Marina Chavchanidze’s research while affiliated with University of Georgia and other places

Aims: Evaluation of State Opioid Substitution Treatment OST (methadone and buprenorphine/naloxone- Addnok-N) program in Georgia and optimization of the routine measurement instrument. Patients were recruited from 4 Tbilisi and 5 regional State Programs in May-October 2013. 2 structured self-questionnaires (one - anonymous for sensitive questions) were developed for patients to assess demographics, retention in treatment, mean drug dose, HIV and Hepatitis C and B status, illicit drug and alcohol use, social activities, crime involvement, health status, HIV risk behavior, treatment compliance and satisfaction. 608 patients (7 females) were surveyed (512 - on Methadone, 96 - on buprenorphine/naloxone). 337 (1 female) patients completed an anonymous questionnaire. Mean age - 39.43±8.7 (21-65 years). 10 (1.64%) respondents were HIV positive; 448 (73.68%) - HCV+ and 24 (3.95%) - HBV+; average methadone dose - 39.27±22.2mg; buprenorphine/naloxone - 7.4±3.6 mg; 64 (40%) of employed began working while in program; 365 (60%) have been in treatment for less than 1 year, and 146 (24%) - for 1-3 years vs. 258 (51%) out of 506 patients surveyed in 2011. 494 (81.2%) reported improvement of social status and 508 (83.5%) - of health status. 305 (90.5%) out of 337 reported no- and 30 (8.9%) - reduction of criminal activity. 467 (76.81%) patients attended individual and 200 (32.9%)-group psychotherapy sessions with various frequencies. The common adverse events: sleep disturbances - 48.84%; weakness - 50.82%; mood disturbances - 42.44%, and heaviness - 36.35%. 257 (46%) reported using of alcohol; 16 - opioids; 29 - sedative/hypnotics; 8 - marijuana and 1 - ATS past 30 days; 55 - drug injection and 11 - sharing of any injection equipment past 6 months. State OST program is effective in Georgia in terms of reduction of illegal drug use, injection risk behavior and criminal activity, and on the other hand - improving of social activity and general health. Treatment retention is less as compared with 2011 survey.

Aims: conduct needs assessments and treatment compliance evaluations in MMT and Suboxone Substitution State Programs in Georgia (Republic of). 506 patients (2 females) were surveyed (92% on Methadone, 8% on Suboxone) from 6 Tbilisi and 4 regional State Programs in 2011 November. Mean age - 40±8,56 (22-65) year; 254 (51.4%) were in treatment for 1-3 year. Evaluation was carried out on the base of structured self-questionnaire that covers demographics, drug use history, general drug use trends, psychotherapeutic sessions' acceptance and open label question regarding treatment challenges and satisfaction. 305 (60.3%) attended individual and 57 (11.3%) group psychotherapy sessions with 50.79% attending once/month or rare. The main reason given for therapy non-attendance - no needs for it (29.48%); the main drugs before admission - heroin (80.04%), buprenorphine (53.49%); Main drugs used in Georgia nowadays - desomorphine ("crocodile"), alcohol and marihuana. Commonly used drugs by program patients (136 positive answers) - alcohol-13.62%, marihuana-10.39%, pregabalin - 8.17%, opioids- 6.62% (mostly-"crocodile"), home-made stimulants-6.23%, sedatives -5.45%. 55.4% are extremely satisfied with treatment, 82.4% - with program staff. Patients' main wishes- free of charge programs (46.4%) and provide take-home doses (22.07%). Methadone and Suboxone ST are being well accepted in Georgia and appear to be reducing illegal opioid use. However, the psychotherapeutic sessions' attendance is very low.

Aims: to evaluate QOL patients being treated with methadone and Suboxone in State-sponsored programs in Georgia. The WHOQOL-BREF (26 questions) version was administered to patients in State substitution program and healthy volunteers to assess their overall function and life satisfaction in physical, mental, social health, and environment domains. Domain scores were calculated and converted to 4-20 and 0-100 scales, identical to the WHOQOL-100. 485 patients (309 from 6 Tbilisi and 176 from 5 regional centers) and 50 healthy volunteers (13 male, 37 female) were surveyed. Significant differences were observed between new admitted patients (0-3 month) and healthy controls by mean physical (47.5 vs. 51.94; CI 95%); psychological (55.0 vs. 60.50; CI 95%) and environmental (46.2 vs. 52.2; CI 95%) domains, but not by social relationships or between Tbilisi and regions. The Social domain scores were raised in accordance with time spent in treatment reaching a maximum improvement within 1-3 years (social- 72.8 vs. 67.7; CI 95%), further with few descending tends round the healthy people's scores. These pilot data show decrements in QOL among patients entering maintenance treatment with improvements in the course of maintenance treatment. It is possible that the increased indicators in social domain up to especially high level within the first 3 years is the result of subjective factors, with the subsequent return to healthy community level.

