Methadone treatment improves tuberculosis treatment among hospitalized opioid dependent patients in Ukraine

Abstract

Background Ukraine’s volatile syndemics of tuberculosis (TB) and HIV among people who inject drugs (PWIDs) introduces numerous treatment challenges for each condition, including high mortality and development of multi-drug resistant TB (MDR-TB). Methods A prospective, non-randomized 90-day observational study was conducted in six Ukrainian TB treatment sites to assess the effectiveness of integrating methadone maintenance (MMT) with TB treatment using: (1) 90-day TB treatment retention; (2) time to treatment discontinuation; (3) TB medication adherence; and (4) subject disposition, including mortality. Of the 110 participants enrolled, 57 received MMT and 53 did not (non-MMT). Results All of the primary outcomes were significantly better in MMT versus non-MMT groups, including 90-day TB treatment completion (89.5% versus 73.6%; p = 0.031), time to TB treatment discontinuation (p = 0.039) and TB medication adherence (97.1% versus 86.2%; p<0.001) after controlling for death. The major reasons for treatment non-completion in the non-MMT group included death (N=3), administrative discharge from the clinic (N =5), loss to follow-up (N =2), and arrest (N=4). Overall, 90-day mortality was high (8.2%). After controlling for covariates differing between the two groups at baseline, the only independent predictor of completing 90 days of TB treatment was receipt of MMT in an integrated treatment setting (AOR = 3.05; 95% CI 1.08–8.66). Conclusions MMT integrated into inpatient TB treatment significantly improves retention in TB treatment and TB medication adherence among PWIDs. These findings call for policy change to increase the number of MMT sites in TB facilities and make MMT a low-threshold treatment option for opioid dependence in Ukraine.

Retention in medication-assisted treatment programs in Ukraine—Identifying factors contributing to a continuing HIV epidemic

“…Irrespective of etiology, the healthcare reform should shift to more integrated care settings (Bachireddy et al, 2014; Sylla, Bruce, Kamarulzaman, & Altice, 2007) that incorporate treatment for HIV, TB and opioid dependence, including in hospitalized settings. Important in our findings is that none of the patients receiving OAT in a TB hospital were retained for 12-months, either due to extraordinary high mortality in HIV/TB co-infected patients or inability to transfer patients to alternative OAT sites (Morozova et al, 2013). …”

“…Explanations for this finding might include that Ukrainian guidelines requires inpatient hospitalization for all TB patients initially and involuntary discharge from OAT because TB hospitals may not provide onsite OAT. Alternatively, drop-out may be higher in TB patients due to high levels of MDR-TB and death in these patients (Morozova, Dvoryak, & Altice, 2013). Irrespective of etiology, the healthcare reform should shift to more integrated care settings (Bachireddy et al, 2014; Sylla, Bruce, Kamarulzaman, & Altice, 2007) that incorporate treatment for HIV, TB and opioid dependence, including in hospitalized settings.…”

One-year mortality of HIV-positive patients treated for rifampicin- and isoniazid-susceptible tuberculosis in Eastern Europe, Western Europe, and Latin America

“…Measures should be taken to help IDU patients to remain in care and overcome structural barriers, improve health literacy, and minimize stigma. There is a need for a patient-centred integrated multidisciplinary approach, involving both HIV and TB clinicians, as well as social support and provision of opiate substitution therapy, which is currently poorly available [28–31]. Integration of HIV and TB services, although improving, is still suboptimal in Eastern Europe and close collaboration of physicians from both specialities is limited.…”

Geographic variability in HIV and injection drug use in Ukraine: Implications for integration and expansion of drug treatment and HIV care

“…Importantly, this study found that OST alone was sufficient in improving the health related quality of life for HIV positive PWID (Bachireddy et al, 2013). Additionally, integration of methadone at inpatient TB facilities in Ukraine has also demonstrated favourable outcomes with respect to TB treatment retention and adherence (Morozova, Dvoryak, & Altice, 2013). …”