Implementation opportunities for scaling up methadone maintenance treatment in Kyrgyzstan: Methadone dosage and retention on treatment over two years

Ivasiy, Roman; Madden, Lynn M.; Farnum, Scott O.; Shumskaya, Natalia; Leon, Samy J. Galvez de; Bromberg, Daniel J.; Kurmanalieva, Ainura; Duishenaliev, Aibek; Tokubaev, Ruslan; Altice, Frederick L.

doi:10.1016/j.dadr.2022.100075

Cited by 4 publications

(5 citation statements)

References 48 publications

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“…As HIV has become a global pandemic, with many regional HIV epidemics being concentrated in PWID, it is critical to understand the Ukrainian response, which is the first of its type. Before the 2022 invasion, prior events, like the Russian invasion in 2014 and the COVID-19 pandemic, also disrupted HIV services and created learning opportunities (12,(23)(24)(25)(26)(27). The COVID-19 pandemic, for example, led to increased psychological distress and heightened drug use among people with HIV (28).…”

Section: Discussionmentioning

confidence: 99%

Early disruptions to syringe services programs during the Russian invasion of Ukraine

Nikitin,

Bromberg,

Pykalo

et al. 2023

Front. Public Health

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IntroductionThe widespread HIV epidemic in Ukraine is concentrated among people who inject drugs (PWID), making access to sterile injection paraphernalia (SIP) like sterile needles and syringes a critical method of HIV/AIDS prevention; however, the Russian invasion has threatened to disrupt the operations of syringe services programs (SSPs), creating a risk of HIV outbreaks among PWID.MethodsWe conducted 10 semi-structured interviews with outreach workers from SSPs. Interviews were purposively sampled to cover three prototypic regions of Ukraine: temporarily Russian-controlled, frontline, and destination. Qualitative results from interviews were then compared against a standardized, nationwide harm reduction database.ResultsWe found that the Russian invasion triggered both supply and demand challenges for SSPs. Demand increased for all regions due to client transitions from pharmacies that closed to SSPs, increases in illicit drug use, greater client openness to NGO support, and displacement of clients to destination regions. Supply decreased for all areas (except for remote destination regions) due to battle-related barriers like curfews, roadblocks, and Internet disruptions; diminished deliveries of SIP and funding; and staff displacement. Time series plots of the number of unique clients accessing harm reduction services showed that an initial decrease in service provision occurred at the start of the war but that most regions recovered within several months except for Russian-controlled regions, which continued to provide services to fewer clients relative to previous years.ConclusionTo ensure continued scale-up of SIP and other HIV prevention services, the SyrEx database should be leveraged to serve as a streamlined harm reduction locator that can inform workers and clients of open site locations and other pertinent information.

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Section: Discussionmentioning

confidence: 99%

Early disruptions to syringe services programs during the Russian invasion of Ukraine

Nikitin,

Bromberg,

Pykalo

et al. 2023

Front. Public Health

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“…The durations for THD are not distinctly labeled in SyRex. Although adequate dosing should be tailored for the individual [44], we selected recommendations from international guidelines that corresponded with prior findings from Ukraine to define optimal dosing, operationalized as > 85 mg per day [32][33][34]. For each cohort, we utilized four quarterly cross-sectional data snapshots (see Supporting information, Figure S1), beginning from the first day (18 March) of the observation period, to capture dose changes and THD transfers occurring within each calendar quarter.…”

Section: Methodsmentioning

confidence: 99%

“…In addition to coaching and rapid-cycle change projects, NIATx introduced stimulus lectures and international travel to observe new treatment ideas from outside the country (e.g. optimizing methadone dose and dose escalation strategies) [32][33][34]. Baseline data, combined with promising practices identified through NIATx coaching, led to regulatory changes in late 2016, allowing for THD and treatment outside specialty clinics [35][36][37][38].…”

Section: Introductionmentioning

confidence: 99%

The impact of emergency guidance to the COVID‐19 pandemic on treatment entry, retention and mortality among patients on methadone in Ukraine

