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Official websites use. Share sensitive information only on official, secure websites. New and explosive HIV epidemics are being witnessed in certain countries of Eastern Europe, including Ukraine, as well as a rapid and dramatic increase in the supply, use, and negative public health consequences of illicit drugs. The IDU-RAR uses a combination of qualitative data collection techniques commonly employed in social science and evaluation research to quickly depict the extent and nature of the given health problem and propose locally relevant recommendations for improvement. The investigators focused their assessment on the contextual factors, drug use, and intervention and policy components of the IDU-RAR. A combination of network and block sampling techniques was used. Data collection methods included direct observation, review of existing data, structured and unstructured interviews, and focus group discussions. Key informants and locations were visited until no new information was being generated. Given that Ukraine has sparse resources to be devoted to this problem, action recommendations should be prioritized, realistic, and initially targeted to persons in greatest need. They are provided in this sequence based on what response can realistically be implemented first with limited additional resources and can make the greatest immediate impact. The actual prevalence is believed to be much higher, with the true number of existing cases estimated at a staggering ,—, Such a figure would make Ukraine the most affected country in the region \[ 7 \]. Political independence in Ukraine and surrounding Eastern European countries in the s has been associated with a rapid and dramatic increase in the supply, use, and negative public health consequences of illicit drugs \[ 8 - 10 , 16 \]. While little reliable epidemiological data on opiate injection drug use IDU is available from Ukraine, existing data defines it as significant concern. There were 83, officially registered cases of drug addiction in Ukraine by the end of \[ 23 \]. According to experts' opinions, the existing number of injection drug users IDUs exceeds official registry data by a factor of 5 to 7 times, depending on the particular region \[ 13 \]. These figures represent only registered cases and therefore underestimate the number of diagnosed cases. Data indicate that an HIV epidemic fuelled by heterosexual transmission is emerging, and its expansion will depend on the size of bridge populations that link high-risk groups with the general population \[ 4 \]. At the time of this study, information about the HIV epidemic came mainly from the most heavily affected Ukrainian cities, such as Odessa, Kharkiv, and Mykolaiv \[ 1 \]. The attempts in these and several other cities to control the epidemic were documented in the areas of youth-based HIV education and social marketing, harm reduction programs such as needle exchange , and narcological hospitals. It was not clear how the epidemic progressed in other parts of the country and whether any prevention or treatment efforts existed outside of the major cities. The RAR method uses a combination of qualitative data collection techniques commonly employed in social science and evaluation research to quickly depict the extent and nature of the given health problem and propose locally relevant recommendations for improvement. One of the key principles of RAR is that data are collected from different sources, which allows continuous examination of the reliability and consistency of the data and enables investigators to make better informed decisions about what evidence should be sought in the next stage of the assessment. RAR is designed to rapidly assess a current problem situation e. IDU in a community. This information is then used to make informed decisions about the development of interventions needed to reduce the adverse health and social consequences of the targeted condition. The WHO Rapid Assessment and Response guide on injection drug use IDU-RAR \[ 19 \] was deemed appropriate for this study because it has been used successfully in resource-limited settings within the United States and around the world \[ 20 \], including two Ukrainian cities — Odessa \[ 1 \] and Kharkiv \[ 13 \]. The Contextual Assessment identifies factors that influence the current and potential situations regarding drug injection and its adverse health consequences, as well as opportunities for the development of interventions. Key areas for assessment include factors for spread of IDU, exacerbation versus amelioration of adverse health consequences of injecting, and factors that are likely to hinder or enable the development of interventions. The Drug Use Assessment focuses on the nature and extent of drug use — who is injecting drugs and where this occurs, as well as trends in injection drug use over time. Finally, the Intervention and Policy Assessment is designed to assess existing interventions and policy responses aimed at reducing drug use and its consequences while allowing the assessment team to examine their effectiveness and develop