Feasibility of Buprenorphine Maintenance Therapy Programs in the Ukraine: First Promising Treatment Outcomes

Schaub, Michael P; Subata, Emilis; Chtenguelov, Victor; Weiler, Gundo; Uchtenhagen, Ambros

doi:10.1159/000217586

Cited by 22 publications

(5 citation statements)

References 13 publications

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“…Hans-Ulrich Wittchen et al found that the retention rate in Germany at 12 months was 75% [13]. Six-month treatment retention rates observed in our study were similar to those found by Ukrainian researchers [14, 15]. Such differences could be explained by the different methodology used in different studies.…”

Section: Discussionsupporting

confidence: 87%

Retention in Georgia opioid substitution therapy program and associated factors

Ruadze

Todadze

2016

Harm Reduct J

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BackgroundSubstance abuse has been considered as a growing challenge in Georgia that is closely linked with human immune deficiency virus (HIV) and hepatitis C transmission due to unsafe injection and other uncontrolled behaviors. Methadone maintenance therapy is one of the major treatment options for opioid-dependent individuals. It has proven efficacy in decreasing illegal opioid consumption and criminal behavior as well as reducing the level of HIV infection, mortality, HCV infection, and increasing social functioning.MethodsThe data was initially extracted from the electronic database, as of October 30, 2015, for the patients undergoing methadone maintenance therapy in 2014 and 2015. We used two types of statistical analysis: binary regression and time-to-event analysis (Kaplan-Meier). For binary regression analysis, patients who initiated the treatment 12, 9, 6, and 3 months prior to October 30, 2015, respectively, were eligible for >12-, >9-, >6-, and >3-month retention analysis. We identified two types of the retention periods: (I) “the program specific retention period” (the time spent (uninterruptedly) in the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria (GFATM) opioid substitution treatment (OST) program after the clients’ last entry) and (II) “being on OST retention period” (the time spent (uninterruptedly) on OST since the clients’ last entry).For time-to-event analysis, the two different endpoints were investigated: (i) dropouts and (ii) being detained.ResultsThe analysis showed that at each time point, “being on OST retention” rates are slightly higher than “program specific retention” rates. The percentages of patients retained in OST treatment after 3, 6, 9, and 12 months from the initiation of the treatment, respectively, were 89, 86, 85, and 83% and the percentages of patients retained in the GFATM program at the same time points were 88, 83, 82, and 80%. Patients older than 40 years are twice as likely to stay in the program compared to younger individuals. Gender is only associated with >9 and >12 months retention with approximately three times the odds for men compared to women. The strength of the association between hepatitis C status and “program specific” retention increases with time spent in the program as p values decrease from 0.07 for >3- and >6-month retention to 0.01 for >9- and >12-month retention. The younger age group was more likely to get dropouts and be detained. HIV status and social status did not show statistically significant association with retention.ConclusionsThese findings identify the need for more support for younger patients as they are more vulnerable to dropouts and detention compared to the older age group, especially during the early stage of treatment.

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Section: Discussionsupporting

confidence: 87%

Retention in Georgia opioid substitution therapy program and associated factors

Ruadze

Todadze

2016

Harm Reduct J

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“…This is despite evidence from several systematic reviews suggesting that: PWID who receive OST have less than half the risk of HIV infection compared with PWID not on OST (MacArthur et al, 2012); OST is associated with greater adherence to ART (Malta, Magnanini, Strathdee, & Bastos, 2010); OST is associated with reductions in illicit opioid use, injecting behaviour, and sharing of injection equipment (Gowing, Farrell, Bornemann, Sullivan, & Ali, 2011); and OST is associated with a reduction by more than half in all-cause mortality among PWID (Degenhardt et al, 2011). These international findings have also been confirmed in studies conducted specifically in Ukraine (Bachireddy et al, 2013; Lawrinson et al, 2008; Schaub, Chtenguelov, Subata, Weiler, & Uchtenhagen, 2010; Schaub, Subata, Chtenguelov, Weiler, & Uchtenhagen, 2009). Additionally, modelling data suggesting that expanding harm reduction services, including OST, and access to ART are the most cost-effective methods of controlling the HIV epidemic in Ukraine (Alistar, Owens, & Brandeau, 2011).…”

Section: Introductionsupporting

confidence: 63%

Geographic variability in HIV and injection drug use in Ukraine: Implications for integration and expansion of drug treatment and HIV care

