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Background: Syringe vending machines (SVM) can improve access to sterile injecting equipment, but they have not been widely implemented or evaluated. We evaluate the cost of SVM installed between July 2019–December 2020 in Tbilisi, Georgia. Methods: The SVM were stocked with several kit types, including injecting equipment for opioid or stimulant users, naloxone, male and female condoms, and pregnancy tests. We gathered financial data from the project to estimate fixed (staff time, start-up costs, equipment, running costs, and consumables) and variable (harm reduction kits) costs. We calculated the full cost of the SVM intervention, cost per user, cost per additional syringe accessed by SVM users, and cost per kit distributed (2020 Euros). Results: SVM access cards were issued to 1132 users, and 29,238 kits were distributed through SVM, total cost €204,358. Staff costs were 51% of total, consumable costs 28%, equipment 10%, and start up, recurrent costs, and overheads 5% or less each. Opioid and stimulant kits were most accessed (35% and 32% of total). Cost per user was €66/year, and cost per transaction €7, of which €5 fixed costs and €2 variable. If monthly transactions increased from the average of 1622/month to highest monthly usage (4714), fixed costs per transaction would decrease to < €1. It cost €0.55 per additional syringe accessed/user/month. Conclusions: This study provides evidence for governments about the cost of SVM, a novel harm reduction intervention. This is particularly relevant where Global Fund is withdrawing and harm reduction services need to be incorporated into national budgets. [ABSTRACT FROM AUTHOR]

Background: This study examines the effects of COVID-19 related restrictions on the supply of illicit drugs, drug-use behaviour among people who use drugs (PWUD) regularly (at least weekly), and drug-related service provision in Tbilisi, Georgia. Methodology: In this mixed methods study, a cohort of 50 Georgian PWUD recruited through a snow-ball sampling participated in a bi-weekly online survey in April–September, 2020. They also took part in the qualitative telephone interviews at 12- and 24-week follow-up time points. In addition, four key informants (field experts) were interviewed monthly to assess their perceptions of changes in the illicit drug market and drug service delivery. Results: Mean age in the sample was 36 (range 18–60); 39 (78%) were males. Perceived availability of drugs was reduced during the lockdown, and many PWUD switched to alternative substances when preferred drugs were not available. On average, participants used significantly fewer substances over the course of the study, from 3.5 substances in the preceding 14 days to 2.1 (aOR 0.92; 95% CI 0.90–0.94). Consumption of cannabis products declined significantly (aOR 0.89; 95% CI 0.84–0.95), likewise alcohol (aOR 0.94; 95% CI 0.88–1.0), diverted medicinal methadone (aOR 0.85; 95% CI 0.8–0.9) and diverted medicinal buprenorphine (aOR 0.91; 95% CI 0.84–0.99). PWUD cited fewer contacts with drug dealers, the lack of transportation, and the lack of conventional recreational environment as the main reasons for these changes. When access to sterile injection equipment was limited, PWUD exercised risk-containing injection behaviours, such as buying drugs in pre-filled syringes (aOR 0.88; 95% CI 0.80–0.96). Harm reduction and treatment programs managed to adopt flexible strategies to recover services that were affected during the initial stage of the pandemic. Conclusions: COVID-19-related restrictive measures mediated specific changes in supply models and drug-use behaviours. While adjusting to the new environment, many PWUD would engage in activities that put them under increased risk of overdose and blood-borne infections. Harm reduction and treatment services need to develop and implement protocols for ensuring uninterrupted service delivery during lockdowns, in anticipation of the similar epidemics or other emergency situations. [ABSTRACT FROM AUTHOR]

