Barriers and Facilitators of HIV Care Engagement: Results of a Qualitative Study in St. Petersburg, Russia

Кузнецова, А. В.; Meylakhs, Anastasia; Amirkhanian, Yuri A.; Kelly, Jeffrey A.; Yakovlev, A. A.; Мусатов, В. Б.; Amirkhanian, Anastasia G

doi:10.1007/s10461-015-1282-9

Cited by 39 publications

(40 citation statements)

References 32 publications

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“…Findings are consistent, however, with themes found in other recent work (Kuznetsova et al, 2016). Additionally, use of rapid assessment is more often deductive and explanatory than the inductive exploratory approaches of “traditional” qualitative research.…”

Section: Discussionsupporting

confidence: 90%

“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

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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.

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Section: Discussionsupporting

confidence: 90%

“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

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“…Patients disengaged from care are at high risk of morbidity, mortality, and HIV transmission. Effective strategies to keep PLHIV in care are critical to ending the HIV epidemic in SSA [10,[26][27][28].…”

Section: Introductionmentioning

confidence: 99%

Qualitative exploration of perceived benefits of care and barriers influencing HIV care in trans Nzoia, Kenya

Naanyu

Ruff

Goodrich

et al. 2020

BMC Health Serv Res

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Background: Substantial efforts have been made to ensure people living with HIV (PLHIV) are linked to and retained in care but many challenges deter care utilization. We report perceived benefits of seeking HIV care and barriers to HIV care that were identified through a formative assessment conducted to advise the development of an alternative care model to deliver antiretroviral treatment therapy (ART) in Trans Nzoia County, Kenya. Methods: Data were collected in 2015 through key informant interviews (KIIs), in-depth interviews (IDIs), and focus group discussions (FGDs). The study involved 55 participants of whom 53% were female. Ten KIIs provided community contextual information and viewpoints on the HIV epidemic in Trans Nzoia County while 20 PLHIV (10 male and 10 female) participated in IDIs. Twenty-five individuals living with HIV participated in four FGDs-two groups for men and two for women. Key informants were purposively selected, while every third patient above 18 years at the Kitale HIV Clinic was invited to share their HIV care experience through IDIs or FGDs. Trained research assistants moderated all sessions and audio recordings were transcribed and analyzed thematically. Results: Findings showed that PLHIV in Trans Nzoia County used both conventional and complementary alternative care for HIV; however, public health facilities were preferred. Popular perceived benefits of adopting care were relief from symptoms and the chance to live longer. Benefits of care uptake included weight gain, renewed energy, and positive behavior change. Individual-level barriers to HIV care included lack of money and food, use of alternative care, negative side effects of ART, denial, and disclosure difficulties. At the community level, stigma, limited social support for conventional HIV treatment, and poor means of transport were reported. The health system barriers were limited supplies and staff, long distance to conventional HIV care, and unprofessional providers. Conclusions: Diverse individual, community and health system barriers continue to affect HIV care-seeking efforts in Kenya. Appreciation of context and lived experiences allows for development of realistic care models.

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“…Unfortunately, the care for patients with an OUD in Russian narcology hospitals is associated with low successful treatment outcomes and follow up rates [24, 32]. To our knowledge, this study is the first to estimate the effectiveness of implementing an evidence-based form of OAT in Russia, as well as the associated costs.…”

Section: Discussionmentioning

confidence: 99%

Implementation of methadone therapy for opioid use disorder in Russia – a modeled cost-effectiveness analysis

Idrisov

Murphy

Morrill

et al. 2017

Subst Abuse Treat Prev Policy

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BackgroundOpioid agonist therapy using methadone, an effective treatment of opioid use disorders (OUD) for people who inject drugs (PWID), is recommended by the World Health Organization as essential to curtail the growing HIV epidemic. Yet, despite increasing prevalence of OUD and HIV, methadone therapy has not yet been implemented in Russia. The aim of this modeling study was to estimate the cost-effectiveness of methadone therapy for Russian adults with a diagnosed OUD.Methods/DesignWe modeled the projected program implementation costs and estimated disability-adjusted life years (DALYs) averted over a 10-year period, associated with the provision of methadone therapy for a hypothetical, unreplenished cohort of Russian adults with an OUD (n = 249,000), in comparison to the current therapies at existing addiction treatment facilities. Our model compared four distinct scenarios of treatment coverage in the cohort ranging from 3.1 to 55%.ResultsProviding methadone therapy to as few as 3.1% of adults with an OUD amounted to an estimated almost 50,000 DALYs averted over 10 years at a cost of just over USD 17 million. Further expanding service coverage to 55% resulted in an estimated almost 900,000 DALYs averted, at a cost of about USD 308 million.ConclusionOur study indicated that implementing opioid agonist therapy with methadone to treat OUD at existing facilities in Russia is highly cost-effective.

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Barriers and Facilitators of HIV Care Engagement: Results of a Qualitative Study in St. Petersburg, Russia

Cited by 39 publications

References 32 publications

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

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

Qualitative exploration of perceived benefits of care and barriers influencing HIV care in trans Nzoia, Kenya

Implementation of methadone therapy for opioid use disorder in Russia – a modeled cost-effectiveness analysis

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