Determinants of willingness to enroll in opioid agonist treatment among opioid dependent people who inject drugs in Ukraine

Abstract

Background Coverage with opioid agonist treatments (OAT) is low (N=8,400, 2.7%) for the 310,000 people who inject drugs (PWID) in Ukraine. In the context of widespread negative attitudes toward OAT in the region, patient-level interventions targeting the barriers and willingness to initiate OAT are urgently needed. Methods A sample of 1,179 opioid dependent PWID not currently on OAT from five regions in Ukraine was assessed using multivariable logistic regression for independent factors related to willingness to initiate OAT, stratified by their past OAT experience. Results Overall, 421 (36%) PWID were willing to initiate OAT. Significant adjusted odds ratios (aOR) for covariates associated with the willingness to initiate OAT common for both groups included: higher injection frequency (previously on OAT: aOR=2.7; never on OAT: aOR=1.8), social and family support (previously on OAT: aOR=2.0; never on OAT: aOR=2.0), positive attitude towards OAT (previously on OAT: aOR=1.3; never on OAT: aOR=1.4). Among participants previously on OAT, significant correlates also included: HIV-negative status (aOR=2.6) and depression (aOR=2.7). Among participants never on OAT, however, living in Kyiv (aOR=4.8) or Lviv (aOR=2.7), previous imprisonment (aOR=1.5), registration at a Narcology service (aOR=1.5) and recent overdose (aOR=2.6) were significantly correlated with willingness to initiate OAT. Conclusions These findings emphasize the need for developing interventions aimed to eliminate existing negative preconceptions regarding OAT among opioid dependent PWID in Ukraine, which should be tailored to the needs of specific characteristics of PWID in geographically distinct setting, higher injection frequency, prior incarceration, and psychiatric and HIV status.

Retention in medication-assisted treatment programs in Ukraine—Identifying factors contributing to a continuing HIV epidemic

“…Such tools must not only target negative attitudes toward OAT by patients and providers (I. Makarenko et al, 2016; Polonsky et al, 2015; Polonsky, Rozanova, et al, 2016), but address higher dosages for patients (Bojko et al, 2016; I. Makarenko et al, 2016).…”

“…Treatment is primarily provided at government-funded treatment settings. Using implementation data from this context defining the individual and organization barriers to OAT (Bojko et al, 2017; Bojko et al, 2015; Bojko et al, 2016; I. Makarenko et al, 2016; J.…”

“…In general, though due to a number of structural and political reasons (Bojko, Dvoriak, & Altice, 2013; Bojko et al, 2015; Bojko et al, 2016; Golovanevskaya, Vlasenko, & Saucier, 2012; Kutsa et al, 2016; I. Makarenko et al, 2016; A.…”

The effects of opioid-agonist treatments on HIV risk and social stability: A mixed methods study of women with opioid use disorder in Ukraine

“…Despite statements from the Joint United Nations Program on HIV/AIDS, the World Health Organization and the United Nations Office on Drugs and Crime that support OAT for HIV prevention, Russia explicitly bans OAT, perpetuating negative attitudes and impeding OAT access in the countries of the former Soviet Union (Cohen, 2010; World Health Organization, 2004). Ukraine has been a leader in OAT implementation in the region, but still struggles with individual, cultural and structural barriers to extensive implementation of OAT programming (Bojko, Dvoryak, & Altice, 2013; Martha J. Bojko et al, 2015; Bojko et al, 2016; Makarenko et al, 2016). Russia’s continued influence in Ukraine, particularly in Crimea and Donbas regions, threatens to reverse progress the Ukrainian government has made towards expanding access to OAT and HIV prevention and treatment services.…”

“…Seeds referred their peers through RDS, thus recruiting participants with no lifetime exposure to OAT. Participants were included in the study if they were ≥18 years old, lived or worked in the study city, met ICD-10 criteria for opioid use disorder, were able to give informed consent, agreed to undergo HIV and HCV rapid testing and were willing to complete a structured survey (Makarenko et al, 2016). IDU in the past 30 days was an inclusion criteria for participants recruited through RDS and all study participants had a lifetime history of opioid injection.…”