Perspectives of clients and providers on factors influencing opioid agonist treatment uptake among HIV-positive people who use drugs in Indonesia, Ukraine, and Vietnam: HPTN 074 study

Abstract

Background Opioid agonist treatment (OAT) is an effective method of addiction treatment and HIV prevention. However, globally, people who inject drugs (PWID) have insufficient OAT uptake. To expand OAT access and uptake, policymakers, program developers and healthcare providers should be aware of barriers to and facilitators of OAT uptake among PWID. Methods As a part of the HPTN 074 study, which assessed the feasibility of an intervention to facilitate HIV treatment and OAT in PWID living with HIV in Indonesia, Ukraine, and Vietnam, we conducted in-depth interviews with 37 HIV-positive PWID and 25 healthcare providers to explore barriers to and facilitators of OAT uptake. All interviews were audio-recorded, transcribed, translated into English, and coded in NVivo for analysis. We developed matrices to identify emergent themes and patterns. Results Despite some reported country-specific factors, PWID and healthcare providers at all geographic locations reported similar barriers to OAT initiation, such as complicated procedures to initiate OAT, problematic clinic access, lack of information on OAT, misconceptions about methadone, financial burden, and stigma toward PWID. However, while PWID reported fear of drug interaction (OAT and antiretroviral therapy), providers perceived that PWID prioritized drug use over caring for their health and hence were less motivated to take up ART and OAT. Motivation for a life change and social support were reported to be facilitators. Conclusion These results highlight a need for support for PWID to initiate and retain in drug treatment. To expand OAT in all three countries, it is necessary to facilitate access and ensure low-threshold, financially affordable OAT programs for PWID, accompanied with supporting interventions. PWID attitudes and beliefs about OAT indicate the need for informational campaigns to counter misinformation and stigma associated with addiction and OAT (especially methadone).

Opioid relapse and its predictors among methadone maintenance patients: a multicenter, cross-sectional study in Vietnam

“…MMT is essential in reducing criminal activities and improving the employment rate and social well-being among patients [ 33 ]. During MMT, patients must face many difficulties and challenges [ 34 , 35 ]. Opioid relapse is a severe problem that can hinder the effectiveness of MMT.…”

Perceived availability and carriage of take-home naloxone and factors associated with carriage among people who inject drugs in England, Wales and Northern Ireland

“…Such data are important to inform future research-based policy so that the distribution of THN can be targeted as effectively as possible. More broadly, we note that we may have missed other important predictors of naloxone carriage, as a myriad of other factors have been shown to influence access to services among PWID, such as perceived need for care, mental health status, education and access to social support (Artenie et al, 2015;Barocas et al, 2014;Kiriazova et al, 2020). The Gelberg-Andersen framework of healthcare access among vulnerable populations draws attention to a wide-range of predisposing, need and enabling factors (Gelberg et al, 2000), and our application of the model was limited to the measures collected within the UAM survey.…”