The impact of transition from Global Fund Support to governmental funding on the sustainability of harm reduction programs: a case study from Albania

Although Albania currently reports a low-level HIV epidemic, the high proportion of patients diagnosed at a late stage indicates a relatively large number of people unaware of their HIV infection. WHO, et al, have recognised that Albania is therefore likely to experience a rapid increase in the number of people diagnosed with HIV and requiring treatment over the next few years.

Since the end of the Global Fund Round 5 grant in 2012, the Albanian Government has failed to support the costeffective functioning of the HIV and TB programs in Albania, resulting in the degredation of services over recent years. The Government has taken over funding of some parts of the HIV Continuum of Care (CoC) for the general population - such as voluntary testing and counselling (VCT) plus first and second line antiretroviral (ARV) drugs - but has only partially supported certain aspects of the priority compoents of the comprehensive package of harm reduction interventions for people who inject drugs (PWID) as recommended by WHO, UNODC and UNAIDS, notably sterile needle/syringe programs (NSP), opioid substitution therapy (OST), rapid HIV tests in the community through outreach services, and the costs incurred by NGOs and CBOs in the referral of Key Affected Populations (KAPs) to confirmatory HIV testing and enrolment into antiretroviral therapy (ART). The only commitment to harm reduction interventions made by the Ministry of Health (MoH) is the procurement of methadone medication at an unspecified time in the future; but this commitment does not include the crucially important associated support services, including medical staff and psycho-social support personnel, without whom international good practice has shown there will likely be considerable drop-out from the methadone maintenance therapy (MMT) program in the future.

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