Article

HIV treatment access and scale-up for delivery of opiate substitution therapy with buprenorphine for IDUs in Ukraine - programme description and policy implications

Yale University AIDS Program, New Haven, CT 06510-2283, United States. <>
The International journal on drug policy (Impact Factor: 2.54). 09/2007; 18(4):326-8. DOI: 10.1016/j.drugpo.2006.12.011
Source: PubMed

ABSTRACT Injection drug use (IDU) accounts for 70 percent of HIV cases in Ukraine. Until buprenorphine maintenance therapy (BMT) was introduced, few effective strategies aimed at achieving reduction in illicit drug use were available as a conduit to anti-retroviral therapy (ARV) among IDUs.
In October 2005, BMT was scaled-up using Global Fund resources in six regions within Ukraine. Entry criteria included opioid dependence, HIV-1 seropositivity, age >or=18 years and reported interest in BMT. All sites included a multidisciplinary team. To date, 207 patients have been initiated on BMT.
The existing infrastructure allows for further scale-up of and administration of BMT and the possibility of co-administration with ARV. The process for prescription and administration of buprenorphine and ARV is at times cumbersome and constrained by current regulations.
More IDU need BMT to improve overall health outcomes. Central to expanding access will be legislative changes to existing drug policy. Moreover, the cost of buprenorphine is prohibitively expensive. Sustainable substitution therapy in Ukraine requires lower negotiated prices for buprenorphine, the addition of methadone, or both to the existing formulary for HIV+ drug users.

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Available from: Frederick Altice, Jan 09, 2014
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    • "To define the country's regions, we employ the standard four-region approach (Arel, 1995; Kubicek, 2000; Zaller et al., 2014) that divides the country into west, east, north/center, and south. Ukraine first introduced OST with buprenorphine in 2004 (Bruce et al., 2007), followed by methadone's introduction in 2007 (Lawrinson et al., 2008), which has since become the primary OST due to cost. Although OST reduces HIV risk behaviors (Altice et al., 2006; Metzger et al., 1993), increases ART access (Altice et al., 2011; Lucas et al., 2010; Uhlmann et al., 2010) and improves retention in HIV care and HIV treatment outcomes (Altice et al., 2011; Palepu et al., 2006), OST coverage in Ukraine remains inadequate, with only 2.6% of the estimated 310,000 PWIDs receiving treatment (Degenhardt et al., 2013; WHO, 2013; Zaller et al., 2014). "
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    ABSTRACT: Ukraine is experiencing one of the most volatile HIV epidemics globally, fueled primarily by people who inject drugs (PWIDs), and a parallel incarceration epidemic. Opioid substitution therapy (OST) is internationally recognized as one of the most effective forms of treatment for opioid dependence and is among the most effective HIV prevention strategies available, yet efforts to adopt it in Ukraine's Criminal Justice System (CJS) have been thwarted. To understand the reluctance of the Ukrainian CJS to adopt OST despite the overwhelming evidence pointing to its health benefits and improved criminal justice outcomes, we conducted the first survey of Ukrainian prison administrative, medical and custodial staff (N=243) attitudes towards addiction in general, OST, and people living with HIV/AIDS (PLWHA) in representative regions of Ukraine. Results revealed that Ukrainian CJS workers' attitudes toward OST, PLWHA, and drug addiction were universally negative, but differed substantially along geographic and occupational lines. Whereas geographic and cultural proximity to the European Union drove positive attitudes in the west, in the southern region we observed an identifiability effect, as workers who worked directly with prisoners held the most positive attitudes. We also found that knowledge mediated the effect of drug intolerance on OST attitudes. In Ukraine, adoption of OST is more influenced by myths, biases and ideological prejudices than by existing scientific evidence. By elucidating existing attitudes among CJS personnel, this study will help to direct subsequent interventions to address the barriers to implementing evidence-based HIV prevention treatments. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
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