Zaller

Mazhnaya

Larney

et al. 2015

International Journal of Drug Policy

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Background Ukraine has the highest HIV burden of any European country with much of the current HIV epidemic concentrated among people who inject drugs (PWIDs) and their sexual partners. Opiate substitution therapy (OST) is limited in Ukraine and expansion of OST is urgently needed to help stem the tide of the HIV epidemic. Methods We accessed publicly available data in Ukraine in order to explore geographic variability with respect to prevalence of HIV, PWIDs and OST programmes. Results The regions of Ukraine with the largest number of opioid dependent persons (the south and eastern portions of the country) correspond to the regions with the highest HIV prevalence and HIV incidence. The number of opioid PWIDs per 100,000 population as well as the number of all OST treatment slots per 100,000 varied significantly across the three HIV prevalence categories. Overall, the proportion of individuals receiving either methadone maintenance therapy (MMT) or buprenorphine maintenance therapy (BMT) was quite low: average across categories: 7.3% and 0.4%, respectively. Additionally, less than half of OST patients receiving MMT or BMT were HIV positive patients. Conclusion There is significant geographic variability in both numbers of HIV positive individuals and numbers of PWIDs across Ukraine, however, there may be a more concentrated epidemic among PWIDs in many regions of the country. Scale up of addiction treatment for PWID, especially OST, can have a significant impact on preventing injection related morbidity, such as HIV and HCV infection. Ukraine can learn from the mistakes other nations have made in denying critical treatment opportunities to PWID.

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“…Critically, provision of this treatment is minimal in many of the countries with highest prevalence of HIV in people who inject drugs,66 67 and treatment for opiate dependence with methadone remains illegal in Russia 58. Increased coverage in many of these countries,15 24 25 however, is a welcome advance.…”

Section: Discussionmentioning

confidence: 99%

“…Opiate substitution treatment has been implemented in 70 countries, but remains unavailable in 66, and in several countries detoxification or residential rehabilitation is the primary mode of treatment 223 Although coverage of opiate substitution treatment is being expanded in some countries, such as Ukraine, India, and China,24 25 26 intervention at a regional and national level remains poor in many countries, including those with a high burden of HIV among people who inject drugs 23…”

Section: Introductionmentioning

confidence: 99%

Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis

MacArthur

Minozzi²,

Martin

et al. 2012

BMJ

406

312

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Objective To quantify the effect of opiate substitution treatment in relation to HIV transmission among people who inject drugs.Design Systematic review and meta-analysis of prospective published and unpublished observational studies.Data sources Search of Medline, Embase, PsychINFO, and the Cochrane Library from the earliest year to 2011 without language restriction. Review methodsWe selected studies that directly assessed the impact of opiate substitution treatment in relation to incidence of HIV and studies that assessed incidence of HIV in people who inject drugs and that might have collected data regarding exposure to opiate substitution treatment but not have reported it. Authors of these studies were contacted. Data were extracted by two reviewers and pooled in a meta-analysis with a random effects model. ResultsTwelve published studies that examined the impact of opiate substitution treatment on HIV transmission met criteria for inclusion, and unpublished data were obtained from three additional studies. All included studies examined methadone maintenance treatment. Data from nine of these studies could be pooled, including 819 incident HIV infections over 23 608 person years of follow-up. Opiate substitution treatment was associated with a 54% reduction in risk of HIV infection among people who inject drugs (rate ratio 0.46, 95% confidence interval 0.32 to 0.67; P<0.001). There was evidence of heterogeneity between studies (I 2 =60%, χ 2 =20.12, P=0.010), which could not be explained by geographical region, site of recruitment, or the provision of incentives. There was weak evidence for greater benefit associated with longer duration of exposure to opiate substitution treatment. ConclusionOpiate substitution treatment provided as maintenance therapy is associated with a reduction in the risk of HIV infection among people who inject drugs. These findings, however, could reflect comparatively high levels of motivation to change behaviour and reduce injecting risk behaviour among people who inject drugs who are receiving opiate substitution treatment.

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Feasibility of Buprenorphine Maintenance Therapy Programs in the Ukraine: First Promising Treatment Outcomes

Cited by 22 publications

References 13 publications

Retention in Georgia opioid substitution therapy program and associated factors

Retention in Georgia opioid substitution therapy program and associated factors

Geographic variability in HIV and injection drug use in Ukraine: Implications for integration and expansion of drug treatment and HIV care

Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis

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