Background: Georgia has a significant risk of ongoing HIV and HCV outbreak. Within this context, harm reduction aims to reduce risk associated with drug use through community activities, such as peer recruitment and involvement. The aim of this study was to identify significant differences between known and hidden populations, and attest to the ongoing utility of peer-driven intervention across multiple years in recruiting high-risk, vulnerable populations through peer networks. It was hypothesised that significant differences would remain between known, and previously unknown, members of the drug-using community, and that peer-driven intervention would recruit individuals with high-risk, vulnerable individuals with significant differences to the known population. Methods: Sampling occurred across 9 months in 11 cities in Georgia, recruiting a total of 2807 drug-using individuals. Standardised questionnaires were completed for all consenting and eligible participants, noting degree of involvement in harm reduction activities. These data underwent analysis to identify statistically significant different between those known and unknown to harm reduction activities, including in demographics, knowledge and risk behaviours. Results: Peer recruitment was able to attract a significantly different cohort compared to those already known to harm reduction services. Peer-driven intervention was able to recruit a younger population by design, with 25.1% of PDI participants being under 25, compared to 3.2% of NSP participants. PDI successfully recruited women by design, with 6.9% of PDI participants being women compared to 2.0% in the NSP sample. Important differences in drug use, behaviour and risk were seen between the two groups, with the peer-recruited cohort undertaking higher-risk injecting behaviours. A mixture of risk differences was seen across different subgroups and between the known and unknown population. Overall risk, driven by sex risk, was consistently higher in younger people (0.59 vs 0.57, p = 0.00). Recent overdose was associated with higher risk in all risk categories. Regression showed age and location as important variables in overall risk. Peer-recruited individuals reported much lower rates of previous HIV testing (34.2% vs 99.5%, p = 0.00). HIV knowledge and status were not significantly different. Conclusions: Significant differences were seen between the known and unknown drug-using populations, and between previous and current research, speaking to the dynamic change of the drug-using culture. The recruitment strategy was successful in recruiting females and younger people. This is especially important, given that this sampling followed subsequent rounds of peer-driven intervention, implying the ability of peer-assisted recruitment to consistently reach hidden, unknown populations of the drug-using community, who have different risks and behaviours. Risk differences were seen compared to previous samples, lending strength to the peer-recruitment model, but also informing how harm reduction programmes should cater services, such as education, to different cohorts. [ABSTRACT FROM AUTHOR]

In July of 2018, the Constitutional Court of Georgia ruled that any punishment for cannabis use is unconstitutional. The study aimed to examine changes in the behavior of regular cannabis users following the legal reform. We conducted an online cross-sectional survey of adults using cannabis regularly at least once a week. Survey included 389 participants, mostly males whose average age was 28 at the time of the survey. Two thirds did not report any change in frequency of cannabis consumption after the law reform. Less frequent users were more likely to report increased consumption. Females were more likely to initiate cannabis use after the legal reform. Perceived availability of cannabis remained unchanged for the majority of participants. Females were more likely to report that the availability increased following the legal changes. A small number of participants reported quitting synthetic cannabinoids and switching to herbal cannabis products. Getting cannabis for free from friends was the most prevalent way of obtaining cannabis, both in pre- and post-reform periods. Future research needs to understand which of the observed changes are linked to health risks or potential benefits, and identify strategies that would prevent negative individual and public health outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The increasing use of new psychoactive substances (NPS) represents a growing public health challenge. This is the first study in Georgia that aims to explore the characteristics of NPS users, patterns of use, and perception of health risks. Methods: We conducted an online survey in which individuals who have used NPS during the past 12 months filled in a structured questionnaire that covered socio-demographics, drug use practices, and perception of effects of NPS use. Results: The final database consisted of 353 questionnaires. Cannabis-, MDMA- and LSD-type NPS were most often used substances. Majority obtained NPS from friends and used NPS in a group of friends. Majority of the respondents did not attribute any physical and mental health problems to NPS use. A range of negative effects was reported. Discussion: Respondents identified a range of negative and positive health and social effects and linked them to the consumption of a particular NPS. Results of this research are important for guiding future efforts to assess health risks associated with NPS use, and to propose harm reduction strategies to mitigate those risks. [ABSTRACT FROM AUTHOR]

