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

Abstract

Background-Injection drug use (IDU) accounts for 70% 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 antiretroviral therapy (ARV) among IDUs.

Feasibility of Buprenorphine Maintenance Therapy Programs in the Ukraine: First Promising Treatment Outcomes

“…In June 2007, methadone was approved by the Ukrainian Ministry of Health and will now also be made available for maintenance treatment. Nevertheless, the number of IDUs receiving agonist maintenance is still very low and the vast majority of IDUs have not yet been reached by OST [4] .…”

“…In addition to the low availability of agonist maintenance in the Ukraine, access to antiretroviral therapy (ART) for IDUs was and still is low, and clinicians have tended to refuse ARTs to active IDUs, believing that they would be poorly adherent [4] . However, recent evidence has emerged that integrating ART and OST in HIV-positive IDUs can optimize outcomes for both opiate addiction and HIV infection status [7] .…”

“…Despite this high prevalence of IDUs, until 2004 drug treatment programs relied on detoxification and abstinence-based rehabilitation in so called 'narcological centers' [4] . Because of political and clinical mistrust of OST, buprenorphine was the only medication available for OST between 2004 and 2007.…”

Opioid pharmacotherapy: Treatment, regimes, constructions and control

“…Though buprenorphine maintenance treatment was started earlier in Ukraine (Bruce, Dvoryak, Sylla, & Altice, 2007), MMT began in 2008, and the first MMT program integrated into a TB-facility was launched in 2009. Out of 109 inpatient TB clinics in Ukraine, only 11 provide MMT, with the majority having only a few clients each.…”

Opioid Addicted Buprenorphine Injectors: Drug Use During and After 12-Weeks of Buprenorphine–Naloxone or Methadone in the Republic of Georgia

“…Opioid substitution therapy (OST) using buprenorphine and methadone has been introduced in some Former Soviet States including Ukraine (Bruce, Dvoryak, Sylla, & Altice, 2007;Dvoriak et al, 2013;Dvoryak & Grishayeva, 2008;Golovanevskaya, Vlasenko, & Saucier, 2012;Lawrinson et al, 2008) and Georgia (Gambashidze, Sikharulidze, Piralishvili, & Gvakharia, 2008;Otiashvili et al, 2010;Piralishvili, Gamkrelidze, Nikolaishvili, & Chavchanidze, 2012) and data are becoming available on its effectiveness in these cultural settings. Findings from the U.S., Western Europe, and Australia have consistently found that OST is associated with substantial reductions in illicit opioid use, criminal activity, and drug related mortality, and that it can play an important role in reducing the spread of HIV by reducing injection risk and improving adherence to antiretroviral therapy (Cornish, Macleod, Strang, Vickerman, & Hickman, 2010;Degenhardt et al, 2010;Gowing, Farrell, Bornemann, Sullivan, & Ali, 2011;Kimber et al, 2010;MacArthur et al, 2012;Malta, Strathdee, Magnanini, & Bastos, 2008;Mattick, Breen, Kimber, & Davoli, 2003;Mattick, Breen, Kimber, & Davoli, 2007;Suntharasamai et al, 2009;Tilson et al, 2007).…”