http://altgeorgia.ge/2012/myfiles/narkotestireba%20ENG-1.pdf

The aim of the study was to understand the prevalence and patterns of the non-medical injecting use of buprenorphine among drug injectors in Georgia. A self-administered questionnaire was distributed among injecting drug users enrolled in Georgian needle exchange programmes. The questions covered topics related to drug use career, patterns (frequency, history, dosage) and reasons for the use of buprenorphine. Pharmaceutical buprenorphine in the form of Subutex was the most commonly injected drug in terms of lifetime (95.5%) and last-month (75%) prevalence of use. 48% of those study participants who had injected Subutex at some point reported having used it to cope with withdrawal or to give up other opioids. 90.5% of Subutex injectors used 1-2 mg as a single dose, and the mean frequency of its injection was 6 times per month. 75% of Subutex injectors had used 3 or more types of illegal drugs during the last 30 days. While widely misused by Georgian drug injectors, Subutex is neither the principal nor the favourite drug, and it is rather used as self-treatment. The authors consider the introduction of buprenorphine maintenance treatment to be a promising effective measure to decrease its non-medical and illegal use.

Background: Injecting drug use (IDU) is a leading driving force of the HIV and hepatitis C epidemics in Georgia. Sixty percent of registered HIV/AIDS cases are attributed to IDU. All existing low-threshold programs targeting IDU in the Republic of Georgia are funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). All of these programs provide standard services to their clients (needle/syringe exchange, voluntary counseling and testing) and employ similar prevention/education interventions. Aim: The aim of the study was to describe the prevalence and patterns of HIV risk behavior among participants of low-threshold programs and assess the impact of preventative interventions on this behavior. Methods: One hundred injecting drug users in three cities of Georgia were interviewed at intake and 6-month follow-up. A self-reported structured questionnaire was developed by the research staff and utilized questions from a risk assessment battery and HIV knowledge questionnaire. Survey questions covered topics related to drug use history, injecting sexual risk behavior, and knowledge of respondents’ HIV and hepatitis C serostatus. Statistical analysis was performed using SPPS-11.5. Results: One hundred (3 female) injecting drug users admitted for needle exchange programs were interviewed at intake, and 74 (1 female) from the same cohort were surveyed at 6-month follow-up. Mean age was 34 (SD=8.35). The mean history of injection drug use was 8.1 years (SD=6.61 years). Forty-one percent of participants reported being ever tested for HIV. One participant was HIV-positive. Among 55 respondents who ever tested for hepatitis C, 80 percent were infected. Buprenorphine (Subutex®) was the most commonly injected drug (68%) during the past 30 days, followed by homemade ephedrine-based drugs (54%), heroin (44%), and opium (35%). The general trend in sharing needles/syringes did not change. At intake, 30 percent admitted sharing at least once during the past month and 31.9 percent reported the same behavior at follow-up. There was a reduction in sharing works and instruments, with 59 percent admitting this behavior at intake and 43 percent reporting it at follow-up. The study shows some reduction in sexual risk behavior— condoms were used more often and sex with more than one partner was reported by 25 percent of respondents at follow-up, compared to 71 percent at intake. HIV knowledge significantly increased—mean rate of correct responses was 77.5 percent at follow-up, compared to only 45 percent at intake. Conclusion: Study findings suggest that prevalence of risk behavior is high among Georgian injecting drug users. Participation in low-threshold programs was associated with improvement in knowledge of HIV and associated risks. However, this increased knowledge did not result in positive change in risky injecting behavior. Alternatively, sexual risk behavior was reduced. There is a need in Georgia for developing and implementing local and culturally sensitive interventions. Acknowledgment: Study was funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and Open Society - Georgia Foundation (OSGF).

Background: Injecting drug use (IDU) is a leading driving force of the HIV and hepatitis C epidemic in Georgia. Sixty-three percent of registered HIV/AIDS cases are attributed to IDU. The aim of the study was to assess patterns of IDU and related risk behavior among injecting drug users and develop relevant risk-reduction interventions. Methods: As part of a descriptive cohort study, 100 injecting drug users in three cities of Georgia were interviewed using structured questionnaires. Survey questions covered topics related to drug use history, injecting and sexual risk behavior (Risk Assessment Battery), and knowledge of respondents' HIV and hepatitis C serostatus. Results: One hundred (including 3 females) injecting drug users admitted for needle exchange programs were surveyed. Mean age was 34 (SD 8.35). Forty-one percent of participants ever tested for HIV, and 2.4 percent of them were HIV-positive. Of 55 percent of respondents who ever tested for hepatitis C, 80 percent were hepatitis C infected. Buprenorphine (Subutex®) was the most commonly injected drug (68%) during the past 30 days, followed by homemade pervitine (54%), heroin (44%), and opium (35%). Past-month prevalence of needle sharing was 30 percent; 59 percent of respondents shared injecting instruments and works (spoon, filter) during the past 30 days, and 37 percent injected drugs preloaded in a needle by others. Past-month prevalence of unprotected sex was 25 percent. Conclusion: Study findings suggest that prevalence of risk behavior is high in Georgia. The majority of injecting drug users are not reached by relevant prevention and treatment services. There is a need for developing locally and culturally sensitive interventions and for scaling up risk-reduction programs targeting injecting drug users in the country. Acknowledgements: Global Fund to Fight AIDS, Tuberculosis and Malaria, Open Society- Georgia Foundation.