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Non\u2010governmental organizations (NGOs) provide PWID with needles\/syringes, condoms, HIV\/HCV testing and linkage to opioid agonist treatment (OAT) and antiretroviral therapy (ART). We estimated their impact and cost\u2010effectiveness among PWID.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A dynamic HIV and HCV transmission model among PWID was calibrated using data from four national PWID surveys (2011\u20132017). The model assumed 37\u201349% coverage of NGOs among community PWID, with NGO contact reducing injecting risk and increasing condom use and recruitment onto OAT and ART. We estimated the historic (1997\u20132021) and future (2022\u20132030, compared to no NGO activities from 2022) impact of NGOs in terms of the proportion of HIV\/HCV infections averted and changes in HIV\/HCV incidence. We estimated the future impact of scaling\u2010up NGOs to 80% coverage with\/without scale\u2010up in OAT (5\u201320%) and ART (64\u201381%). We estimated the cost per disability\u2010adjusted life\u2010year (DALY) averted of current NGO provision over 2022\u20132041 compared to NGO activities stopping over 2022\u20132026, but restarting after that till 2041. We assumed average unit costs of US$80\u201390 per person\u2010year of NGO contact for PWID.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>With existing coverage levels of NGOs, the model projects that NGOs have averted 20.0% (95% credibility interval: 13.3\u201326.1) and 9.6% (5.1\u201314.1) of new HIV and HCV infections among PWID over 1997\u20132021, respectively, and will avert 31.8% (19.6\u201339.9) and 13.7% (7.5\u201318.1) of HIV and HCV infections over 2022\u20132030. With NGO scale\u2010up, HIV and HCV incidence will decrease by 54.2% (43.3\u201363.8) and 30.2% (20.5\u201336.2) over 2022\u20132030, or 86.7% (82.9\u201389.3) and 39.8% (31.4\u201344.8) if OAT and ART are also scaled\u2010up. Without NGOs, HIV and HCV incidence will increase by 51.6% (23.6\u201376.3) and 13.4% (4.8\u201321.9) over 2022\u20132030. Current NGO provision over 2022\u20132026 will avert 102,736 (77,611\u2013137,512) DALYs when tracked until 2041 (discounted 3% annually), and cost US$912 (702\u20131222) per DALY averted; cost\u2010effective at a willingness\u2010to\u2010pay threshold of US$1548\/DALY averted (0.5xGDP).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>NGO activities have a crucial preventative impact among PWID in Ukraine which should be scaled\u2010up to help achieve HIV and HCV elimination. Disruptions could have a substantial detrimental impact.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26073","type":"journal-article","created":{"date-parts":[[2023,4,4]],"date-time":"2023-04-04T05:10:06Z","timestamp":1680585006000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Modelling the impact and cost\u2010effectiveness of non\u2010governmental organizations on HIV and HCV transmission among people who inject drugs in Ukraine"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4584-0068","authenticated-orcid":false,"given":"Jack","family":"Stone","sequence":"first","affiliation":[{"name":"Population Health Sciences University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3462-2898","authenticated-orcid":false,"given":"Adam","family":"Trickey","sequence":"additional","affiliation":[{"name":"Population Health Sciences University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine G.","family":"Walker","sequence":"additional","affiliation":[{"name":"Population Health Sciences University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Bivegete","sequence":"additional","affiliation":[{"name":"Population Health Sciences University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadiya","family":"Semchuk","sequence":"additional","affiliation":[{"name":"Alliance for Public Health  Kyiv Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yana","family":"Sazonova","sequence":"additional","affiliation":[{"name":"Alliance for Public Health  Kyiv Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Varetska","sequence":"additional","affiliation":[{"name":"Alliance for Public Health  Kyiv Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7860-693X","authenticated-orcid":false,"given":"Frederick L.","family":"Altice","sequence":"additional","affiliation":[{"name":"Yale University School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetiana","family":"Saliuk","sequence":"additional","affiliation":[{"name":"Alliance for Public Health  Kyiv Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8291-5890","authenticated-orcid":false,"given":"Peter","family":"Vickerman","sequence":"additional","affiliation":[{"name":"Population Health Sciences University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,4,3]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(16)30325-5"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(19)30085-8"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25608"},{"key":"e_1_2_11_5_1","unstructured":"The Global Fund. 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