Tbilisi is fast becoming a regional hub for electronic dance music. This study describes the use of illicit psychoactive drugs by frequent nightclub visitors in a club setting. We conducted 16 qualitative in-depth interviews with young nightclubbers with a history of drug use in Tbilisi. The majority of respondents had experience with two or more drugs consumed in a club setting, with the most prevalent substances being MDMA/ecstasy, amphetamines, and synthetic cannabinoids. Most respondents had limited information regarding the drugs they consumed. Often this information was provided by dealers or friends and was limited to the name of the drug (but not the substance) and its expected effects. Receiving often unknown substances from unknown people was prevalent. The majority of respondents reported combining psychoactive substances with alcohol, or mixing the use of other substances. Participants by their own account indicated a lack of knowledge about the adverse effects of drugs, as well as an ignorance of overdose signs and response strategies. Study findings may guide future efforts to investigate the prevalence and context of club drug use in the country, to assess health risks associated with it, and to propose strategies to mitigate those risks. [ABSTRACT FROM AUTHOR]

This study aimed to assess the impact of a culturally sensitive, comprehensive women-centered intervention on psychoactive substance use among women in the Republic of Georgia. Study participants included 128 women who had injected psychoactive substance(s) in the past 30 days and had enrolled in a randomized controlled trial that compared Reinforcement-Based Treatment and the Women’s CoOp (RBT+WC) to usual care (UC). RBT+WC provided a structured 12-session intervention designed to reduce HIV/HCV risk and psychoactive substance and alcohol use, and to improve mental and physical health, whereas UC provided information booklets on the same topics and case management for 12 sessions. Urine drug screening was conducted at baseline, treatment completion, and 3-month follow-up. The findings showed that RBT+WC was not more effective than UC, although both treatments positively impacted opioid, benzodiazepine, and amphetamine/methamphetamine use. The findings suggest that RBT+WC represents a promising comprehensive women-centered intervention for reducing substance use and HIV risks for Georgian women who use substances. [ABSTRACT FROM AUTHOR]

In 2006 the country of Georgia implemented Article 45 of the Administrative code and Article 273 of the Criminal Code of Georgia, a public policy that enable police to detain any individual, anywhere, at any time on grounds of suspicion of drug use; and require them to submit to urine screening to test for the presence of illegal drugs and their metabolites. This policy is referred to as the street drug testing policy. Positive drug screening results in fines and potential jail time. The purpose of this paper is to conduct a cost analysis of this policy and assess the execution of the policy and the extent to which the policy meets its stated aims. Methods: This study employed cost analysis methodology to calculate annual direct material and labor costs associated with carrying out Georgia's street level drug testing policy. These costs encompassed law enforcement, drug testing, associated judicial processes, imprisonment and income offset through fines collected during the two years covered in this study (2008 and 2014). In addition, we measured: fidelity of the execution of the policy measured by the accuracy of the percentage of people detained who were found to actually have used drugs; and the policy's effectiveness in deterring drug use among those who tested positive. Impact on drug use behavior was measured through impact analysis interviews conducted with a national sample of 500 detainees who tested positive for drugs under Article 45 and Article 273. Results: Using conservative financial estimates the cost of carrying out the policy offset by fine revenues broke even in 2008 (-111,889 GEL); however, by2014 the costs increased 20% in conjunction with an 18% increase in the number of people detained for testing. However, the percentage of people who tested positive for drugs declined 39% indicating decreased fidelity in the execution of the policy; accompanied by a financial imbalance of -10,277,909 GEL. Moreover, effectiveness analysis revealed that within one month of being detained and having tested positive for drug use, over 90% of individuals had returned to pre-detention drug use levels, and within 12 months 100% of detainees had resumed prior drug use behaviors. Conclusion: The financial costs associated with Georgia's street level drug screening policy has rapidly increased while becoming decreasingly accurate and efficient in its execution. Moreover, data indicates that the policy is not effective in reducing or stopping drug use among those who tested positive. In conclusion, it is fiscally unsustainable to continue the policy as it is being executed and the policy is ineffective in changing drug use behavior among people who use illegal substances. [ABSTRACT FROM AUTHOR]

