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The proposed South Africa Addiction Technology Transfer Center (ATTC) reflects a strategic international partnership between the New England ATTC – one of the longest continuously operating ATTCs in the USA - and the University of Cape Town, the oldest and highest-ranked University in South Africa. The primary focus of this ATTC is to develop and strengthen South Africa’s workforce to provide evidence-based integrated substance use disorder (SUD), mental health, and HIV care. South Africa accounts for the largest share of new HIV infections of any country in the world. South Africa also has alarming rates of substance use and SUDs including: 38.7% lifetime alcohol use, 30.0% tobacco use, 8.4% cannabis, and 19.3% psychoactive drug use. Although lifetime alcohol prevalence rates are comparable to other regions, harms experienced per liter of alcohol are higher in South Africa than many regions; for example, Fetal Alcohol Spectrum Disorders are several times higher than anywhere else in the world. National data and our team’s experience in the region indicate five key service gaps: (1) lack of expertise in integrated SUD-HIV care; (2) significant unmet need for quality SUD treatment; (3) insufficient workforce capacity for SUD treatment; (4) lack of implementation of national policies and partnerships to support an addiction treatment infrastructure; and (5) lack of culturally and linguistically appropriate care. The proposed South Africa ATTC will pursue three objectives. Objective 1 is to develop short-term training and resources for front-line treatment providers, supervisors, administrators, allied health professionals, and lay workers. Process goals include provision of training to 1,000 individuals annually (5,000 over the five-year project) through a range of face-to-face workshops, community-based training events, eLearning courses, and conferences that support strategic task shifting. Objective 2 is to develop standards of professional practice for mental health and SUD treatment providers, including partnering with academic institutions to train and educate the next generation of providers. Process indicators include delivery of training and technical assistance activities to policy-makers and government stakeholders, and expansion of University curriculum and capacity. Objective 3 is to develop strategies to enhance recruitment and retention of mental health and SUD treatment, peer, and other recovery support providers. Process goals include development of a learning collaborative and creation of governmental policies that encourage recruitment and retention. Pursuit of these objectives will yield long-term improvements in the quality and consistency of integrated SUD-HIV prevention, treatment and care in a site of global strategic importance.

Vietnam has one of Asia's fastest growing HIV rates, and by the end of 2015, the number of people living with HIV was approximately 250,000. Since 2011, the Vietnam HIV-Addiction Technology transfer Center (VHATTC) has provided training, technical assistance (TA), and skill development to providers, policy-makers, faculty, and students across Vietnam to aid them in developing effective strategies for combating their overlapping HIV and substance use disorders (SUD) epidemics. The proposed project will continue these successful efforts through state-of-the-art technology transfer and sustainability assurance strategies. With organizational support, technical expertise and mentoring from University of California, Los Angeles (UCLA), and University of Minnesota (UCSD), the VHATTC will serve as an invaluable HIV and SUD TA/training resource. Our team brings unprecedented experience to the project, with continued efforts at Hanoi Medical University (HMU) and University of Medicine and Pharmacy, Ho Chi Minh City (UMP). We will benefit from the addition of University of Labor and Social Affairs (ULSA), a distinguished social work and social affairs university in Hanoi with existing ties to our current VHATTC partners. The SUD and HIV workforces vary in capacity and competency level required to meet the needs of this geographically and socio-economically diverse region. The VHATTC will deploy well tested and proven strategies consistent with SAMHSA's mission - innovative training and dissemination, TA, implementation support, and fidelity maintenance strategies to develop an infrastructure capable of integrating relevant science and person-oriented practice. TA/training will focus on behavioral health services and SUD and HIV prevention, care, treatment, and recovery. Our focus is on expanding provider and student level TA and training, while simultaneously strengthening systems of care toward improved patient access, engagement and health outcomes. The VHATTC has seven main goals: Goal 1: build a sustainable, multi-university alliance responsive to policy and workforce needs; Goal 2: maintain and grow collaborative relationships with governmental and non-governmental agencies across the region in related system development activities; Goal 3: participate in ATTC network-wide activities that support resource-sharing the adoption of EPBs, RSS, and educational standards; Goal 4: Develop individual and joint (cross-university) 5-year strategic work plans that focus on both in-service and pre-service workforce strengthening; Goal 5: Utilize innovative technology transfer strategies to promote adoption and implementation of evidence supported practices; Goal 6: ensure fidelity to professional standards and best practices via on-going TA, supervision and implementation support for target TA/training recipient. Goal 7: Participate in ongoing evaluation and monitoring of program goals, objectives, key highlights, outcomes, behavioral health disparity impact, barriers, and resolution.

Fueled by an inadequate response to an epidemic of injection drug use (IDU), Ukraine is home to more people infected with HIV than any other European nation (1). Although people who inject drugs (PWID) are currently the key population (KP) with the highest rates of HIV (21.9%), high rates of HIV among female sex workers (FSW: 7.0%) and among men who have sex with men (MSM: 8.5%) can also be directly linked to IDU or indirectly among partners of PWID. In response to this co-evolving epidemic, the University of California, San Diego (UCSD) Department of Psychiatry in collaboration with the University of California Los Angeles, Integrated Substance Abuse Programs (UCLA) proposes to create an International PEPFAR Addiction Technology Transfer Center in Ukraine (UIPATTC) at the Ministry of Health (MOH) of Ukraine in partnership with the Ukrainian Research Institute of Social and Forensic Psychiatry and Drug Abuse (URISFPDA). The UCSD/UCLA/Ukraine team brings unprecedented experience to the project. Under the direction and leadership of the SAMHSA Substance Abuse HIV/AIDS Treatment Advisor and in collaboration with the PEPFAR program in Ukraine, we will develop a technical assistance and training (TA/T) plan to implement the following: 1) A national entity responsible for drug and alcohol policies that will implement and scale up evidence-based best practices (EBP) adapted to the Ukrainian context for treatment of substance use (SUDs) and mental health (MH) disorders across Ukraine; 2) Programs for certification, licensing and accreditation of staff, clinics and programs; 3) EBP and quality improvement practices to measure progress toward and achieve national goals toward HIV eradication; 4) Programs and policies to identify and remove barriers to HIV care and treatment for KPs with SUDs and co-occurring disorders; 5) TA/T for the rapid improvement of knowledge, skills, and attitudes of policy makers and practitioners at the local and national level; and 6) Peer and other recovery support service programs for KPs. The UIPATTC will assist in building a network and leveraging the resources of key governmental, non-governmental, and civil society organizations and international partners. TA/T will be focused on behavioral health service provision, including knowledge and skills development on HIV/AIDS prevention, care, and treatment; SUD care; HIV treatment and prevention in the context of co-occurring SUD and MH disorders; and societal engagement. We will contribute to identification and removal of barriers and enhance access to EBPs, with special focus on KPs. This comprehensive effort will take place in the context of the PEPFAR action agendas: Impact, Efficiency, Sustainability, Partnership and Human Rights. The overall goal is to assist the PEPFAR and Ukrainian Government in reaching the Joint United Nations Program on HIV/AIDS (UNAIDS) 90/90/90 targets, and improve linkages and program planning at every level (2).