Decisions Decisions Behavioural Economics Willingness and ability of
Decisions, Decisions: Behavioural Economics Willingness and ability of OST clients to pay for some OST services in Odesa region in the light of Ukraine crisis Liudmyla Khomych, Deloitte Consulting Overseas Projects LLC, USAID Project “HIV Reform in Action”, Kyiv, Ukraine “No conflicts of interest to declare” #IAS 2017 | @IAS_Conference
#IAS 2017 | @IAS_conference Outline • • Background Methodology Results Conclusions and Next steps
#IAS 2017 | @IAS_conference Background – Ukraine The second-highest HIV prevalence rate in Eastern Europe 238, 000 PLHIV (2016)1 Key populations – HIV prevalence 2 (IBBSs 2015): • • • PWID - 21. 9%; FSW - 7. 0%; MSM - 8. 5%. KPs size estimations 2: 346, 900 PWIDs 80, 100 CSWs 181, 500 MSM Sources: 1 Spectrum 2 IBBS 2015 – Alliance for Public Health
#IAS 2017 | @IAS_conference Background – Ukraine (cont. ) OST programs (as of June 1, 2017): • 9, 615 OST clients • 177 OST sites • 2. 8% out of estim. # of PWIDs Source: OST Program Data, available at http: //phc. org. ua/pages/diseases/opioid_addiction/stat-docs Alliance for Public Health, http: //aph. org. ua/uk/pro-nas/napryamy-roboty/zamisna-
#IAS 2017 | @IAS_conference Background – Ukraine (cont. ) Funding sources for OST programs 2013 -2015 Public 3% International 91% 2013 Public 9% Private 6% International 83% 2014 Public 4% Private 8% International 92% 2015 Source: UNAIDS, Ukraine NASA reports for 2013 -14, 2015 Private 4%
#IAS 2017 | @IAS_conference Background (cont. ) • • Potential financial reduction of the international donors’ support for OST programs The state financing of OST (and other) programs in Ukraine complicated by economic crisis. Building and piloting a sustainable model for the provision of critical services to KPs and PLHIV at the rayon/city level. The implementation of the alternative financing models such as co-payment is optimal way to secure critical for PWIDs services.
#IAS 2017 | @IAS_conference Are there willingness and ability of current OST clients to pay for some OST services? Financial devaluation of hryvnia (in more than 3 times!)
#IAS 2017 | @IAS_conference Odesa region Kyiv Poltava Cherkasy Dnipro Mykolaiv Odesa Kherson
#IAS 2017 | @IAS_conference Odesa region • One of the highest HIV burden in Ukraine • Concentrated HIV epidemic • Key populations - HIV prevalence 1 (IBBSs 2015): PWID - 27. 5%; FSW - 9. 5%; MSM - 12%. • Odesa KPs size estimation 1: 38, 300 PWIDs 7, 700 CSWs 11, 900 MSM Sources: 1 IBBS 2015 – Alliance for Public Health
#IAS 2017 | @IAS_conference Odesa region (cont. ) • 2 OST sites – Odesa city (AIDS Center, TB clinic) • 1 OST site – Izmail city (Izmail Central Municipal Hospital) • 418 OST clients • 1. 1% out of estim. # of PWIDs Sources: OST Program Data, available at http: //phc. org. ua/pages/diseases/opioid_addiction/stat-docs Alliance for Public Health, http: //aph. org. ua/uk/pro-nas/napryamy-roboty/zamisnapidtrymuvalna-terapiya/
#IAS 2017 | @IAS_conference Methodology • Study design: cross-sectional • Study timeframe: summer 2016 • Study population: current OST clients in Odesa city • Random sampling strategy • Structured questionnaire • Univariate and bivariate analysis (to estimate correlates of clients’ willingness to pay for some OST services)
#IAS 2017 | @IAS_conference Results – Basic characteristics Study sample (current OST clients), N=161 Sex: male, % Average age, years (SD) % before 25 years 77. 6 41. 98 (8. 0) 0. 6 Marital status: not married (single), % 49. 7 Education: secondary, % 66. 5 Regular employees, % 29. 2 Income medium/not rich (self-reporting), % 43 Salary as a main source of income, % 57 OST duration (more than 12 months), % 73. 9
#IAS 2017 | @IAS_conference Results – Willingness to pay Study sample (current OST clients), N=161 18 Perceived benefits: “possibility to uptake additional medical care at OST site”, health improvement, reducing financial burden Correlates P-value income per family member 0. 009 self-assessment of financial well-being 0. 008 perceived social support 0. 014 <200 UAH (89. 5%), 87 89% 56 200 -500 UAH (9. 8%), 2001 -3000 UAH (0. 7%) Yes Conditional Yes No Don't know yet
#IAS 2017 | @IAS_conference For what OST clients are ready to pay Study sample (current OST clients), N=161 To receive therapy (drugs) for a few days, % 80 To take therapy (drugs) at the nearest HC facility for a few days, % 65 Anonymous, % 41 To buy drugs in the pharmacy, % 35 To increase daily dose, % 24 To replace methadone, % 18 18 89% 56 87 Yes Conditional Yes No Don't know yet
#IAS 2017 | @IAS_conference For what OST clients are ready to pay Study sample (current OST clients), N=161 To receive therapy (drugs) for a few days, % 80 To take therapy (drugs) at the nearest HC facility for a few days, % 65 Anonymous, % 41 To buy drugs in the pharmacy, % 35 To increase daily dose, % 24 To replace methadone, % 11 >200 UAH 18 89% 56 87 Yes Conditional Yes No Don't know yet
#IAS 2017 | @IAS_conference Conclusions • Clients of OST program in Odesa region demonstrated willingness and ability to pay for some OST services despite on economic crisis in the country. • 200 UAH is the modal amount per month. • Their willingness depends on socio-economic status of PWID and his/her family. • These important correlates of willingness and ability to pay should be considered for design and implementing OST co-payment service delivery model in Odesa region.
#IAS 2017 | @IAS_conference Next steps • OST costing per patient per. Service month (regional-sensitive 408 methodology) • Developing alternative OST co-payment models • Policy development on OST co-payment models • Introducing an alternative models in the region. 948 UAH Methadone 540 Adapted: M. Duda at the National AIDS Conference 2016, Ukraine
#IAS 2017 | @IAS_conference Acknowledgements Co-authors L. Khomych 1, O. Yaremenko 1, O. Postnov 2, N. Avaliani 1, M. Duda 1 1 Deloitte Consulting Overseas Projects, LLC, USAID Project HIV Reform in Action, Kyiv, Ukraine, 2 Ukrainian Research Antiplague Institute named after Mechnikov, Odesa, Ukraine Funding IP in Odesa region Other partners Natalia Davydenko Natalia Kitstenko, Illia Podolian, Yevgen Bratsun, et al. PEPFAR USAID Ethical approval IRB at Ukrainian Institute on Public Health Policy, Kyiv, Ukraine Alliance for Public Health National Public Health Center under MOH of Ukraine
#IAS 2017 | @IAS_conference Thank you! Дякую! Contacts: Liudmyla Khomych M&E and SI Advisor, HIV Reform in Action Project, Kyiv, Ukraine Deloitte Consulting Overseas Projects, LLC Office (+380) 44 281 23 66 E-mail: info@hivreforminaction. org, lkhomych@hss-share. net. ua www. hivreforminaction. org www. facebook. com/HIVReform. UA/
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