Background: Since the end of 2015, reports by service providers have indicated a new trend in kitchen (homemade) production of an injection drug prepared from an ephedrine-containing conifer bush that is indigenous to the region.Objective: The aim of this report is to describe an emerging new homemade psychoactive drug synthesized from the ephedra plant, and the drug consumption methods associated with its' use in the Eurasia.Methods: Focus groups conducted with 16 people, self-identified as injection drug users (IDU's) who reported at least one incidence of ephedra preparation injection during the previous 30-days.Results: Participants were male, mean age of 43 and mean length of drug use of 22.2 years. Participants identified “conifer vint” as the most frequently injected drug during the 30-day period preceding the focus group. The source plant of the drug identified, as “conifer vint” is plant-based ephedra extracted from a common conifer bush that grows wild and is pervasive in the region. The process of synthesis resembles the production of “vint” (conversion of ephedrine to methamphetamine by reduction) and involves several legal and widely available chemical precursors. The final product of the synthesis is a strong injectable CNS stimulant solution.Conclusions/Importance: The production and use of raw ephedra from a pervasive indigenous plant reflect a new trend in psychoactive drug preparation and use that warrants international attention and has global implications for emerging trends in drug use. [ABSTRACT FROM PUBLISHER]

Background: Sharing injection equipment remains an important rout of transmission of HIV and HCV infections in the region of Eastern Europe and Central Asia. Tajikistan is one of the most affected countries with high rates of injection drug use and related epidemics.The aim of this qualitative study was to describe drug use practices and related behaviors in two Tajik cities - Kulob and Khorog.Methods: Twelve focus group discussions (6 per city) with 100 people who inject drugs recruited through needle and syringe program (NSP) outreach in May 2014. Topics covered included specific drugs injected, drug prices and purity, access to sterile equipment, safe injection practices and types of syringes and needles used. Qualitative thematic analysis was performed using NVivo 10 software.Results: All participants were male and ranged in age from 20 to 78 years. Thematic analysis showed that cheap Afghan heroin, often adulterated by dealers with other admixtures, was the only drug injected. Drug injectors often added Dimedrol (Diphenhydramine) to increase the potency of "low quality" heroin. NSPs were a major source of sterile equipment. Very few participants report direct sharing of needles and syringes. Conversely, many participants reported preparing drugs jointly and sharing injection paraphernalia. Using drugs in an outdoor setting and experiencing withdrawal were major contributors to sharing equipment, using non-sterile water, not boiling and not filtering the drug solution.Conclusion: Qualitative research can provide insights into risk behaviors that may be missed in quantitative studies. These finding have important implications for planning risk reduction interventions in Tajikistan. Prevention should specifically focus on indirect sharing practices. [ABSTRACT FROM AUTHOR]

Background: Since early 2000, intensive policing, wide scale street drug testing, and actions aimed at limiting the availability of specific drugs have been implemented in Georgia. Supporters of this approach argue that fear of drug testing and resulting punishment compels drug users to stop using and prevents youth from initiating drug use. It has been also stated that reduction in the availability of specific drugs should be seen as an indication of the overall success of counter-drug efforts. The aim of the current review is to describe the drug-related law enforcement response in Georgia and its impact on illicit drug consumption and drug-related harm.Method: We reviewed relevant literature that included peer-reviewed scientific articles, stand-alone research reports, annual drug situation reports, technical reports and program data. This was also supplemented by the review of relevant legislation and judicial practices for the twelve year period between 2002 and 2014.Results: Every episode of reduced availability of any "traditional" injection drug was followed by the discovery/introduction of a new injection preparation. The pattern of drug consumption was normally driven by users' attempts to substitute their drug of choice through mixing together available alternative substances. Chaotic poly-substance use and extensive utilization of home-made injection drugs, prepared from toxic precursors, became common. Massive random street drug testing had little or no effect on the prevalence of problem drug use.Conclusions: Intensive harassment of drug users and exclusive focus on reducing the availability of specific drugs did not result in reduction of the prevalence of injecting drug use. Repressive response of Georgian anti-drug authorities relied heavily on consumer sanctions, which led to shifts in drug users' behavior. In most cases, these shifts were associated with the introduction and use of new toxic preparations and subsequent harm to the physical and mental health of drug consumers. [ABSTRACT FROM AUTHOR]