recommendations. As a first step of the rapid assessment, the principal investigator met with key collaborators in Vinnitsya to assemble an assessment team and identify key informants. Immediately following the initial consultation, a conceptual map of the Vinnitsya community was developed. The map captured key locations for the needs assessment including major gathering points for IDUs, areas where drugs are sold, needle exchange sites, treatment facilities, transportation routes, and other key locations. The investigator traveled to all key locations to develop a physical map, noting activities that would help to provide some insight into the nature of IDU. In order to create a representative sample of informants, a combination of network and block sampling techniques was used. The network sampling method involved a chain of referrals initiated by the key informants. All key informants were asked to provide a list of individuals who would be able to offer additional information on a given area of the needs assessment. These individuals were then contacted for further information and asked to provide another list of informants. This approach was used until no new information was being generated. The block sampling technique was similar to the networking sampling, but instead of using key informants as the starting point, the needs assessment team traveled to key locations identified by the mapping exercise to identify new informants. As an example, the leading investigator frequently traveled to a local market in the Vishinka district identified as a gathering point for IDUs to develop rapport with IDUs and gain access to new informants who would be willing to provide information on the IDU situation in Vinnitsya. Data were collected using a combination of rapid assessment methods, including direct observation, review of existing data including statistical data from government reports, annual reports from non-governmental organizations \[NGOs\], local research studies, and media , structured and unstructured interviews, and focus group discussions. An important component of the needs assessment was the triangulation of information, or cross-checking of collected data through the multiple sources. This allowed for collection of more representative data with higher confidence in its accuracy. The first occurrences of HIV infection in the Vinnitsya region were officially registered with the Sanitation and Epidemiological Service between and At this point, only 3 HIV infections were registered. The regional Sanitation and Epidemiological Service statistics for the year revealed that the largest proportion of HIV infections occurred through injection drug use Individuals in the 20—29 age group accounted for the largest proportion of HIV infections Within this age group, the male to female ratio was 3 to 1. The most heavily affected areas within the Vinnitsya Oblast were Gaisyn, Ladyzhyn, and the city of Vinnitsya with In for the first time heterosexual route of transmission has prevailed with Information gathered from NGOs and local researchers suggests similar trends. Many of the students were surprised to learn that HIV cases were reported in Vinnitsya and admitted that they were not as well informed about the disease as they needed to be. These individuals were well aware of the presence of HIV in the community, and some even knew someone who had already contracted the virus. Vinnitsya residents living with HIV face a great deal of stigma and lack a widespread support system within their community. According to infectious disease treatment providers at a local hospital in Vinnitsya, HIV positive patients tend to stay secluded and often are very concerned that other people not learn about their infection. It is not unlikely for someone diagnosed with HIV infection to seek treatment and consultation with a physician during evening hours or at other times when they would be less likely to be seen by other people at the medical facility. Though many physicians seemed compassionate toward HIV positive patients particularly infectious disease specialists working with HIV patients , direct observations and interviews with medical staff revealed that HIV positive individuals were stigmatized within treatment facilities. Test results that were to be kept confidential were openly shared in patient charts, and HIV patients were placed in isolation blocks. Interviews with nurses and other clinical staff revealed that some of the staff were reluctant to treat HIV infected patients. HIV positive patients at a local narcological dispensary stayed in an isolation block consisting of a small single-bed patient room, a nurse's cabinet, and a small waiting area. Anyone in the facility could easily determine who was staying in the isolation block and why he or she was there as the restricted area was clearly labeled. Aside from counseling provided by some physicians who work with HIV-positive patients, there was very little evidence of routine counseling and follow-up for individuals who are tested for HIV. Prevention activities found in the area were classified according to the three categories: primary