Starting from June 25, 2009 the Government of Uzbekistan decided to close a pilot methadone and buprenorphine substitution treatment program in the country. Approximately 200 clients have been enrolled in the program. They have all passed opioid detoxification.

An evaluation of the pilot conducted by WHO experts in 2007 included recommendations for expansion to more sites, allocation of greater space to existing site, greater psychosocial support to clients. The Ministry of Health of Uzbekistan has circulated its official position regardinmg the closure of the project stating: “…pilot OST project has finished. The results of the pilot project didn’t prove effectiveness of such intervention. Uzbekistan might review its decision and resume OST in future if sufficient evidence on its effectiveness be collected by then will be provided.”

Many specialists on drug dependence treatment which are familiar with the situation in the country underline that low quality of implementation of the OST is the main reason that has led to poor results of the program. At the same time they state importance of continuation of the OST while focusing efforts on improving its performance.

OST pilot programme was funded by Global Fund in terms of project of the 3rd Round. Given issues with supply interruption of methadone in Kyrgyzstan (twice), Azerbaijan and Moldova, all of which are funded by Global Fund, GFATM board was asked to include methadone and buprenorphine in its considerations on stock outs, originally intended for antiretroviral treatment, and to more actively engage in the question of emergency supplies or guidelines on treatment continuity.

A sentinel surveillance study conducted in Tashkent in 2007 revealed that prevalence of HIV among IDUs is very high – <25%.  The closure of pilot substitution program in Uzbekistan may lead to new outbreak of HIV among IDUs which may result in raise of new HIV cases among sexual partners of IDUs. It will also affect antiretroviral treatment adherence among people living with HIV who were using substitution therapy.

Currently the Steering Committee members of EHRN have initiated an open letter to Uzbekistan Government which would be signed by international physicians who work in the area of OST. The initiative is also supported by OST working group, members of which are Anya Sarang, Leonid Vlasenko, Aleksandras Slatvickis and others.

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