Background: This paper reports on the feasibility and initial efficacy of a culturally sensitive, comprehensive women-centered substance use intervention for women who inject drugs in Georgia in terms of the primary and secondary sex risk outcomes. The hypothesis under examination was that, relative to case management participants, participants in a culturally sensitive, comprehensive women-specific and -centered intervention would, on average, show significant decreases in past-30-day frequency of unprotected sex, unprotected sex at the last sexual encounter, and increases in condom use and safer sex actions.Methods: The study was a two-arm randomized trial, in which 173 potentially eligible women were screened, and those 128 women determined to be eligible were assigned at random to either Reinforcement-based Treatment plus Women's Co-Op (RBT + WC) or case management (CM). RBT + WC participants received 12 sessions of a structured intervention with the goal of reducing risky sex and substance use and improving physical and mental health. CM participants received 12 sessions of case management and informational brochures that focused on the same issues on which RBT + WC focused. Participants were assessed at baseline, post-treatment, and 3 months following treatment enrollment.Results: Analyses revealed case management having significantly overall higher Safer Sex action scores than RBT + WC, and a significant decrease over time for past 30-day number of unprotected sex acts. Unprotected sex at the last encounter and Condom Use action scores were nonsignificant.Conclusions: Women who inject drugs in Georgia are engaging in risky sexual practices, and are in need of an intervention that addresses these risky behaviors. Reasons for the failure to find differences between a culturally sensitive, comprehensive women-centered intervention and case management tailored to the needs of women who inject drugs in Georgia may have been the result of inadequate power to detect an effect in a sample whose drug use was not as serious as warranted by the intervention. (ClinicalTrials.gov Identifier: NCT01331460 ). [ABSTRACT FROM AUTHOR]

Background: "Low dead space" syringes with permanently attached needles retain less fluid, blood, and HIV after use than standard "high dead space" syringes. This reduces the probability of HIV transmission if they are shared by people who inject drugs (PWID). The World Health Organization recently recommended that needle and syringe programs (NSP) offer clients low dead space syringes. The success of this recommendation will depend on PWID switching to low dead space needles and syringes. This paper examines the needles and syringes that PWID in Tajikistan use and factors that influence their choices. Methods: In May 2014, we conducted six focus groups in Kulob and six in Khorog, Tajikistan, with a total of 100 participants. NSP staff members recruited participants. Focus group topics included the needles and syringes used and factors that influence choice of needles and syringes. Focus groups were conducted in Russian and Tajik, audio recorded, transcribed, and translated into English. The translated files were imported into NVivo 10 for coding and analysis. Results: All participants in both cities were male and reported injecting heroin. Everyone also reported using syringes with detachable needles almost exclusively. The most popular syringe sizes were 2 and 5 ml. Needles ranged in gauge from 25 to 21 g. Needle gauge was influenced by the size of the vein, the viscosity of drug solution to be injected, and problems with blood clotting. Needles ranged in length from 12 to 38 mm, with 25 and 32 mm being the most popular. Needle length was influenced by the depth of the vein being used. Many PWID inject volumes of fluid greater than 1 ml into deep veins that require needles at least 25 mm long and 25 g in diameter. Conclusion: Most low dead space syringes are 1-ml insulin syringes with 12 mm 28 g permanently attached needles. Findings from this project suggest that these will not be acceptable to PWID who need larger syringes and longer and thicker needles that are detachable. Low dead space detachable needles appear to be an acceptable option that could overcome barriers to the widespread use of low dead space equipment for reducing HIV and HCV transmission. [ABSTRACT FROM AUTHOR]

