drugs” is formed by mono-drugs, their share is 84.2 %, while combined drugs make 12.9 %, and only 2.9 % belongs to medicinal plant raw materials and their mixtures. Among mono-drugs, the most numerous by the number of trade names is the group of sulfonylureas and biguanides, the percentage of which is 33.9 %. The pharmaceutical market of antidiabetic drugs in Ukraine is import-dependent, as the share of foreign medicines from 24 importing countries is 59.3 %. Domestic manufacturers of drugs for type 2 diabetes are 10 pharmaceutical companies, among which production output is dominated by JSC “Farmak” – 31.9 %. Preparations based on medicinal plant raw materials are manufactured by PJSC “Liktravy” and PJSC Pharmaceutical Factory “Viola” in the form of mixtures and medicinal raw materials. Conclusions. The nomenclature ranges of drugs, which according to the ATC classification belong to the category A10 “Antidiabetic drugs”, are analyzed and the structure of the segment is described. The range of herbal antidiabetic drugs has been studied and their share in the structure of the pharmaceutical market of Ukraine has been determined. The prevalence of foreign-made drugs over domestic ones has been established.

POSA195 Assessment of Consumption of Antidepressant Drugs in Ukraine in 2015-2019

The issue of mental health is acute in our time. The World Bank notes a significant (50 %) increase in mental illness over two decades, beginning in the 1990s. Among persistent health and disability disorders in Ukraine, neuropsychiatric disorders rank third among men (11.3 %) and second among women (16.5 %). Therefore, it is essential to timely identify mental illnesses and provide appropriate and adequate correction, including antidepressants, to improve patients' quality of life. The study aimed to establish outpatient and hospital consumption in 2015-2019 in Ukraine of antidepressant drugs (N06A according to ATC classification).

Peculiarities of Implementation of The Concept of Providing Quality of Drugs in Ukraine

Peculiarities of Implementation of The Concept of Providing Quality of Drugs in Ukraine

TB stigma and its correlates among HIV-positive people who inject drugs in Ukraine.

BACKGROUND: TB is commonly stigmatized. Correlates of perceived TB stigma have not been assessed specifically among HIV-positive people who inject drugs (PWIDs). It is also unclear how perceived TB stigma intersects with other forms of stigma affecting this population. We aimed to evaluate perceived TB stigma, its correlates and its intersection with HIV and substance use stigma among HIV-positive PWIDs in Ukraine.METHODS: Among 191 participants at three sites across Ukraine, we assessed stigma scores, socio-demographic, behavioral and health-related variables by TB status (history of active TB infection, history of treatment for latent TB infection LTBI, no history of TB infection). We used self-reported history of LTBI treatment as a proxy for LTBI status. We used ordinary least squares to estimate factors associated with perceived TB stigma.RESULTS: Lower perceived TB stigma scores were associated with LTBI status (adjusted beta (aβ) -0.2, 95% CI -0.3 to 0.0; P = 0.032). Higher perceived TB stigma scores were associated with higher substance use stigma scores (aβ 0.1, 95% CI 0.0 to 0.2; P = 0.004). Depressive symptoms were common in this sample, although not significantly associated with TB status.CONCLUSION: History of LTBI treatment appears to impact beliefs about perceived TB stigma. Individuals who endorse higher substance use stigma are more likely to hold stigmatizing perceptions about people with TB. HIV-positive PWIDs with history of active TB infection or LTBI treatment commonly experience mental health distress. This stigma intersection needs further exploration in this population, including of its relation with mental health, to provide further insights for targeted interventions.

Scientific-methodological approach for standardization of herbal raw materials and herbal preparations using high-performance thin-layer chromatography procedure