prevention of occurrence , secondary diagnostics and treatment , and tertiary minimization of adverse consequences. The school-based program, organized by a local NGO, was implemented at only one of the 40 local elementary schools. The program modeled after the American Project Hope utilized innovative educational methods, through which children took part in skill building exercises including self-efficacy building and learned through peer-education. This program, however, did not have a built-in evaluation or measures to ensure sustainability. Primary prevention efforts carried out by a local NGOs reached out to high-risk populations, including commercial sex workers and IDUs, in the city of Vinnitsya and surrounding smaller cities. Educational booklets included information on safer sex practices and where to go for treatment. Some referrals to substance abuse treatment also were made. This effort, however, was fully funded through a time-bound grant, and it was not clear whether it would be sustained. The AIDS Center at the local hospital provided HIV infected individuals with necessary medical attention and some counseling services and linked them with other sources of information. Availability of antiretroviral therapy was limited due to high cost. Patients had to make arrangements to buy their own medications. This situation was likely to change with the Ukrainian government's intention to provide subsidized antiretroviral therapy in the near future, supported by the grant from the Global Fund. During the Soviet era, IDU was largely hidden and mostly limited to individuals from wealthy families. The drugs that were consumed during that time usually included 'clean' drugs such as morphine and heroin. Substance abuse treatment providers who treated patients during the Soviet era indicated that the nature of drug use in Vinnitsya has changed dramatically over the past decade. In the years following Ukraine's independence, drug use has increased rapidly and shifted from purer, more expensive drugs to drugs that can be made at home. According to recovering IDUs from a local church, raw materials became easily accessible, and preparation procedures were passed around like cooking recipes. One especially potent amphetamine-like injectible drug, commonly referred to as 'vint,' was prepared using readily available chemicals that could be purchased at drug stores and local pharmacies. Though this particular recipe came at a price, IDUs could easily learn how to prepare a homemade opiate solution 'hanka' or 'shirka' from their peers. Individuals who were new to IDU could purchase ready-filled syringes or small medicine containers with the opiate solution at a local market. According to informants at a market in the Vishinka District of Vinnitsya city, drug dealers often IDUs themselves were able to do their business there without getting much attention from law enforcement while having good access to new customers. An inexperienced person might be invited to the dealer's apartment or a nearby garage, as attested by social workers at a local needle exchange program, where the dealer would help him or her to inject the drug. There were no reliable epidemiological studies available to estimate the prevalence rates of opiate IDU in Vinnitsya and surrounding areas. Ten percent of the annual admissions to the area's only RND for drug and alcohol treatment were diagnosed with opiate disorders, but the actual prevalence rate in Vinnitsya was estimated to be more than ten times that figure or 2, persons with opiate disorders personal communication with Pavel Slobodyenyuk, M. D, According to reports from the regional Sanitation and Epidemiology Service, rural areas were the most heavily affected in terms of opiate IDU and reportedly include the regions of Koziatyn, Zhmerynka, Trostyanets, Ladyzhyn and Illinitsi, as well as various small towns such as Hnivan and Vapniarka. Results from this study indicated a combination of numerous factors that encouraged the spread of opiate IDU, including Ukraine's economic situation, social changes following the country's independence, easy access to poppy plants, and lack of knowledge. As Ukraine transitioned from the old i. The sale of hanka quickly became a prosperous business. The drug production was not difficult, the raw material was grown in the area, and the demand for opiates was increasing. The cultivation of poppies has been part of the Ukrainian culture for many generations. Consequently, there was fairly easy access to poppies in the Vinnitsya region, especially in the rural areas. IDUs were able to gather poppy straws directly from the fields or purchase them from babushkas grannies at the local market. A 1-ml dose of hanka sold for about 5. Selling a liter of hanka in a day allowed one to make more than ten times the income an average person makes in a month. There did not appear to be a single driving force behind the increase in drug use among young adults. Discussions with IDUs at local treatment facilities and needle exchange programs revealed that people turn to drugs for different reasons. Some people sold drugs to make money while others were