Kostyantyn Dumchev1, Sergii Dvoryak2, Olena Chernova2, Olga Morozova3, Frederick L Altice4. 1. Ukrainian Institute on Public Health Policy, Kyiv, Ukraine. Electronic address: dumchev@uiphp.org.ua. 2. Ukrainian Institute on Public Health Policy, Kyiv, Ukraine. 3. Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA. 4. Yale University School of Medicine and School of Public Health, New Haven, CT, USA.
Abstract
BACKGROUND: Opioid agonist treatments (OAT) are widely-used, evidence-based strategies for treating opioid dependence and reducing HIV transmission. The positive benefits of OAT are strongly correlated with time spent in treatment, making retention a key indicator for program quality. This study assessed patient retention and associated factors in Ukraine, where OAT was first introduced in 2004. METHODS: Data from clinical records of 2916 patients enrolled in OAT at thirteen sites from 2005 to 2012 were entered into an electronic monitoring system. Survival analysis methods were used to determine the probability of retention and its correlates. RESULTS: Twelve-month retention was 65.8%, improving from 27.7% in 2005, to 70.9% in 2011. In multivariable analyses, the correlates of retention were receiving medium and high doses of medication (compared to low doses, dropout aHR=0.57 for both medium and high doses), having not been tested for HIV and tuberculosis (compared to not being tested, dropout aHR=4.44 and 3.34, respectively), and among those who were tested-a negative TB test result (compared to receiving a positive test result, dropout aHR=0.67). CONCLUSION: Retention in Ukrainian OAT programs, especially in recent years, is comparable to other countries. The results confirm the importance of adequate OAT dosing (≥60mg of methadone, ≥8mg of buprenorphine). Higher dosing, however, will require interventions that address negative attitudes toward OAT by patients and providers. Interruption of OAT, in the case developing tuberculosis, should incorporate continuity of OAT for TB patients through integrated care delivery systems.
BACKGROUND: Opioid agonist treatments (OAT) are widely-used, evidence-based strategies for treating opioid dependence and reducing HIV transmission. The positive benefits of OAT are strongly correlated with time spent in treatment, making retention a key indicator for program quality. This study assessed patient retention and associated factors in Ukraine, where OAT was first introduced in 2004. METHODS: Data from clinical records of 2916 patients enrolled in OAT at thirteen sites from 2005 to 2012 were entered into an electronic monitoring system. Survival analysis methods were used to determine the probability of retention and its correlates. RESULTS: Twelve-month retention was 65.8%, improving from 27.7% in 2005, to 70.9% in 2011. In multivariable analyses, the correlates of retention were receiving medium and high doses of medication (compared to low doses, dropout aHR=0.57 for both medium and high doses), having not been tested for HIV and tuberculosis (compared to not being tested, dropout aHR=4.44 and 3.34, respectively), and among those who were tested-a negative TB test result (compared to receiving a positive test result, dropout aHR=0.67). CONCLUSION: Retention in Ukrainian OAT programs, especially in recent years, is comparable to other countries. The results confirm the importance of adequate OAT dosing (≥60mg of methadone, ≥8mg of buprenorphine). Higher dosing, however, will require interventions that address negative attitudes toward OAT by patients and providers. Interruption of OAT, in the case developing tuberculosis, should incorporate continuity of OAT for TBpatients through integrated care delivery systems.
Authors: Sasha Uhlmann; M-J Milloy; Thomas Kerr; Ruth Zhang; Silvia Guillemi; David Marsh; Robert S Hogg; Julio S G Montaner; Evan Wood Journal: Addiction Date: 2010-03-10 Impact factor: 6.526
Authors: Louisa Degenhardt; Bradley M Mathers; Andrea L Wirtz; Daniel Wolfe; Adeeba Kamarulzaman; M Patrizia Carrieri; Steffanie A Strathdee; Kasia Malinowska-Sempruch; Michel Kazatchkine; Chris Beyrer Journal: Int J Drug Policy Date: 2013-09-04
Authors: Gregory M Lucas; Amina Chaudhry; Jeffrey Hsu; Tanita Woodson; Bryan Lau; Yngvild Olsen; Jeanne C Keruly; David A Fiellin; Ruth Finkelstein; Patricia Barditch-Crovo; Katie Cook; Richard D Moore Journal: Ann Intern Med Date: 2010-06-01 Impact factor: 25.391
Authors: Andrea J Low; Gitau Mburu; Nicky J Welton; Margaret T May; Charlotte F Davies; Clare French; Katy M Turner; Katharine J Looker; Hannah Christensen; Susie McLean; Tim Rhodes; Lucy Platt; Matthew Hickman; Andy Guise; Peter Vickerman Journal: Clin Infect Dis Date: 2016-06-25 Impact factor: 9.079
Authors: Adam Viera; Daniel J Bromberg; Shannon Whittaker; Bryan M Refsland; Milena Stanojlović; Kate Nyhan; Frederick L Altice Journal: Epidemiol Rev Date: 2020-01-31 Impact factor: 6.222
Authors: Roman Ivasiy; Lynn M Madden; Scott O Farnum; Natalia Shumskaya; Samy J Galvez de Leon; Daniel J Bromberg; Ainura Kurmanalieva; Aibek Duishenaliev; Ruslan Tokubaev; Frederick L Altice Journal: Drug Alcohol Depend Rep Date: 2022-07-19
Authors: Kathryn E Lancaster; Irving F Hoffman; Brett Hanscom; Tran Viet Ha; Kostyantyn Dumchev; Hepa Susami; Scott Rose; Vivian F Go; Sarah A Reifeis; Katie R Mollan; Michael G Hudgens; Estelle M Piwowar-Manning; Paul Richardson; Sergii Dvoriak; Zubairi Djoerban; Tetiana Kiriazova; Oleksandr Zeziulin; Samsuridjal Djauzi; Chu Viet Ahn; Carl Latkin; David Metzger; David N Burns; Jeremy Sugarman; Steffanie A Strathdee; Susan H Eshleman; William Clarke; Deborah Donnell; Lynda Emel; Lisa E Sunner; Laura McKinstry; Nirupama Sista; Erica L Hamilton; Jonathan P Lucas; Bui D Duong; Nguyen Van Vuong; Riza Sarasvita; William C Miller Journal: J Int AIDS Soc Date: 2018-10 Impact factor: 5.396
Authors: Tetiana Kiriazova; Vivian F Go; Rebecca B Hershow; Erica L Hamilton; Riza Sarasvita; Quynh Bui; Kathryn E Lancaster; Kostyantyn Dumchev; Irving F Hoffman; William C Miller; Carl A Latkin Journal: Harm Reduct J Date: 2020-10-01
Authors: Martin Busch; Charlotte Klein; Alfred Uhl; Hans Haltmayer; Maurice Cabanis; Jean Nicolas Westenberg; Marc Vogel; R Michael Krausz Journal: Harm Reduct J Date: 2021-02-24