The high-performance thin-layer chromatography (HPTLC) is widely used for quality control of herbal raw materials (HRM).
 The purpose of this work were to define the problematic issues of quality control of herbal drugs in Ukraine and to develop a systematic scientific and methodological approach for the standardization of HRM and herbal drugs using the modern analytical technique of HPTLC: to optimize the existing and develop new methods of identification and determination of adulterations, and to develop alternative methods of quantitative determination, as well as studying of the stability.
 As a result of a critical evaluation of existing approaches for the standardization of HRM and herbal drugs of Ukraine’s flora, numerous problematic issues were identified, including the existence of a limited number of national monographs / national parts of monographs on the HRM of the Ukraine’s flora, which were not previously standardized by other pharmacopeias; non-consideration of Ukraine’s flora species (non-pharmacopoeial) in monographs on closely related species that introduced in the State Pharmacopoeia of Ukraine; lack of specificity of combinations of physical and chemical methods used for quality control; lack of specificity and reproducibility, the labor intensity of methods; necessity of usage of toxic solvents and precursors; use of different groups of markers and methods for the HRM and its finished product or HRM and its closely related species, etc. The proposed systematic scientific and methodological approach includes: a preliminary collection of information about the object of study, markers/groups of bioactive substances, approaches to its standardization; theoretical evaluation of existing techniques of quality control in monographs on HRM and experimental approbation using samples of domestic plants, determination of the need for optimization of existed methods by the parallel development of specific, reproducible and documented methods for identification, adulterations’ detection, quantification, and bio-detection (if necessary) by HPTLC method. The approach is illustrated with examples.
 The proposed approach can be used for comprehensive HPTLC analysis of domestic HRM and herbal drugs for research, prevention of adulteration, standardization of initial HRM and its finished product, pharmaceutical development, and stability studies.

Retrospective analysis of the pharmaceutical market of cardiological drugs in Ukraine for 2016–2020

In Ukraine, cardiovascular disease is the leading cause of death and is the highest cause of death among all countries. Nationwide, cardiovascular disease’s mortality has increased by almost 8% over the past 29 years.
 The aim of the work was to analyze the domestic pharmaceutical market of cardiac drugs (code of anatomical-therapeutic chemical classification (hereinafter – ATС) – C01, and C01 E separately) for the 2016–2020 in terms of pharmacotherapeutic groups, manufacturers, dosage forms and others.
 The object of the study was the data of the State Expert Center of the Ministry of Health of Ukraine, the proposals of distributors received from the «Morion» platform for 2016–2020. The research was carried out using modern methods of analysis, systematization and generalization, mathematical and statistical calculations.
 According to the database of the State Expert Center of the Ministry of Health in Ukraine, 256 cardiac drugs by dosage forms have been registered. Analysis of the group of cardiac drugs by ATС classification, allowed to establish a significant dominance of group C01 E – Other cardiac drugs – from 66% to 68% over the years of the study. According to the results of the analysis, a positive trend has been established – the dominance of domestically produced drugs in the group of cardiac drugs in the pharmaceutical market of Ukraine during 2016–2020. The general list of manufacturers presenting cardiac drugs in Ukraine consists of 66–68 companies, where the share of domestic companies was 53–55% during the study period. There is a steady trend towards a slight predominance of solid dosage forms (54–56% during the study period).
 In summary, it should be noted that the analysis of the domestic wholesale market of cardiac drugs showed a significant wide of the group’s assortment, the significant dominance of the group «Other cardiac drugs» in the overall structure, showed a positive trend of domestic cardiac drugs; among dosage forms, solid and liquid dosage forms have been presented evenly.

Study of Development problems dynamics of Ukrainian market of stomach ulcer treatment drugs

This article presents the analysis results of Ukrainian pharmaceutical market segment of stomach ulcer treatment drugs. It was determined that, judging by the quantitative indexes, Ukrainian market of anti-ulcer medication is an actively developing structure that maintains the stability of its development qualitative characteristics nonetheless. For example, during two years (01 June 2016 – 01 June 2018) the quantities of medicinal products and companies that represent these products in Ukraine have both grown: from 396 to 448 names (13.13%) and from 90 companies (25 of them Ukrainian) to 98 (28, correspondingly). On the background of quantity growth of Ukrainian-made drugs from 84 (2016) to 92 (2018), the specified market segment has shown significant dependency on import. For example, the proportion (%) of foreign production drugs has grown from 78.79% (2016) to 79.46% (2018). KRKA is an uncontested leader by the quantity of marketed medicinal products (2016 – 28 products, 2018 – 32 products). The products of Takeda Pharmaceutical Company Limited are presented in the second place (22 and 23 products, corresponding to the years under study). The products of Dr. Reddy's Laboratories take the third place (20 and 21 products, corresponding to the years under study). The said pharmaceutical market segment has kept its monopolistic pattern of distribution as judged by the manufacturing companies whose products are presented in Ukraine, and by international non-proprietary names of products and their pharmacotherapeutic groups. For example, just 8 foreign manufacturing companies were responsible for 40.17% (2016) and 31.92% (2018) of imported assortment of anti-ulcer drugs, and 7 domestic companies were responsible for 64.29% (2016) and 61.54% (2018) of domestic assortment of these drugs. In 2016 75.76% and in 2018 – 71.65% of the whole assortment of anti-ulcer drugs were presented by the drugs from the following groups: A02B-Drugs for peptic ulcer and gastro-oesophageal reflux disease (Gord), A02BC Proton pump inhibitors (55.30% and 50.22%, corresponding to the years under study). Five drugs (A02BC02-Pantoprazole, A02BC01-Omeprazole, A02BC05-Esomeprazole, A02BC03-Lansoprazole, A02BD Combinations for eradication of Helicobacter pylori) presented more than a half of marketed assortment of anti-ulcer products (2016 – 56.57%, and 2018 – 55.14%). Tableted dosage forms (2016 – 58.33%, and 2018 – 55.80%) and drugs of synthetic origin (2016 – 76.26%, and 2018 – 78.13%) have kept their leading positions on the market. Authors have discovered that during 2015-2018 the average retail prices of anti-ulcer drugs have shown the trend of systematic growth. The highest growth of average retail prices was observed for A02BX13-Alginic acid ( avg.=1.37), and the lowest ‒ for A02BC06-Dexlansoprazole ( avg.=1.04). The given above characteristics of the market segment that was studied allow us to state the need to develop and establish the national program of import substitution for the assortment of anti-ulcer drugs in Ukraine.

