Obstacles in provision of anti-retroviral treatment to drug users in Central and Eastern Europe and Central Asia: A regional overview

Bobrova, Natalia; Sarang, Anya; Stuikyte, Raminta; Lezhentsev, Konstantin

doi:10.1016/j.drugpo.2007.01.015

Cited by 43 publications

(22 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is necessary because there is a dearth of pooled evidence investigating the role of social factors affecting HCV treatment. We therefore draw upon previous work on the conditionality of HIV treatment access for PWID as a way of conceptualising ‘social factors’ and their relevance [23-25]. This work on HIV treatment maps the treatment access environment as a product of interplay between macro-level factors (such as the adverse impacts of criminalisation, social and material inequality, and health policy) and meso-level factors (such as related to systems of service administration, management and delivery) [26].…”

Section: Reviewmentioning

confidence: 99%

Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors

2013

View full text Add to dashboard Cite

BackgroundEvidence documents successful hepatitis C virus (HCV) treatment outcomes for people who inject drugs (PWID) and interest in HCV treatment among this population. Maximising HCV treatment for PWID can be an effective HCV preventative measure. Yet HCV treatment among PWID remains suboptimal. This review seeks to map social factors mediating HCV treatment access.MethodWe undertook a review of the social science and public health literature pertaining to HCV treatment for PWID, with a focus on barriers to treatment access, uptake and completion. Medline and Scopus databases were searched, supplemented by manual and grey literature searches. A two step search was taken, with the first step pertaining to literature on HCV treatment for PWID and the second focusing on social structural factors. In total, 596 references were screened, with 165 articles and reports selected to inform the review.ResultsClinical and individual level barriers to HCV treatment among PWID are well evidenced. These include patient and provider concerns regarding co-morbidities, adherence, and side effect management. Social factors affecting treatment access are less well evidenced. In attempting to map these, key barriers fall into the following domains: social stigma, housing, criminalisation, health care systems, and gender. Key facilitating factors to treatment access include: combination intervention approaches encompassing social as well as biomedical interventions, low threshold access to opiate substitution therapy, and integrated delivery of multidisciplinary care.ConclusionCombination intervention approaches need to encompass social interventions in relation to housing, stigma reduction and systemic changes in policy and health care delivery. Future research needs to better delineate social factors affecting treatment access.

show abstract

Section: Reviewmentioning

confidence: 99%

Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors

2013

View full text Add to dashboard Cite

show abstract

“…TB clinicians cannot prescribe ART, and ART is dispensed only from the separate HIV services center after review of the patient’s case by the committee. As a consequence of this interim analysis and a previous qualitative study, 15 interventions were begun to 1) improve the content of the message about ART initiation given by the consulting infectious diseases specialist and reduce the time between the first and subsequent follow-up evaluations, with the aim of lowering the rate of patient refusal; 2) create a new managerial position within the Irkutsk TB Dispensary specifically to liaise with the HIV services center; 3) reduce the time to action on HIV laboratory results that dictate urgency of ART (e.g., CD4 count and viral load testing currently not performed onsite at Irkutsk TB hospitals); and 4) administratively prioritize referrals for ART from the TB hospitals to hasten committee approval and dispensation of ART.…”

Section: Discussionmentioning

confidence: 58%

Undertreated HIV and drug-resistant tuberculosis at a referral hospital in Irkutsk, Siberia

Heysell

Огарков

Жданова

et al. 2016

int j tuberc lung dis

View full text Add to dashboard Cite

SUMMARY SETTING A referral hospital for tuberculosis (TB) in Irkutsk, the Russian Federation. OBJECTIVE To describe disease characteristics, treatment and hospital outcomes of TB-HIV (human immunodeficiency virus). DESIGN Observational cohort of HIV-infected patients admitted for anti-tuberculosis treatment over 6 months. RESULTS A total of 98 patients were enrolled with a median CD4 count of 147 cells/mm3 and viral load of 205 943 copies/ml. Among patients with drug susceptibility testing (DST) results, 29 (64%) were multidrug-resistant (MDR), including 12 without previous anti-tuberculosis treatment. Nineteen patients were on antiretroviral therapy (ART) at admission, and 10 (13% ART-naïve) were started during hospitalization. Barriers to timely ART initiation included death, in-patient treatment interruption, and patient refusal. Of 96 evaluable patients, 21 (22%) died, 14 (15%) interrupted treatment, and 10 (10%) showed no microbiological or radiographic improvement. Patients with a cavitary chest X-ray (aOR 7.4, 95%CI 2.3–23.7, P = 0.001) or central nervous system disease (aOR 6.5, 95%CI 1.2–36.1, P=0.03) were more likely to have one of these poor outcomes. CONCLUSION High rates of MDR-TB, treatment interruption and death were found in an HIV-infected population hospitalized in Irkutsk. There are opportunities for integration of HIV and TB services to overcome barriers to timely ART initiation, increase the use of anti-tuberculosis regimens informed by second-line DST, and strengthen out-patient diagnosis and treatment networks.

show abstract

“…Among those living with HIV, people who inject drugs (PWID) are more likely to avoid or delay HIV care until disease progression (Giordano et al, 2005; Samet et al, 1998; Tobias et al, 2007; Torian, Wiewel, Liu, Sackoff, & Frieden, 2008), particularly in Russia (Bobrova, Sarang, Stuikyte, & Lezhentsev, 2007; Tkatchenko-Schmidt et al, 2010), where injection drug use accounts for most new HIV cases (Federal AIDS Center, 2014). Research indicates that facilitators of HIV care include case management, psychological and social support, opioid agonist therapy, integrated addiction and HIV treatment, acceptance of HIV status, and addressing HIV and drug stigma (Kamarulzaman & Altice, 2015; J.…”

Section: Introductionmentioning

confidence: 99%

“It is easier for me to shoot up”: stigma, abandonment, and why HIV-positive drug users in Russia fail to link to HIV care

et al. 2016

View full text Add to dashboard Cite

Many HIV-positive people who inject drugs (PWID) globally are not receiving HIV care. This represents a major challenge among key populations to end the global HIV epidemic. This qualitative study explored the process and associated barriers of linking HIV-positive PWID who are in addiction treatment to HIV care in St. Petersburg, Russia. We conducted three focus groups and seven semi-structured interviews with participants in the LINC (“Linking Infectious and Narcology Care”) project at addiction and HIV hospitals in St. Petersburg. The sample consisted of 25 HIV-infected patients with opioid dependence and seven health care providers, including addiction and infectious disease physicians and case managers. A variety of intertwining factors influence effective engagement of PWID with HIV treatment. Stigma, problematic patient-provider relationships, and fragmented health care were the main challenges for HIV care initiation by PWID, which were further exacerbated by injection drug use. Effective linkage of PWID to HIV care requires acknowledging and addressing stigma’s role and different perspectives of patients and providers.

show abstract

Obstacles in provision of anti-retroviral treatment to drug users in Central and Eastern Europe and Central Asia: A regional overview

Cited by 43 publications

References 12 publications

Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors

Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors

Undertreated HIV and drug-resistant tuberculosis at a referral hospital in Irkutsk, Siberia

“It is easier for me to shoot up”: stigma, abandonment, and why HIV-positive drug users in Russia fail to link to HIV care

Contact Info

Product

Resources

About