Sergii Dvoriak1, Andrey Karachevsky2, Sumedha Chhatre3, Robert Booth4, David Metzger5, Joseph Schumacher6, Nina Chychula7, Anna Pecoraro5, George Woody8. 1. Director, Ukrainian Institute of Public Health Policy, 4 Malopidvalna Str. Of. 6 Kyiv, 01001 Kyiv, Ukraine. 2. Department of Psychiatry and Drug Abuse, O.O. Bogomolets National Medical University, 34, Peremogy Avenue, 01601 Kyiv, Ukraine. 3. Treatment Research Institute, Suite 600, 150 South Independence Mall (W), Philadelphia, PA 19106, United States. 4. Department of Psychiatry, University of Colorado, 1741 Vine Street, Denver, CO 80206, United States. 5. Perelman School of Medicine at the University of Pennsylvania and Treatment Research Institute, Suite 600, 150 South Independence Mall (W), Philadelphia, PA 19106, United States. 6. School of Medicine, University of Alabama, 1530 3rd Avenue South, Birmingham, AL, United States. 7. Department of Veterans Affairs Medical Center, 39th & Woodland Avenues, Philadelphia, PA 19104, United States. 8. Perelman School of Medicine at the University of Pennsylvania and Treatment Research Institute, Suite 600, 150 South Independence Mall (W), Philadelphia, PA 19106, United States. Electronic address: woody@tresearch.org.
Abstract
BACKGROUND: With up to 40% of opioid injectors infected with HIV, Ukraine has one of the most concentrated HIV epidemics in the world, mainly due to unsterile injection practices and a historical absence of effective prevention services. Harm reduction programs, including syringe exchange and a small buprenorphine treatment program, were introduced in 2004 and methadone maintenance was allowed in 2007. Despite an initial expansion, by 2009, only 3221 injectors were receiving methadone treatment. A growing body of research on methadone maintenance has found high retention rates with reduction in opioid use and HIV risk behaviors. We report on the acceptability and initial outcome of methadone treatment as a function of HIV status, an issue that has not yet been reported for injectors in Ukraine. METHODS: Longitudinal observational study of a 12-week course of methadone treatment in 25 HIV+ and 25 HIV- opioid addicted individuals recruited from a harm reduction program and the city AIDS Center. Drug use and HIV risk were assessed at baseline and weeks 4, 8, 12 and 20; all patients were offered continued methadone maintenance in the Kyiv city program at the end of 12 weeks. RESULTS: Fifty-four individuals were asked if they were interested in the study and 50, demographically similar to other samples of opioid addicted Ukrainians, agreed to participate. Two died of non-study related causes; the other 48 completed assessments at weeks 4, 8 and 12, and 47 completed followups at week 20. Significant reductions were seen in use of heroin (p<0.0001), other opiates/analgesics (p<0.0001), and HIV risk behaviors (drug, sex, total; all p<0.0001). All 48 patients chose to continue methadone after the 12-weeks of study medication ended. Unlike most opioid treatment studies, sexual risk was somewhat higher than injecting risk at study intake. CONCLUSIONS: Methadone maintenance was well accepted by HIV+ and HIV- opioid dependent individuals and has the potential for significant public health impact if made more widely available with sustained access and support.
BACKGROUND: With up to 40% of opioid injectors infected with HIV, Ukraine has one of the most concentrated HIV epidemics in the world, mainly due to unsterile injection practices and a historical absence of effective prevention services. Harm reduction programs, including syringe exchange and a small buprenorphine treatment program, were introduced in 2004 and methadone maintenance was allowed in 2007. Despite an initial expansion, by 2009, only 3221 injectors were receiving methadone treatment. A growing body of research on methadone maintenance has found high retention rates with reduction in opioid use and HIV risk behaviors. We report on the acceptability and initial outcome of methadone treatment as a function of HIV status, an issue that has not yet been reported for injectors in Ukraine. METHODS: Longitudinal observational study of a 12-week course of methadone treatment in 25 HIV+ and 25 HIV- opioid addicted individuals recruited from a harm reduction program and the city AIDS Center. Drug use and HIV risk were assessed at baseline and weeks 4, 8, 12 and 20; all patients were offered continued methadone maintenance in the Kyiv city program at the end of 12 weeks. RESULTS: Fifty-four individuals were asked if they were interested in the study and 50, demographically similar to other samples of opioid addicted Ukrainians, agreed to participate. Two died of non-study related causes; the other 48 completed assessments at weeks 4, 8 and 12, and 47 completed followups at week 20. Significant reductions were seen in use of heroin (p<0.0001), other opiates/analgesics (p<0.0001), and HIV risk behaviors (drug, sex, total; all p<0.0001). All 48 patients chose to continue methadone after the 12-weeks of study medication ended. Unlike most opioid treatment studies, sexual risk was somewhat higher than injecting risk at study intake. CONCLUSIONS:Methadone maintenance was well accepted by HIV+ and HIV- opioid dependent individuals and has the potential for significant public health impact if made more widely available with sustained access and support.
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Authors: D S Metzger; G E Woody; A T McLellan; C P O'Brien; P Druley; H Navaline; D DePhilippis; P Stolley; E Abrutyn Journal: J Acquir Immune Defic Syndr (1988) Date: 1993-09
Authors: Danielle C Ompad; Jiayu Wang; Konstantin Dumchev; Julia Barska; Maria Samko; Oleksandr Zeziulin; Tetiana Saliuk; Olga Varetska; Jack DeHovitz Journal: Int J Drug Policy Date: 2017-02-01