This article examines the current status of women-centered substance use disorder treatment in Georgia. Four major issues are identified that adversely impact the delivery of effective services for women with substance use disorders: Policy Issues, Sociocultural Issues, Programmatic/Structural Issues and Personal/Interpersonal Issues. These four issues are seen to form a complex, dynamic system that serves to maintain the current ineffective service delivery system and suppresses movement toward an effective service delivery for this highly marginalized and at-risk population. How these issues, and their interplay, present continuing barriers to the development and implementation of effective treatment for this population are outlined and discussed. In order to overcome these barriers, solutions must be sought in four areas: Policy reform, Public health campaigns, Development and implementation of comprehensive women-specific confidential treatment models and Empowering women. Specific goals in each of these areas that would achieve a positive impact on various aspects of the functioning of the current service delivery system for women with substance use disorders are suggested. Simultaneously seeking solutions in all four of these areas would improve the service delivery system and benefits women with substance use disorders. [ABSTRACT FROM PUBLISHER]

This study describes the initiation and maintenance of illicit drug use, risky behaviors, and the substance use treatment experiences of women in Georgia. Qualitative interviews with 55 drug-using women (mean age 36 years; SD = 9.52), were conducted during April–September 2011. Participants presented diverse histories of drug use initiation and substance use, risky behaviors, and drug treatment participation. All participants reported concurrent use of different substances, including home-produced injection preparations. Women described their experiences of both the positive and negative effects (physical and psychological) that they attributed to their use of drugs. Findings enrich our understanding of the environment in which substance use is initiated and maintained in a female population in Georgia, and illustrate the importance of culture and the role of social factors in the development of injection drug use. Results can provide direction for tailoring the development of interventions for substance use disorders, public policy discussions regarding the treatment of women who use drugs, and future research on substance use among women in Georgia and other post-Soviet nations. [ABSTRACT FROM PUBLISHER]

This study examined attitudes and perspectives of 34 health service providers through in-depth interviews in the Republic of Georgia who encountered an injection drug-using woman at least once in the past two months. Most participants' concept of drug dependence treatment was detoxification, as medication-assisted therapy was considered part of harm reduction, although it was thought to have relatively better treatment outcomes compared to detoxification. Respondents reported that drug dependence in women is much more severe than in men. They also expresSed less tolerance towards drug-using women, as most providers view such women as failuresas a good mother, wife, or child. Georgian women are twice stigmatized, once by a society that views them as fulfilling only a limited purposeful role and again by their male drug-using counterparts. Further, the vast majority of respondents were unaware of the availability of specific types of drug-treatment services in their city, and even more did not seek connections with other service providers, indicating a lack of linkages between drug-related and other services. The need for women-specific services and a comprehensive network of service linkages for all patients in drug treatment is critical. These public health issues require immediate consideration by policy makers, and swift action to address them. [ABSTRACT FROM AUTHOR]

This study examined attitudes and perspectives of 34 health service providers through in-depth interviews in the Republic of Georgia who encountered an injection drug-using woman at least once in the past two months. Most participants' concept of drug dependence treatment was detoxification, as medication-assisted therapy was considered part of harm reduction, although it was thought to have relatively better treatment outcomes compared to detoxification. Respondents reported that drug dependence in women is much more severe than in men. They also expressed less tolerance towards drug-using women, as most providers view such women as failures as a good mother, wife, or child. Georgian women are twice stigmatized, once by a society that views them as fulfilling only a limited purposeful role and again by their male drug-using counterparts. Further, the vast majority of respondents were unaware of the availability of specific types of drug-treatment services in their city, and even more did not seek connections with other service providers, indicating a lack of linkages between drug-related and other services. The need for women-specific services and a comprehensive network of service linkages for all patients in drug treatment is critical. These public health issues require immediate consideration by policy makers, and swift action to address them. [ABSTRACT FROM AUTHOR]

Background: Known drug users in the Republic of Georgia are 99% male. Georgian social context includes close family social structure, intense police scrutiny over daily life, and minimal social service infrastructure. Drug use is dangerous and individuals rely on family support to address socially stigmatizing problems.Objective: The aim was to examine the changes in problem severity over time experienced by 40 adult opioid-injecting men with drug-free female partners in the Republic of Georgia who participated in a randomized clinical trial examining the feasibility and efficacy of a 22-week comprehensive intervention that paired behavioral treatment with naltrexone.Methods: This secondary data analysis study examined the results from a project that had randomized participants to either a comprehensive intervention that paired behavioral treatment with naltrexone or usual care (UC) and examined changes in Addiction Severity Index (ASI) composite scores.Results: The comprehensive intervention showed three times the decline in ASI drug use and legal composite scores than did the UC condition in males in the Republic of Georgia, both p < .009.Conclusion: The results suggest that the use of a comprehensive behavioral intervention paired with naltrexone leads to significant reductions in drug use and legal problems in opioid-injecting males in the Republic of Georgia.Scientific Significance: A comprehensive intervention that paired behavioral treatment with naltrexone provides a promising approach to protect drug users against relapse and legal risks. [ABSTRACT FROM AUTHOR]