drawn to use IDU out of boredom, curiosity, or an attempt to be part of a social circle. As graduates from universities and technical colleges, young adults often had to travel to larger cities to find employment. When they first arrived they would try to find a social circle and a place to belong. This was how many people were introduced to people who inject drugs, according to IDUs and substance abuse treatment providers. Furthermore, the consumption of alcohol is a very important part of the Ukrainian culture. With the economic situation under strain, people turned to alcohol to escape the harsh realities of everyday life. IDU is slowly becoming the mechanism of abuse among young people who wished to do the same. Though information collected through different sources did not contradict this observation, more research is needed to confirm that there is indeed an association between alcohol use and illicit drug use. Another important factor that was indicated as a possible facilitator of drug use, and one that should also be explored through further research, is the changing social environment among school-aged children. As the economy began to crumble, many parents were forced to take on additional jobs to compensate for low income. Their children were under less supervision, and some community representatives speculate that they became more vulnerable to exploring drugs. Extracurricular activities such as sports and various special interest clubs were free-of-charge during the Soviet era. Following the fall of the Soviet Union, however, local schools no longer had the necessary financial resources to sponsor extracurricular activities, and thus children were left with more free time and less to do. These are factors that may play a role in the increasing IDU epidemic. However, more research is needed in this area. While young people from the Vinnitsya community were exposed to various forms of pro-drug messages including the cultural acceptance of alcohol abuse on practically a daily basis, the effort to counteract the influence of these messages by informing the public about the dangerous consequences of substance abuse was minimal. Aside from the recent implementation of school-based anti-drug programs and a special radio program that reaches out to the Vinnitsya city residents, there was very little evidence of anti-drug propaganda i. This was especially true in the rural areas, where the information was needed the most. The promotion of anti-drug messages in schools tended to be the most favored primary prevention approach toward controlling the spread of IDU in this area. The RND has been active in launching several school-based anti-drug prevention programs in all 40 local schools in Vinnitsya, as well as schools in the surrounding areas. Most schools and teachers were surprisingly open to this type of intervention. Students were also quite open and interested in the topics presented and actively asked and answered questions. These programs, however, did not appear to be carried out to their fullest potential. They were not theory-based or standardized in their delivery. The focus of the sessions was primarily on IDU and excluded more common substances such as tobacco and alcohol. The programs were mostly didactic with no experiential components. Teaching materials and information were not always age appropriate, and there were no hand-out materials or resources to obtain help or further information about drug abuse. Furthermore, the programs did not have a built-in evaluation system. Another school-based primary prevention program implemented by a local NGO, titled Project Hope, was modeled after a project that started in the United States and has been implemented in many areas around the world — including Moscow and three Ukrainian cities Kharkiv, Odessa, and Kremenchoug. The goal of the program was to teach children in 1 st —4 th grades self-efficacy skills i. Teachers also were provided with guides on how to conduct interactive sessions and ideas on how to get parents involved. Older children were encouraged to participate in a voluntary Children's Club, in which children taught each other about the negative consequences of drug, alcohol and tobacco use and sexual activity, as well as sexually transmitted diseases. This program, however, was being implemented at only one school in the Vinnitsya area, and no information on its efficacy has been presented. The local media also were involved in primary prevention. The public radio aired a special program on drugs, during which various substance-abuse specialists talked about the consequences of drug abuse and how to deal with addiction. The program also included individuals who had personal experience with substance abuse and were willing to share their story with others. The goal of the program was to provide people with the necessary information to encourage young people not to take drugs or encourage individuals who use drugs to seek treatment. The local newspaper also has created a special section with information about drug use i. Most of this information, however, was limited to individuals who live in Vinnitsya