Olga Morozova1, Sergey Dvoriak2, Iryna Pykalo3, Frederick L Altice4. 1. Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, USA. 2. Ukrainian Institute on Public Health Policy, Kyiv, Ukraine; Academy of Labour, Social Relations and Tourism, Kyiv, Ukraine. 3. Ukrainian Institute on Public Health Policy, Kyiv, Ukraine. 4. Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, USA; Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, USA. Electronic address: frederick.altice@yale.edu.
Abstract
BACKGROUND: Ukraine's HIV epidemic is concentrated among people who inject drugs (PWID), however, coverage with opioid agonist therapies (OATs) available mostly at specialty addiction clinics is extremely low. OAT integrated into primary healthcare clinics (PHCs) provides an opportunity for integrating comprehensive healthcare services and scaling up OAT. METHODS: A pilot study of PHC-based integrated care for drug users conducted in two Ukrainian cities between 2014 and 2016 included three sub-studies: 1) cross-sectional treatment site preference assessment among current OAT patients (N=755); 2) observational cohort of 107 PWID who continued the standard of care versus transition of stabilized and newly enrolled PWID into PHC-based integrated care; and 3) pre/post analysis of attitudes toward PWID and HIV patients by PHC staff (N=26). RESULTS: Among 755 OAT patients, 53.5% preferred receiving OAT at PHCs, which was independently correlated with convenience, trust in physician, and treatment with methadone (vs. buprenorphine). In 107 PWID observed over 6 months, retention in treatment was high: 89% in PWID continuing OAT in specialty addiction treatment settings (standard of care) vs 94% in PWID transitioning to PHCs; and 80% among PWID newly initiating OAT in PHCs. Overall, satisfaction with treatment, subjective self-perception of well-being, and trust in physician significantly increased in patients prescribed OAT in PHCs. Among PHC staff, attitudes towards PWID and HIV patients significantly improved over time. CONCLUSIONS: OAT can be successfully integrated into primary care in low and middle-income countries and improves outcomes in both patients and clinicians while potentially scaling-up OAT for PWID.
BACKGROUND: Ukraine's HIV epidemic is concentrated among people who inject drugs (PWID), however, coverage with opioid agonist therapies (OATs) available mostly at specialty addiction clinics is extremely low. OAT integrated into primary healthcare clinics (PHCs) provides an opportunity for integrating comprehensive healthcare services and scaling up OAT. METHODS: A pilot study of PHC-based integrated care for drug users conducted in two Ukrainian cities between 2014 and 2016 included three sub-studies: 1) cross-sectional treatment site preference assessment among current OATpatients (N=755); 2) observational cohort of 107 PWID who continued the standard of care versus transition of stabilized and newly enrolled PWID into PHC-based integrated care; and 3) pre/post analysis of attitudes toward PWID and HIVpatients by PHC staff (N=26). RESULTS: Among 755 OATpatients, 53.5% preferred receiving OAT at PHCs, which was independently correlated with convenience, trust in physician, and treatment with methadone (vs. buprenorphine). In 107 PWID observed over 6 months, retention in treatment was high: 89% in PWID continuing OAT in specialty addiction treatment settings (standard of care) vs 94% in PWID transitioning to PHCs; and 80% among PWID newly initiating OAT in PHCs. Overall, satisfaction with treatment, subjective self-perception of well-being, and trust in physician significantly increased in patients prescribed OAT in PHCs. Among PHC staff, attitudes towards PWID and HIVpatients significantly improved over time. CONCLUSIONS:OAT can be successfully integrated into primary care in low and middle-income countries and improves outcomes in both patients and clinicians while potentially scaling-up OAT for PWID.
Authors: Frederick L Altice; R Douglas Bruce; Gregory M Lucas; Paula J Lum; P Todd Korthuis; Timothy P Flanigan; Chinazo O Cunningham; Lynn E Sullivan; Pamela Vergara-Rodriguez; David A Fiellin; Adan Cajina; Michael Botsko; Vijay Nandi; Marc N Gourevitch; Ruth Finkelstein Journal: J Acquir Immune Defic Syndr Date: 2011-03-01 Impact factor: 3.731
Authors: Harry Jin; Valerie A Earnshaw; Jeffrey A Wickersham; Adeeba Kamarulzaman; Mayur M Desai; Jacob John; Frederick L Altice Journal: AIDS Care Date: 2014-03-14
Authors: Donata Kurpas; Dorota Stefanicka-Wojtas; Andrei Shpakou; David Halata; András Mohos; Aelita Skarbaliene; Gindrovel Dumitra; Ludmila Klimatckaia; Jana Bendova; Victoria Tkachenko Journal: Int J Integr Care Date: 2021-11-08 Impact factor: 5.120