Background: Known drug users in the Republic of Georgia are 99%% male. Georgian social context includes close family social structure, intense police scrutiny over daily life, and minimal social service infrastructure. Drug use is dangerous and individuals rely on family support to address socially stigmatizing problems. Objective: The aim was to examine the changes in problem severity over time experienced by 40 adult opioid-injecting men with drug-free female partners in the Republic of Georgia who participated in a randomized clinical trial examining the feasibility and efficacy of a 22-week comprehensive intervention that paired behavioral treatment with naltrexone. Methods: This secondary data analysis study examined the results from a project that had randomized participants to either a comprehensive intervention that paired behavioral treatment with naltrexone or usual care (UC) and examined changes in Addiction Severity Index (ASI) composite scores. Results: The comprehensive intervention showed three times the decline in ASI drug use and legal composite scores than did the UC condition in males in the Republic of Georgia, both p < .009. Conclusion: The results suggest that the use of a comprehensive behavioral intervention paired with naltrexone leads to significant reductions in drug use and legal problems in opioid-injecting males in the Republic of Georgia. Scientific Significance: A comprehensive intervention that paired behavioral treatment with naltrexone provides a promising approach to protect drug users against relapse and legal risks. [ABSTRACT FROM AUTHOR]

Background: HIV and Hepatitis C virus (HCV) infections are strongly related to injection drug use in the Republic of Georgia. Little information is available about HIV and HCV status, sexual risk, support for their partner, and risk for physical violence among the female partners of opioid-injecting men in the Republic of Georgia, many of whom may not be using drugs, yet may be at high risk of being infected with HIV and HCV from their drug-using partners. Methods: In order to better understand the risks for females whose partners are injecting drugs, the present study conducted an initial investigation of the non-substance-using female partners of 40 opioid-injecting men who were participating in a clinical trial examining the feasibility and efficacy of a 22-week comprehensive intervention that paired behavioral treatment with naltrexone. The 40 female partners were assessed at their male partners' study intake.Results: The female sample was 32.3 years old (SD=6.7), 37 (93%) were married, with 15.5 years of education. A majority reported at least partial employment the majority of the time during the past 3 years, with only one woman reported being unemployed most of the time during the past 3 years. They self-reported they were 3% HIV-positive and 8% HCV-positive. Their HIV sex risk scores indicated a relatively low risk. However, only 4 (10%) women reported using a condom most of the time while having sex and 15 (38%) report not having had sex during the last 30 days. Experiences of interpersonal violence were common, with 42% reporting physical abuse by their partner during the last year and 48% reporting feeling unsafe in their current relationship. Conclusions: The alarmingly high rate of failure to use barrier protection methods, together with the high percentage who did not know their HIV and HCV status, suggest that it may be beneficial to include non-substance-using female partners in prevention programs along with their partners to reduce the risk of HIV and HCV spreading from the population of injection-drug-using males into the general population. [This secondary analysis study was funded by an international supplement to the parent randomized clinical trial "Treating the Partners of Drug Using Pregnant Women: Stage II (HOPE)". ClinicalTrials.gov Identifier: NCT00496990.] [ABSTRACT FROM AUTHOR]