and did not reach the rural areas, where the information also was needed. IDUs in the area were able to exchange used needles and syringes for new, sterile needles and syringes at no cost. The goal of the program was to reduce the potential harm of IDU by reaching out to individuals who put themselves at risk for physical injuries, nerve damage, and infection with sexually transmitted diseases and various blood-borne viruses including HIV, Hepatitis B and Hepatitis C. Educational booklets distributed included information on safer injection practices to avoid serious injuries such as nerve damage , safer sex practices, and information on where to go for treatment. Though the authorities have supported harm reduction programs such as this, needle exchange was not yet fully accepted within the community. According to the social workers from the Vyshenka District NEP, the local police had been suspicious that the social workers were involved in the drug trade. The police had been known to send in undercover agents, for instance, to see whether they could purchase drugs or poppy straws from the social workers. The program was advertised through 'word of mouth' due to the stigma placed on IDUs. There tended to be a lack of coordination between the NGO and other organizations in the community, all of which would help to make the program more effective. No empirical information on the effectiveness of this program has been presented to the research or local community over the three years of program operation. The RND a bed inpatient, government supported hospital is the only facility for the diagnostics and medical treatment of alcohol and drug related disorders in Vinnitsya. Located in the south Leninsky district, it is staffed by medical doctors, psychologists, social workers, and nurses. It also carries out the expert assessment of substance use disorders for local road police and the criminal justice system and provides educational lectures to local and rural elementary schools. There were more 24 thousand persons 'registered' as patients of the RND. The patient population was primarily male and approximately 60 percent from the city of Vinnitsya and 40 percent from rural areas. Most patients were being treated for alcohol-related disorders. Only 10 percent were opiate IDUs, despite the increasing demand for treatment of this problem. Treatment was organized into three stages: medical, psychotherapy, and rehabilitation. Primary emphasis was placed on medical treatment. Though the RND is a public health facility, the government covers only a small portion of the total cost of treatment, which barely covers staff salaries. Treatment in public institutions is considered free, which means that patients do not pay any hospital or physician charges. However, since the breakdown of the Soviet system, the state budget does not make provisions for medication. The RND provided treatment primarily for the patients' physical dependency medical detoxification with very little aftercare, and it was plausibly reported that many patients have short remission times and return to alcohol or drug abuse just a few months following the completion of the treatment. Each patient is recommended to follow up with a psychologist or a regional narcologist after discharge; however no monitoring system is in place, which prevents valid outcome assessment. According to the treatment providers' personal experience, very few patients do see their psychologist or narcologist before the next full-blown relapse. Factors that may hinder the effectiveness of the treatment include: high cost and short length of treatment, lack of evidenced-based interventions, lack of outpatient treatment and drug use monitoring, and absence of narcotic substitution medication therapies. There are essentially no eligibility criteria for admission; any resident of Vinnitsya oblast could enter the RND if diagnosed with a substance use disorder. High costs of medication and little faith in the efficacy of available treatment among potential patients further decrease the attractiveness of drug treatment in Vinnitsya. There was a great amount of prejudice toward IDUs both within the community and among medical professionals that presented another barrier to the effective treatment of IDUs. Interviews with medical practitioners revealed discriminatory attitudes toward IDUs. Furthermore, IDUs were not the most 'liked' patients, even at the RND, where patients with alcohol dependency were said to get preferential treatment. Alcohol dependency may be more acceptable due to the strong cultural role of alcohol in this society. Some medical professionals viewed IDUs as 'hopeless cases' or as individuals who are 'impossible to treat. Furthermore, some health professionals explained that IDUs are so mentally disturbed due to brain damage that they are no longer receptive to any treatment. Direct observations at the treatment center revealed that it was not unlikely to see a physician on duty refuse treatment to HIV positive IDUs and send them to another facility i. The director and staff of the RND, however, were highly compassionate and motivated to