1. EVALUATION OF A SAFE INJECTION PROJECT IN UZBEKISTAN Dr. Erkin I. Musabaev Institute of Postgraduate Medical Education, Tashkent Uzbekistan Health Ministry

2. Uzbekistan - a new independent state Population - 25 millions Km 2 - 447000 sq. km - total More than 60% of uzbek population are children under 14 yrs Ratio people living in rural areas/living in urban areas – 62%/38%

3. Blood-born pathogens transmission in Uzbekistan 6-7% of the population have HCV infection Prevalence of HBV is 10% HIV/Aids reported cases 1700 (the number of cases doubles every six month) A number of outbreaks among IDUs are reported

4. Intervention program of injection safety in Uzbekistan Implementation steps Pilot project in 4 medical settings (Samarkand region, Uzbekistan) Supported by SDC (Swiss Agency for Development) February 2001 – April 2002 Development of the National Program according to the experience of the pilot project. April-May 2002 Over 200 syringes exchange places for IDUs has been established Implementation of the Intervention Program in two northern provinces of Uzbekistan supported by UNICEF, 2002 2003-2006 Implementation on the national level?

5. Ancient Samarkand – a pilot city of the safe injection program

6. OT8 indicator (injection use) Definition of OT8 number of prescriptions with at least one injection OT8= total amount of prescription lists surveyed OT8 in actual survey in Uzbekistan: 56/107= 52% Conclusion: more than half of the patients presenting in an ambulatory primary health care setting are treated with at least one injection Uzbekistan, rapid assessment February 2001

7. Proportion of doctors (24), nurses (25) and population (44) who mention spontaneously HIV, HBV, HCV and jaundice as a risk of dirty injections Uzbekistan, rapid assessment February 2001

8. Achievements and failures of pilot project Achievements: The behavior of nurses had changed (markedly reduced amount of recapping) A new system of wastes disposal has been established with utilization of safe boxes and Monford incinerator A number of injections prescribed decreased One incinerator for four policlinics had been constructed as well as a person had been trained to use it. Failures: To change the attitude of the local population to injection

9. Steps of implementation of the national safe injection program in two northern provinces of Uzbekistan, 2002 Preparation of training materials for educational modules Initial assessment of the injection practice in the these regions Training –Health care workers (injection prescribes and injection providers) –General population Constructing of 40 Monford incinerators (20 per each region) Final assessment

10. Irrigation canal in the Aral sea area. Dredger graved in desert 10 years ago.

11. Training materials A manual for doctors A manual for nurses Three posters for HCWs and One posters for general population

12. Poster for nurses

14. Conclusion The safe injection program had started in Uzbekistan 2 yrs ago The national policy on injection safety had been developed on May, 2002 Hopefully the program will help to reduce the risk of BBPs transmission on the national level

15. Bukhara and other regions – planned for 2003-2005