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Opioid Agonist Treatment and Improved Outcomes at Each Stage of the HIV Treatment Cascade in People Who Inject Drugs in Ukraine

Mazhnaya, Alyona, MS, MPH*,†,‡; Marcus, Ruthanne, PhD, MPH§; Bojko, Martha J., PhD§; Zelenev, Alexei, PhD§; Makarenko, Iuliia, MS*; Pykalo, Iryna, MPH; Filippovych, Sergii, MD*; Dvoriak, Sergii, MD, PhD║,¶; Altice, Frederick L., MD, MA†,‡,§

JAIDS Journal of Acquired Immune Deficiency Syndromes: November 1, 2018 - Volume 79 - Issue 3 - p 288–295
doi: 10.1097/QAI.0000000000001827
Epidemiology
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Background: The HIV treatment cascade is a crucial tool to guide HIV prevention and treatment strategies. The extent to which opioid agonist treatments (OATs) such as methadone and buprenorphine influence this cascade was examined in a nationwide study of people who inject drugs (PWID) in Ukraine.

Setting: Cross-sectional stratified survey of PWID followed by HIV and hepatitis C virus testing in 5 Ukrainian cities.

Methods: Opioid-dependent PWID (N = 1613) were sampled from January 2014 to March 2015. Analysis was confined to 520 participants with HIV, with 184 (35.4%) prescribed OAT. Weighted logistic regression models were used to assess independent factors associated with the 5 steps in the HIV treatment cascade.

Results: Compared with PWID not on OAT (N = 336), participants who prescribed OAT (N = 184) were significantly more likely to be diagnosed (91% vs. 71%), linked (81% vs. 52%), and retained (69% vs. 35%) in HIV care, and prescribed (56% vs. 31%) and optimally (>95% of doses) adherent to antiretroviral therapy (41% vs. 22%). Receiving OAT contributed most as an independent factor with every step of the cascade. Other steps in the HIV treatment cascade were influenced by age, depression, and geographical variability.

Conclusions: OAT remains an essential and effective strategy to not only treat patients with opioid use disorder, but also a crucial strategy to engage PWID in care to meet UNAIDS 90-90-90 targets. Geographical differences suggest local structural impediments. With low OAT coverage prescribed for 2.9% of the estimated 347,000 PWID in Ukraine, OAT expansion requires strategic interventions that target the individual, clinical care settings, policies, and funding.

*Treatment, Procurement and Supply Management Department, International Charitable Foundation “Alliance for Public Health”, Kyiv, Ukraine;

Division of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT;

Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;

§AIDS Program, Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT;

Ukrainian Institute on Public Health Policy, Kyiv, Ukraine; and

Department of Social Work, Academy of Labour, Social Relations and Tourism, Kyiv, Ukraine.

Correspondence to: Alyona Mazhnaya, MS, MPH, Treatment, Procurement and Supply Management Department, International Charitable Foundation “Alliance for Public Health”, 5 Dilova Street, building 10A, 9th floor, Kyiv 03680, Ukraine (e-mail: hmazhnaya@gmail.com).

Supported by the National Institute on Drug Abuse for funding for research (R01 DA029910, R01 DA043125, and R01 DA033679) and career development (K24DA017072 and K01DA037826) and the Global Health Equity Scholars Program funded by the Fogarty International Center and the National Institute of Allergy and Infectious Diseases (Research Training Grant R25 TW009338) as well as New York State International Training and Research Program through an in-country training grant funded by the Fogarty International Center (D43TW000233).

Preliminary data presented at the 21st International AIDS Conference; July 18–22, 2016; Durban, South Africa.

The authors have no funding or conflicts of interest to disclose.

A.M. was responsible for study design, survey construction, data analysis, conceptualizing and conducting the analysis, data interpretation, writing the first draft, and reviewing the manuscript. R.M., M.J.B., I.M., and I.P. were involved with study design, survey construction, and reviewing the manuscript. A.Z. was involved in data analysis and interpretation and reviewing the manuscript. S.D. was involved in study design and reviewing the manuscript. S.F. was the site coinvestigator and was involved in the study design and reviewing the manuscript. F.L.A. was the principal investigator and was involved in the funding, study design, survey construction, data analysis, conceptualizing the analysis, data interpretation, and final review of the manuscript.

Received February 01, 2018

Accepted July 02, 2018

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