The Future of Opioid Agonist Therapies in Ukraine: A Qualitative Assessment of Multilevel Barriers and Ways Forward to Promote Retention in Treatment

Abstract

Opioid agonist therapies (OAT) to treat opioid addiction in people who inject drugs (PWID) began in Ukraine in 2004. Scale-up of OAT, however, has been hampered by both low enrollment and high attrition. To better understand the factors influencing OAT retention among PWID in Ukraine, qualitative data from 199 PWIDs were collected during 25 focus groups conducted in five Ukrainian cities from February-April 2013. The experiences of PWID who were currently or previously on OAT or currently trying to access OAT were analyzed to identify entry and retention barriers encountered. Transcribed data were analyzed using a grounded theory approach. Individual beliefs about OAT, particularly misaligned treatment goals between clients and providers, influenced PWID's treatment seeking behaviors. Multiple programmatic and structural issues, including inconvenient hours and treatment site locations, complicated dosing regimens, inflexible medication dispensing guidelines, and mistreatment by clinic and medical staff also strongly influenced OAT retention. Findings suggest the need for both programmatic and policy-level structural changes such as revising legal regulations covering OAT dispensing, formalizing prescription dosing policies and making OAT more available through other sites, including primary care settings as a way to improve treatment retention. Quality improvement interventions that target treatment settings could also be deployed to overcome healthcare delivery barriers. Additional patient education and medical professional development around establishing realistic treatment goals as well as community awareness campaigns that address the myths and fears associated with OAT can be leveraged to overcome individual, family and community-level barriers.

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

“…Though MMT treatment guidelines now recommend achieving a dose of 60 mg per day within the first 30 days of treatment, dose escalation was markedly slower during the time of this study observation (Bojko et al, 2016; Polonsky, Rozanova, et al, 2016). Alternative explanations include of psychosocial support, inability of some patients to comply with strict program regulations or treatment expectations that OAT was intended as a long-term strategy.…”

“…Such tools must not only target negative attitudes toward OAT by patients and providers (I. Makarenko et al, 2016; Polonsky et al, 2015; Polonsky, Rozanova, et al, 2016), but address higher dosages for patients (Bojko et al, 2016; I. Makarenko et al, 2016).…”

“…Alternative explanations include of psychosocial support, inability of some patients to comply with strict program regulations or treatment expectations that OAT was intended as a long-term strategy. Until March 2016, no take-home doses were allowed in Ukraine, requiring OAT patients to travel to OAT sites daily where sites had restricted dispensing times (Bojko et al, 2015; Bojko et al, 2016; The State Service of Ukraine, 2014; UNAIDS, 2009) and where police often harassed OAT clients (Izenberg et al., 2013; Polonsky, Azbel, et al, 2016). Subsequent policy reforms in 2016 have allowed both prescription and take-home dosing for buprenorphine and methadone, although this practice has not yet been widely implemented.…”

“…Treatment is primarily provided at government-funded treatment settings. Using implementation data from this context defining the individual and organization barriers to OAT (Bojko et al, 2017; Bojko et al, 2015; Bojko et al, 2016; I. Makarenko et al, 2016; J.…”

“…In general, though due to a number of structural and political reasons (Bojko, Dvoriak, & Altice, 2013; Bojko et al, 2015; Bojko et al, 2016; Golovanevskaya, Vlasenko, & Saucier, 2012; Kutsa et al, 2016; I. Makarenko et al, 2016; A.…”