Evaluation of a Pilot Medication-Assisted Therapy Program in Kazakhstan: Successes, Challenges, and Opportunities for Scaleup

Abstract

Study Aims. Evaluate the quality and effectiveness of the medication-assisted therapy (MAT) pilot in Kazakhstan and review implementation context and related challenges. Methods. We performed a desk review of MAT policy and program documents and reviewed medical records at three MAT sites in Kazakhstan. MAT patients (n = 93) were interviewed to assess their perceptions of the program and its impact on their health, criminal, drug use, and HIV risk related behaviors as well as expenditures on nonprescribed psychoactive drugs. Persons injecting drugs who are not in treatment, MAT program staff, and other stakeholders were interviewed to obtain their perspectives on MAT. Results. Legislation supports introducing MAT as a standard of care for treatment of opioid dependence; however, its progress has been hampered by active opposition. Inadequate access and coverage, insufficient supply management, scarce infrastructure of narcological facilities, limited opportunities for staff development, and restrictive methadone dispensing policies compromise the quality of the intervention and limit its potential benefits. There were significant reductions in criminal, drug use, and HIV risk related behaviors in patients receiving MAT. Conclusions. The MAT pilot in Kazakhstan demonstrated its feasibility and effectiveness in the local context and is recommended for scaleup throughout the country.

HIV risks among injecting and non-injecting female partners of men who inject drugs in Almaty, Kazakhstan: Implications for HIV prevention, research, and policy

“…The low numbers of women receiving drug treatment points to the need for increases in drug treatment services in Almaty, Kazakhstan, where methadone and buprenorphine are not available (Boltaev et al, 2012). Access to services for FWID may also be impeded by structural barriers including discrimination, drug policies, police exploitation, and stigma (Odinokova, Rusakova, Urada, Silverman, & Raj, 2012; UNODC, 2013).…”

“…However, in recent years there has been a steady rise in the incidence of sexual transmission of HIV, especially among heterosexual partners of men who inject drugs (MWID) (UNAIDS, 2012b). In 2011, heterosexual transmission consisted of slightly more than half (50.7%) of all newly acquired HIV cases in Kazakhstan (Boltaev, Deryabina, Kusainov, & Howard, 2012; Boltaev et al, In press). The majority of females who inject drugs (FWID) have male sex partners who also inject, whereas the majority of MWID have non-injecting female sex partners (Roberts, Mathers, & Degenhardt, 2010).…”

Drug use as a driver of HIV risks

“…Indonesia in particular saw a ten-fold increase in HIV incidence between 2006 and 2011 (33). In 2011, heterosexual transmission represented half of all new HIV infections in Kazakhstan (34, 35), suggesting that a transition from IDU-concentrated epidemics to heterosexual HIV epidemics (5) is occurring in Central Asia. Condom use between PWID and their sex partners remains low (17, 20, 36) and non-injecting female sex partners may be at particular risk (16).…”

“…Opioid substitution therapy (OST) has yet to become widely available in Eastern Europe and Central Asia where rates of IDU are high. Political opposition in Kazakhstan delayed the introduction and scale-up of nationwide OST programs (34) and in Uzbekistan, an OST pilot project was declared ineffective prematurely, accompanied by denial of the evidence supporting OST’s effectiveness at reducing HIV (34). In Russia, OST remains illegal (57).…”

Intersecting epidemics of HIV, HCV, and syphilis among soon-to-be released prisoners in Kyrgyzstan: Implications for prevention and treatment

“…Kyrgyzstan has been a regional leader in HIV prevention and harm reduction efforts, bolstered by political and legal support from NGOs, international donors and several state agencies (Ancker & Rechel, 2015; Schonning & Stuikyte, 2009). It is the only country in Central Asia and one of only seven countries worldwide that integrates both OAT and NSP into its nationwide HIV prevention strategy for both communities and prisons, albeit with suboptimal coverage (Boltaev et al, 2012; Degenhardt et al, 2010; International AIDS Society, 2011). High OAT coverage is effective for both primary (Altice et al, 2010) and secondary HIV prevention by increasing antiretroviral therapy (ART) utilization (Altice, et al, 2011; Lucas et al, 2010; Uhlmann et al, 2010), improving HIV treatment outcomes (Altice, et al, 2011; Palepu et al, 2006) within prison (Haig, 2003) and during the post-release period, (Kinlock et al, 2012) as well as reducing HIV risk behaviors (Altice et al, 2006; Metzger et al, 1993).…”