Features of correction of a pathological condition of small animals at the diabetes mellitus with obesity

The article presents the results of clinical studies of domestic cats and dogs with diabetes mellitus on the background of obesity at the beginning and for a month of treatment. Domestic cats with diabetes were prescribed active exercise and industrial diet Royal Canin Diabetic Feline, dogs – Royal Canin Diabetic DS37. The portion size was determined according to the manufacturer's recommendations. Treatment of small animals for obesity, both alimentary and endocrine, preferably involves feeding food in limited quantities to cause controlled weight loss, as well as increased physical activity, which can provide additional energy expenditure. Successful weight loss can reduce the effects of comorbidities associated with obesity, such as improved mobility in osteoarthritis, increased insulin sensitivity and the reversal of other metabolic disorders, and improved quality of life. The main pathogenetic therapy for animals with diabetes for both domestic cats and dogs is the mandatory use of insulin. Researching the market of drugs in Ukraine, we chose the most affordable and effective veterinary drug – Caninsulin. The dose of insulin was selected individually for each animal by plotting a curve of blood glucose concentration over three days. At the beginning of treatment and at the end of the course, we conducted a comprehensive study of animals of both species. In cats, the general condition significantly improved as a result of treatment: only one animal remained depressed, the number of cases of hyporexia decreased, only 25.0 % of animals remained pale mucous membranes; temperature within the physiological norm; vomiting and bradycardia were not reported. A decrease in the rate of shortness of breath and drowsiness also indicates an improvement in the condition of cats with obesity due to diabetes. The improvement of the general condition of domestic dogs is evidenced by the restoration of the condition of the coat (about 4 times), the restoration of appetite in 66.7 %. Only one dog had anemia of the mucous membranes. Anxiety, bradycardia, hypothermia and itching disappeared completely. Within one month, there was a tendency to decrease the body weight of animals of both groups, but due to the insufficient duration of treatment, their fatness still remained excessive. Which indicates the need for further correction of the pathological condition.

The pharmacoepidemiological analysis of the influenza pharmacotherapy in Ukraine

Influenza and other acute respiratory viral infections (ARIs) are the most common among human diseases that require timely medical attention and treatment with the most effective drugs. The aim of the study is pharmacoepidemiological analysis of drugs for the treatment of influenza registered in Ukraine. Materials and methods of research. The study was based on data from the State Register of Medicines of Ukraine, information on the results of the epidemic season of influenza and acute respiratory infections of the Center for Public Health of the Ministry of Health of Ukraine, declared drugs under the International Nonproprietary or Common Name in Ukraine as of January 2021. Methods: retrospective, descriptive and frequency analyzes. Results and discussion. A pharmacoepidemiological analysis of influenza drugs in Ukraine was conducted. It was found that the incidence of influenza and SARS during the study period decreased by 3.1% of the total population. Fatalities due to influenza and SARS increased by 41 cases during the study period, which may be related to the coronavirus pandemic. According to the results of a marketing study of antiviral drugs, it was found that the largest share in the structure of registered trade names are interferons (11 trade names). Conclusions. The analysis of the market showed that among the antiviral drugs registered in Ukraine for the studied period the dominance of domestic drugs is noted - 54% (respectively of foreign origin - 46%). Analysis of the distribution of domestic analogues of antiviral drugs by manufacturers found that the largest (5 and 4 TN) belongs to LLC "Research and production company" Interpharmbiotek and FZ "Biopharma" Ltd., Ukraine, Bila Tserkva. Key words: influenza; pharmacoepidemiological analysis; antiviral drugs