improve the state of treatment services for alcohol and drug related disorders at the RND. A response designed to positively impact mortality and morbidity associated with HIV and IDU in this part of the world must be swift and comprehensive. As such, we recommend using the resources and staff of ICOHRTA for initiating and sustaining the implementation of the following priorities. IROHRTA resources and staff can link in-country stakeholders with educational materials, risk assessments, skill building protocols, and evidence-based prevention and intervention protocols, training. They also can offer assistance with writing grants to procure funds for HIV testing supplies, condoms, bleach kits, educational materials, research, and salary support for prevention staff. Most people who have HIV do not know they have it. Furthermore, many people at risk are afraid to be tested because of the stigma associated with IDU and HIV and fear of testing positive. One way to address the AIDS epidemic is to give people an opportunity to know their HIV status so that they can take precautions to avoid further spread and seek treatment if they are infected \[ 25 , 26 \]. Identification of those in need of help through effective outreach, motivational enhancement, risk assessment, and VCT must be the first priority to make an immediate impact on those at greatest risk in Vinnitsya. Vinnitsya has various locations appropriate for VCT sites. Training of agency staff is recommended in effective peer outreach strategies, risk assessment, motivational enhancement, and VCT protocols. Immediate diversion of agency funds and applications for small grants are recommended to fund the purchasing of HIV test kits. Successful outreach and VCT will immediately break down the first barrier to assessing the problem through anonymous testing, epidemiological prevalence surveys, and provision of prevention, education, and treatment to those most in need. The second priority is the prevention of HIV transmission among high risk populations through education, skills development, and distribution of free condoms with support from the ICOHRTA. HIV positive IDUs should be targeted first for secondary prevention by VCT providers via education about their risk of transmitting HIV to others and how to prevent transmission through abstinence or reduce it through condom use. They should first have access to free condoms and be trained in correct condom use and then interpersonal sexual negotiation skills to practice safer sex or abstinence. Drug and alcohol use in general reduces the practice of safer sex and drug use behaviors, but IDU is the most risky behavior due to the opportunity to spread the virus by sharing needles, syringes or other contaminated drug use paraphernalia. Therefore, training in needle and syringe cleaning with bleach should be given high priority. Persons who are HIV positive may be suffering from despair and depression and be less motivated than high risk populations to practice safer sex or IDU behaviors. It is recommended that VCT prevention staff be adequately trained in the areas of coping with HIV diagnosis, apathy, depression, and even suicidal ideation. Finally, prevention staff should work on identification and notification of sexual and IDU partners. They should be targeted next for prevention and education. Many of the prevention strategies proposed above for HIV positive persons apply to these groups. They should be provided with the abovementioned programs to prevent drug use prevention, teach sexual negotiation skills and provide condoms. They also should be encouraged to return for re-testing after three months. This group should be assessed for unsafe sex behaviors and non-IDU risky drug and or alcohol use. They should be provided with condoms, HIV prevention education, risk reduction skills, and information about the use of drugs and alcohol and practicing unsafe sex. Once high risk populations are identified and tested for HIV, and prevention and education have been implemented, attention should be given to reducing harm from existing risky behaviors and enhancing opportunities for treatment. The philosophy of harm reduction, as opposed to abstinence, should guide the initial delivery of tertiary prevention. While abstinence from both sex and IDU behaviors is the only safe way to prevent HIV transmission, this advice is often met with resistance, takes a long time to achieve, and is not realistic for many persons. This NEP reaches out to the community from two street sites, offering clean needle exchange and alcohol swabs. The concept of NEPs in Vinnitsya is not fully accepted by the police, and the NEP sites are regularly monitored for any illegal practices. It is recommended that the ICOHRTA investigators meet with the leader of this NGO and discuss ideas of offering free condoms and prevention literature, making referrals for treatment, site expansion, and additional funding. Assessment of drug addiction treatment model preferences was assessed among providers and patients of the RND in preparation for the technology transport of behavioral, HIV prevention, motivational enhancement, and