Ivasiy,

Madden,

Meteliuk

et al. 2024

Addiction

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Background and aimsUkraine’s Ministry of Health released urgent COVID‐19 guidelines, allowing for early implementation of take‐home dosing (THD) for opioid agonist therapies (OAT) such as methadone. Enrollment in OAT and retention in the program are the most effective HIV prevention strategies for people who inject drugs (PWID). This study aimed to evaluate the impact of Ukraine’s COVID‐19 emergency guidance on OAT treatment enrollment, retention on treatment and mortality.Design and settingUsing Ukraine’s national OAT registry for 252 governmental clinics across 25 regions, we conducted a 12‐month comparative prospective cohort survival analysis. This study compared newly enrolled methadone patients within the initial 6 months following the COVID‐19 guidance (COVID) with patients from the preceding year (pre‐COVID) in a country with high adult HIV prevalence (1.2%) that is concentrated in PWID.ParticipantsIn the nation‐wide sample of newly enrolled PWID in Ukraine, comprising 2798 individuals, 1423 were in the COVID cohort and 1375 were in the pre‐COVID cohort. The majority were male (86.7%), with an average age of 39.3 years.MeasurementsPrimary outcomes were average monthly enrollment per cohort, treatment retention and mortality, with internal time‐dependent predictors, including THD and optimal (> 85 mg) methadone dosing.ResultsRelative to the pre‐COVID period, the monthly average patient enrollment was statistically significantly higher during the COVID period (283.7 versus 236.0; P < 0.0001), where patients were more likely to transition to THD and achieve optimal dosing earlier. Significant differences were observed in the proportions of person‐months on THD (41 versus 13%, P < 0.0001) and optimal dosing (38 versus 31%, P < 0.0001) between the COVID and pre‐COVID cohorts. Predictors of treatment retention, expressed as adjusted hazard ratios (aHR), included early THD [aHR = 1.90, 95% confidence interval (CI) = 1.47–2.45], early optimal dosing (aHR = 1.71, 95% CI = 1.37–2.13) and prior methadone treatment (aHR = 1.39, 95% CI = 1.15–1.68). These factors persisted, respectively, in the pre‐COVID (aHR = 2.28, 95% CI = 1.41–3.70; aHR = 1.84, 95% CI = 1.32–2.56; and aHR = 1.36, 95% CI = 1.06–1.74) and COVID (aHR = 1.91, 95% CI = 1.40–2.59; aHR = 1.61, 95% CI = 1.20–2.16; and aHR = 1.49, 95% CI = 1.08–1.94) cohorts. Survival did not differ significantly between the two prospective cohorts.ConclusionUkraine’s prompt adoption of early take‐home dosing for opioid agonist therapies, such as methadone, following the emergency COVID‐19 guidance appears to have increased enrollment into methadone and improved treatment retention for people who inject drugs without adverse effects on patient survival.

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“…The 2015 OAT guidelines do not include buprenorphine and start with methadone dosages of 10-30mg, with daily increases of 5-10mg (and a maximum weekly increase of 30mg) until the patient is stabilized at 60-120mg daily (RCHD 2015). Several clinical studies confirm that doses of 90mg or more and take-home dosing are associated with better health outcomes (Ivasiy et al 2022;Farnum et al 2021;Meteliuk et al 2021). Rather than treating OUD as a chronic disease, as recommended globally (WHO 2009), Kazakhstani policies provide maintenance for six months, followed by treatment that tapers off upon the patient's request.…”

Section: Medication Dosingmentioning

confidence: 99%

Stalled Scale-Up of Opioid Agonist Therapies for HIV Prevention in Kazakhstan: History, Policy, and Recommendations for Change

Liberman,

Ivasiy,

Altice

et al. 2024

Journal of Illicit Economies and Development

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HIV incidence and mortality are increasing in Eastern Europe and Central Asia and are concentrated in people who inject drugs. Maintenance with opioid agonist therapies (OAT) like methadone or buprenorphine is the best treatment for opioid use disorder and a key HIV-prevention strategy in the region. In Kazakhstan, the scale-up of methadone has been minimal since methadone's introduction in 2008 and has been supported through international charitable organizations. As the Republic of Kazakhstan is designated to assume financial and administrative oversight of OAT, legislative gains can ensure treatment continuity and scale-up. Here, we review legislative barriers to OAT scale-up in Kazakhstan using an implementation science lens. We review legislative, political, and cultural barriers that undermine the efficient distribution and allocation of medications and impose burdensome clinical and administrative demands on patients and clinicians. Legislative reform is required to support further OAT expansion. We therefore provide policy recommendations to overcome these barriers to increase access to this life-saving, life-prolonging, evidence-based medical treatment. Minimally, these include increased numbers of clinical sites and patients at these sites; re-engineering OAT delivery across the country and directly to patients; introducing newer formulations of OAT; and creating an open bidding process to procure treatment medications. 70 Liberman et al.

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Implementation opportunities for scaling up methadone maintenance treatment in Kyrgyzstan: Methadone dosage and retention on treatment over two years

Cited by 4 publications

References 48 publications

Early disruptions to syringe services programs during the Russian invasion of Ukraine

Early disruptions to syringe services programs during the Russian invasion of Ukraine

The impact of emergency guidance to the COVID‐19 pandemic on treatment entry, retention and mortality among patients on methadone in Ukraine

Stalled Scale-Up of Opioid Agonist Therapies for HIV Prevention in Kazakhstan: History, Policy, and Recommendations for Change

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