The analysis of approaches to conducting bioequivalence studies and the policy of “transparency” of their results in Ukraine, the United States and the European Union

Providing the population of Ukraine with quality, effective and, at the same time, economically affordable medicines is a priority task of the healthcare system. Taking into account the relatively low cost of their development generic drugs are available to the majority of the country’s population; thus, bioequivalence studies are needed to obtain data on their efficacy and safety. Ukraine is currently in the process of harmonizing domestic regulatory requirements for generic drugs and conducting bioequivalence studies with global ones. Therefore, it is important to find out the differences in approaches to the registration of generics and studies of their bioequivalence in Ukraine and other countries. Another important aspect is to provide the policy of “transparency” of bioequivalence research results, which contributes to the use of better drugs. Aim. To analyze domestic and global approaches to the organization of the bioequivalence research and provide the policy of “transparency” of their results. Materials and methods. A comparative analysis of approaches to drug registration, requirements for generic drugs and bioequivalence studies and ways to provide the policy of “transparency” of their results in Ukraine, the United States and the European Union was conducted. Results. The analysis has revealed that the methods of registration of drugs in Ukraine, the United States and the EU are the same. Approaches to providing the “transparency” of the results of bioequivalence studies differ since in Ukraine the publication of such information is not mandatory and is at the discretion of pharmaceutical manufacturers. Conclusions. Domestic regulatory requirements for assessing generic drugs are harmonized with the world ones. Today, there is a need to introduce a mandatory requirement for the publication of bioequivalence studies, and it will contribute to providing an effective “transparency” policy.

Past 12-month nonfatal overdose among people who inject drugs in Ukraine: City-level estimates and risk factors from a cross-sectional study

BackgroundNonfatal overdose contributes to high morbidity and is among the strongest proxies for the occurrence of overdose fatality – the leading cause of death among those who use opioids. In Ukraine, a majority of people who inject drugs (PWID) use opioids, but little is known about the relationship between drug market characteristics, nonfatal overdose (NFOD) prevalence, and risk factors for NFOD. MethodsWe used cross-sectional respondent-driven sampling (RDS) data to explore the variability of recent (past 12 months) NFOD among PWID across Ukrainian cities and associations with individual factors. The population-averaged -cross-sectional associations were estimated and compared using generalized linear models for the binary outcome (NFOD vs. not) with robust variance estimates. ResultsRecent self-reported NFOD varied between 1% and 14 % across Ukrainian cities. In adjusted analyses, overdose was associated with fewer years of injecting drugs; a higher number of types of drugs used in the past 12 months; using desomorphine, methadone, tramadol, heroin, amphetamine-type drugs or cocaine within past 12 months; using alcohol daily or weekly; recent drug treatment; and history of incarceration. Buying drugs or their ingredients through "stashes" (i.e., drugs secretly hidden in various places) and the perception of drug price increase were associated with higher odds of reporting NFOD. ConclusionThe identified risk factors underscore the importance of evidence-based prevention efforts, such as scaling-up opioid agonist therapy, providing naloxone in the community and upon prison release, targeting those most likely to witness overdose and sharing overdose prevention strategies with them, and continuous monitoring of trends and contributing factors.

Violence, HIV Risks, and Polysubstance Use Among HIV-Positive People Who Inject Drugs in Ukraine.

Violence experience has been consistently associated with HIV risks and substance use behaviors. Although many studies have focused on intimate partner violence (IPV), the role of violence at a structural level (i.e., police abuse) remains relevant for people who inject drugs. This study evaluated the association of IPV and police-perpetrated violence experiences with HIV risk behaviors and substance use in a cohort of HIV-positive people who inject drugs in Ukraine. We also evaluated possible moderation effects of gender and socioeconomic status in the links between violence exposure and HIV risk and polysubstance use behaviors. Data came from the Providence/Boston-CFAR-Ukraine Study involving 191 HIV-positive people who inject drugs conducted at seven addiction treatment facilities in Ukraine. Results from logistic regressions suggest that people who inject drugs and experienced IPV had higher odds of polysubstance use than those who did not experience IPV. Verbal violence and sexual violence perpetrated by police were associated with increased odds of inconsistent condom use. The odds of engaging in polysubstance use were lower for women in relation to police physical abuse. We found no evidence supporting socioeconomic status moderations. Violence experiences were associated with substance use and sexual HIV risk behaviors in this cohort of HIV-positive people who inject drugs in Ukraine. Trauma-informed prevention approaches that consider both individual and structural violence could improve this population's HIV risks.