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Aim: The aim of the study was to understand the prevalence and patterns of the non-medical injecting use of buprenorphine among drug injectors in Georgia. Method: A self-administered questionnaire was distributed among injecting drug users enrolled in Georgian needle exchange programmes. The questions covered topics related to drug use career, patterns (frequency, history, dosage) and reasons for the use of buprenorphine. Results: Pharmaceutical buprenorphine in the form of Subutex® was the most commonly injected drug in terms of lifetime (95.5%) and last-month (75%) prevalence of use. 48% of those study participants who had injected Subutex at some point reported having used it to cope with withdrawal or to give up other opioids. 90.5% of Subutex injectors used 1–2 mg as a single dose, and the mean frequency of its injection was 6 times per month. 75% of Subutex injectors had used 3 or more types of illegal drugs during the last 30 days. Conclusion: While widely misused by Georgian drug injectors, Subutex is neither the principal nor the favourite drug, and it is rather used as self-treatment. The authors consider the introduction of buprenorphine maintenance treatment to be a promising effective measure to decrease its non-medical and illegal use. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

There is concern that the tremendous economic, social, and political upheavals that the Republic of Georgia has undergone in the years since the fall of the Soviet Union may have created an environment fertile for HIV transmission. Notably absent from official statistics and HIV-related research in Georgia is discussion of men who have sex with men (MSM) and, therefore, little is known about the MSM population or its potential to acquire or transmit HIV. Data were collected from 30 MSM recruited through a testing and counseling center in Tbilisi, the capital of Georgia. Two focus groups with six men each and 18 individual in-depth interviews were conducted between October 2006 and February 2007. The study participants described a Georgian culture that is largely intolerant of sexual contact between men. In describing the various forms of discrimination and violence that they would face should their sexual identities be discovered, the MSM in this sample described a variety of behaviors that they and other Georgian MSM undertake to conceal their sexual behavior. Many of these could put these men and their partners at risk for HIV. Although official HIV rates in Georgia are still low, results from this qualitative study indicate that efforts to educate and to provide unobtrusive and anonymous testing and counseling services to MSM may be critical to the deterrence of an HIV epidemic in the Republic of Georgia. [ABSTRACT FROM AUTHOR]

Background: The growing HIV epidemic in Eastern Europe and Central Asia has been driven by high rates of injection drug use. The Republic of Georgia has among the highest injection drug use rates globally, with a prevalence of 2.24%. The reach of evidence-based HIV prevention interventions like needle and syringe programs (NSP) among people who inject drugs (PWID) has remained below rates that could significantly impact the epidemic. Syringe vending machines (SVM) are an effective and cost-effective supplement to standard NSP; if acceptable to PWID, SVM could reach hard-to-reach PWID and cover geographic areas where fixed or mobile NSPs do not operate. The aim of this study was to assess the perceived acceptability of SVM among out-of-service (harm reduction or substance use treatment) PWID in Tbilisi, Georgia. Methodology: Participants were recruited using respondent-driven sampling (RDS) to participate in cross-sectional, face-to-face interviews. We conducted individual interviews using a structured questionnaire that covered participants' socio-demographics, drug use practices, and perceived acceptability of SVM. Uni-variate analyses were employed for data analysis. Results: The final sample (n = 149) was almost exclusively male with a mean age of 42.2 years and mean years of injection drug use of 14.4 years. Heroin, buprenorphine, and stimulants were the main drugs injected. Eighty-five percent of the sample had never received any harm reduction services, and 30% had never been tested for HIV. Fifteen percent of the sample reported sharing injection equipment with others during last month. All but one participant agreed that PWID would benefit from SVM and 145 (97%) said they would personally use SVM. Ninety percent of those sampled stated that they would use HIV self-tests if available from vending machines. The most highly endorsed features of SVM were provision of free injection equipment, no need to deal with pharmacies, uninterrupted 24/7 access, and availability of HIV self-testing kits. Discussion: Perceived acceptability of syringe vending machines was extremely high among PWID not currently receiving any harm reduction or treatment services, with strong support indicated for uninterrupted free access to sterile injection equipment, privacy, and anonymity. Introducing SVM in Georgia holds the potential to deliver significant public health benefits by attracting hard-to-reach PWID, reducing unsafe injection behavior, and contributing to HIV testing uptake and linkage to care. [ABSTRACT FROM AUTHOR]