relapse prevention interventions \[ 21 \]. The National Institute of Drug Abuse NIDA is funding this transport of interventions for IDU and HIV risk under the leadership of the second author through training in evidenced-based psycho-social and behavioral treatments, increased use of family support, and ultimately sustaining a raised standard of care at the RND. An increase in IDU in Ukraine within the last decade, for instance, may be explained by complex factors such as the country's economic crisis, rapid social change, and increased poverty and unemployment \[ 7 \]. It is therefore possible that the statistics from these areas may be inadequate due to underreporting. Thus, there may not be such a large difference between the heavily affected regions i. Odessa, Mykolaiv, Dnipropetrovs'k, and Donets'k and other regions of the country. The most heavily infected regions may simply have better reporting systems and resources for HIV testing. Second, while the statistics for Ukraine as a whole seem to indicate that there is a shift toward heterosexual transmission of HIV, a great majority of the HIV infections reported prior to in the Vinnitsya region were among IDUs. In fact, there were no officially registered HIV infections in this region until the year , and the current distribution of HIV infections by risk group actually resembles the national statistics for that same year. Unexpectedly, the majority of newly registered HIV cases in Vinnitsya in were attributed to heterosexual transmission It can be explained either by a true shift in the epidemic dynamics or by improved surveillance after the establishment of the Regional AIDS Centre; however, there are no sufficient data to document either explanation. In any case given that the great bulk of existing HIV cases are among IDUs it is reasonable to conclude that high, significant problems lie ahead without enhanced prevention and treatment efforts. There also is a shift in the nature of drug use and the demographics of individuals who abuse drugs in this part of the country. Currently, individuals who abuse drugs tend to be younger, and the drugs tend to be more potent and riskier than they were when Ukraine was a part of the Soviet Union. Drug abuse appears to start with the use of alcohol and smoking of cannabis among children as young as 10 years of age, which may help to explain the earlier onset of IDU. Konoplya, a strong cannabis-based substance that was not as common among teenagers during the Soviet era perhaps due to a stricter regulation at the borders , may serve as a gateway drug, leading the way to experimentation with more risky drugs i. Because many IDUs make the opiate solution themselves in non-sterile home-laboratories, they have control over its strength; face a greater chance of contaminating the solution i. Prevention and treatment efforts have been attempted with limited success due to inadequate resources, training, and the burgeoning IDU problem in the area. Avenues for change in the drug addiction prevention and treatment fields are open due to caring and motivated health care providers and public health officials. Changes may have to be made at the levels of individuals, services, communities, environments, and policies. Consequently, it will take a collective effort to make significant progress. Katerina Barcal, MPH conceived of the study and its design, the collection of data, organizing the data for qualitative analysis, drafting the article and making final edits, and giving final approval for publication. Joseph E. Schumacher, PhD mentored Ms. Barcal in the study conceptualization, design, data analysis, manuscript preparation, giving final approval for publication. Kostyantyn Dumchev, MD, MPH participated in the design and methodology of the study, collection of the data, organization of the data, editing the manuscript, and giving final approval for publication. Larisa Vasiliyevna Moroz, MD, PhD participated in the acquisition and interpretation of the data, editing the manuscript, and giving final approval for publication. It would not have been possible to conduct the rapid assessment without the help and contribution of our collaborators and various individuals from the Vinnitsya, Ukraine area including health professionals from the Vinnitsya National Pirogov Memorial Medical University PMU and the Regional Narcological Dispensary RND. We would especially like to thank Dr. Vasiliy Maximivich Moroz, President of the PMU, for inviting us to Vinnitsya and allowing us to conduct this research through the medical university. Pavel Slobodyanyuk, Director of the RND, and his staff allowed us to learn more about their center through observation, staff shadowing, and interviews. We would also like to acknowledge the contributions of Dr. Igor Matkovskiy, Dr. As a library, NLM provides access to scientific literature. Harm Reduct J. Find articles by Katerina Barcal. Find articles by Joseph E Schumacher. Find articles by Kostyantyn Dumchev. Find articles by Larisa Vasiliyevna Moroz. Received Dec 2; Accepted Sep 15; Collection date Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

Plovdiv buying Heroin