ОГЛЯД ПРОГРАМИ ЗАМІСНОЇ ПІДТРИМУВАЛЬНОЇ ТЕРАПІЇ ЯК ЗАСІБ СОЦІАЛЬНОЇ ПРОФІЛАКТИКИ ВІЛ ДЛЯ ЛЮДЕЙ, ЯКІ ВЖИВАЮТЬ ІН'ЄКЦІЙНІ НАРКОТИКИ В УКРАЇНІ

Currently, the prevalence of HIV in people who inject drugs in Ukraine is over 22 %. Medication-assisted treatment (MAT) is an effective evidence-based means of HIV prevention in people who inject drugs (PWID). The objective of this article was to present the overview of medication-assisted program in Ukraine. Descriptive statistics were used to summarize the open-access official data as well as the results of most recent studies in the field of research to analyze and describe the current state of MAT program for PWID. Presented results summarize demographic, clinical data and access to psycho-social support of PWID on MAT in Ukraine as well as present effective approaches for program scale up for prevention of HIV transmission in people who inject drugs in Ukraine.

ЕФЕКТИВНІСТЬ КОМБІНОВАНОГО ЛІКУВАННЯ ХВОРИХ НА БРОНХІАЛЬНУ АСТМУ З НЕЙТРОФІЛЬНИМ ТИПОМ ЗАПАЛЕННЯ

THE EFFICACY OF COMBINED THERAPY IN PATIENTS WITH NEUTROPHILIC BRONCHIAL ASTHMA Yu. I. Feshchenko, L. A. Iashyna, G. L. Gumeniuk, V. I. Ignatieva, M. A. Polianska, S. G. Opimakh, I. V. Zvol, S. M. Moskalenko, N. A. Vlasova, L. A. Halai State organization «F. G. Yanovsky National institute of phthisiology and pulmonology National Academy of medical sciences of Ukraine» , Kyiv, Ukraine Abstract. Background: Issues of neutrophilic bronchial asthma remain unresolved and the investigations of the pathogenesis and treatment of this disease endotype are currently continuing. The aim of the study: This study aimed to develop the technology of the treatment of the neutrophilic asthma with the use of available drugs in Ukraine. Methods. The study involved 30 patients with neutrophilic asthma. The first (control) group consisted of 15 patients who received standard therapy with a combination of budesonide and formoterol. The second (main) group consisted of 15 patients who received the treatment according the technology (ultrafine beclomethasone dipropionate, formoterol, tiotropium bromide and additionally for the first 10 days — inhalation of 10.0 % acetylcysteine solution through a nebulizer). All patients were surveyed with the Asthma Control Test (ACT), the Asthma Control Questionnaire (ACQ). The quality of life of patients was assessed by a St. George’s Respiratory Questionnaire. All patients underwent spirometry and a 6-minute walking test (6MWT). Results: In the prescription of complex therapy to patients with neutrophilic asthma clinical and functional efficacy was achieved in 93.3 % of patients. There were observed statistically significant increase in the ACT from (14.3 ± 1.3) to (20.3 ± 0.8) points (p < 0.05), a decrease in the ACQ from (2.3 ± 0.2) ) to (1.1 ± 0.1) points (p < 0.05), clinically significant reduction in the number of symptoms from (71.4 ± 5.6) points to (51.3  5.0) points, p < 0.05 according to the results of the St. George’s Respiratory Questionnaire, and a statistically significant increase in MEF50 from (28.9 ± 4.5) % to (41.6 ± 4.2) %, p < 0.05, MEF25 — from (19.1 ± 2.9) % to (27.6 ± 2.6) %, p < 0.05 and FEV1 /FVC from (67.2 ± 3.5) % to (76.1 ± 2.3) %, p < 0.05 after 3 months of complex treatment, as well as a statistically significant increase in the number of meters passed in the 6MWT from (266.3 ± 16.2) m to (312.0 ± 14.4) m, p < 0.05, reduction of shortness of breath on the Borg scale before test from (2.5  0.3) points to (1.5 ± 0.1) points, p < 0.05 and after the test — from (4.1 ± 0.3) points to (3.1 ± 0.3) points, p < 0.05. Conclusions: The technology of treatment of patients with neutrophilic asthma allows to improve the control of the asthma symptoms and quality of life of the patients, bronchial patency at the small airways and reduce fixed bronchial obstruction, as well as increase exercise tolerance. Key words: bronchial asthma, neutrophilic inflammation, combined therapy.