Project information

Project title

"HIV/AIDS prevention and care among injecting drug users and in prison settings in Estonia"
Duration 02 November 2009 - 15 June 2011
Project objectives

1. Build national consensus on effective implementation strategies to address HIV/AIDS among IDUs and in prisons.

2. Increase coverage of comprehensive HIV/AIDS prevention and care services among IDUs and in prison settings.

3. Generate and share strategic information to keep HIV programme on track and to respond to the rapidly evolving HIV-AIDS epidemics among IDUs and in prison settings.
Results 1. Training activities. During reporting period 29 trainings on 8 topics took place, 592 specialists were trained:
  • Case-management: 2 trainings, 21 participants;
  • Case-management for PLHIV: 2 trainings, 31 participants;
  • Data Protection and Service Provision: 3 trainings, 42 participants;
  • Drugs, drug addiction & work with addicted people for prison staff & medical personnel: 12 trainings, 204 participants;
  • Motivational Interview: 4 trainings, 36 participants;
  • Infectious diseases and occupational risks: 4 trainings, 85 participants;
  • Stress management and burn-out prevention for harm reduction workers: 2 trainings, 33 participants;
  • Summer school for HIV and drug treatment service providers: 140 participants.

Specialists from the following organizations attended the trainings (in total 45 different organisations):

  • Prisons (5): Viru Vangla, Tallinna Vangla, Tartu Vangla, Harku Vangla, Murru Vangla (all Estonian prisons are covered);
  • Hospitals (6): AS Rakvere Haigla, SA Narva Haigla, AS LTKH, SA IVKH, SA Jõhvi Hooldushaigla, SA Tallinna Lastehaigla;
  • Service providers for IDUs and PLHIV (NGOs) (24):  OÜ Corrigo, OÜ Sõltuvuste Ravikeskus, OÜ TK ELulootus, OÜ Aasa Kliinik, SA Studio OÜ, Supervisiooni ja Coachingu Ühing, SA Sillamäe Narkorehabilitatsioonikeskus, MTÜ Eesti Psühhosotsiaalse Rehabilitatsiooni Ühing, MTÜ AIDSi Tugikeksus, MTÜ Teekond, MTÜ EHPV, MTÜ ESPO, MTÜ Pealinna Abikeskus, MTÜ Eestimaa Abikeskused, MTÜ Eluliin, MTÜ Allium Keskus, MTÜ Me aitame sind, MTÜ Art-ateljee Modus, NNARK MTÜ Sind ei jäeta üksi, MTÜ Convcitus Eesti, MTÜ Sotsiaal-rehabilitatsioonikeskus Loksa, MTÜ Päästearmee, MTÜ Iseseisev Elu, MTÜ Tapa AIDSi Ennetuskeskus-Narkonõustamiskeskus;
  • State and local governmental organizations (9): Paide Sotsiaaltöökeskus, Tallinna Laste Turvakeskus, Tallinna Sotsiaaltöö Keskus, Tallinna Sotsiaal- ja Tervishoiuamet, Kriminaalhooldus (Pärnu, Narva), Haabersti LOV, Pirita LOV, Lääne MV, Ida Politsei Prefektuur.

2. Intervisions for MMT service providers. The first intervision for MMT service providers took place 04.03.2010, the second took place on 05.05.2010, international intervision 18.05.2010 in Riga and the third national intervision took place 22.10.2010 in Narva. The next national intervisions are planned for February - April 2011. Based on the experience gained during organisation of intervisions for MMT service providers, intervisions for NSP staff have started. The first intervision took place in Tallinn 17.12.2010 (Estonian group) and the second (Russian group) is planned for 04.02.2011.

3. Supervisions for NGOs working in prisons . Supervision for NGO Convictus Estonia took place 18-19.03.2010. The second supervision was planned for December 2010 but was postponed until January 2011.

4. Meetings and discussions with national stakeholders in the frame of National Coordination Committee on Drug Prevention and Drug Control and the Governmental HIV Commission. Next meetings of the National Coordination Committee on Drug Prevention and Drug Control and the Governmental HIV Commission will take place on January 26 th, 2011. Main activities and results of the UNODC project in 2011 as well as plans for the last project period will be presented.

5. Meetings with the representative of the Estonian Psychiatrists' Association on updating the MMT guidelines took place to discuss the need for further development of the pharmacotherapy of opioid dependence with methadone, identify possible trainers and agree on how to proceed with the quality improvement of the services.

6. Scholarships, trainings on international level:

  • "Intervision as a tool for enhancing quality of  methadone maintenance therapy" 18.05.2010, Riga;
  • "Equivalent HIV prevention and care in prison settings: from policy to practice" 01-02.06.2010, Riga;
  • "Drugs, Alcohol and Criminal Justice: ethics, effectiveness and economics of intervention - the second European conference of the CONNECTIONS project" 23-25.06.2010 London (only technical assistance);
  • "Harm reduction in the Baltic States - the way forward", 25-26.10.2010 Riga;
  • "Promoting access to HIV testing and counselling services for injecting drug users in the Baltic States", 10.12.2010, Vilnius (flight cancelled due to weather conditions).

7. Elaboration of guidelines on pharmacotherapy of opioid dependence with methadone. According to initial work-plan revision of the existing guidelines on pharmacotherapy of opioid dependence with methadone was planned to be outsourced to the Estonian Psychiatrists' Association. However, due to limited human recourses Estonian Psychiatrists' Association preferred that the NIHD will prepare the draft version, which will then be reviewed by Association. In order to prepare the draft specialists from the NIHD worked through and prepared materials based on latest guidelines issued by WHO and guidelines adopted in Lithuania. Relevant materials were translated to Estonian. Finalisation of the preparation of the new guidelines was delayed (deadline was December 2010) due to severe lack of human recourses in NIHD. This remains the most problematic activity within the project; additional measures should be implemented to insure that the goal is reached within the project.

8. Elaboration of training modules on pharmacotherapy and HIV prevention in prisons. Elaboration of the training modules on pharmacotherapy has been postponed to 2011 due to the delays in reviewing the guidelines on pharmacotherapy of opioid dependence with methadone. Main challenge for Estonia remains lack of possible trainers who could also be involved in preparing the training modules and need to relay on international trainers. Based on the decision of Ministry of Justice the activity on elaboration of training modules on HIV prevention in prisons has been cancelled.

9. Elaboration of informational materials. Two informational materials have been developed (MMT and safer injecting/overdose prevention) and printing is planned for March 2011. Also, two posters are being published in April 2011 - one on overdose prevention and one on MMT. All publications will be in Estonian and Russian.

10. Pilot project on continuum of MMT between arrest houses and prisons. Conducting the pilot project in cooperation with Ministry of Interior and Ministry of Justice on provision of methadone maintenance therapy (MMT) in arrest houses. Pilot activities started in May 2010. Service provision in Tallinn arrest house started in May 2010, in Viru arrest house in December 2010.

11. Pilot project on integrating MMT/ARV in the community settings. Conducting the pilot project in cooperation with WHO on the base of West Tallinn Central Hospital on integration of ART and MMT in Tallinn. Pilot project started on April 26 th 2010. According to activity reports the amount of clients has increased from 10 in May (the same in June, July, August, September) till 14 in October and 15 in November and December 2010. 1 client left and 1 client came to programme in December. Average dose of methadone in December was 93,6 mg, the highest one was 275 mg and the lowest one was 35 mg. During the last month there were 14 visits to a social worker and 8 visits to a doctor.

UNODC budget

87,592.00 EUR