Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2017 Apr 1:173:132-138.
doi: 10.1016/j.drugalcdep.2016.12.025. Epub 2017 Feb 21.

Primary healthcare-based integrated care with opioid agonist treatment: First experience from Ukraine

Olga Morozova  1 , Sergey Dvoriak  2 , Iryna Pykalo  3 , Frederick L Altice  4
Affiliations
Observational Study

Primary healthcare-based integrated care with opioid agonist treatment: First experience from Ukraine

Olga Morozova et al. Drug Alcohol Depend. .

Abstract

Background: Ukraine's HIV epidemic is concentrated among people who inject drugs (PWID), however, coverage with opioid agonist therapies (OATs) available mostly at specialty addiction clinics is extremely low. OAT integrated into primary healthcare clinics (PHCs) provides an opportunity for integrating comprehensive healthcare services and scaling up OAT.

Methods: A pilot study of PHC-based integrated care for drug users conducted in two Ukrainian cities between 2014 and 2016 included three sub-studies: 1) cross-sectional treatment site preference assessment among current OAT patients (N=755); 2) observational cohort of 107 PWID who continued the standard of care versus transition of stabilized and newly enrolled PWID into PHC-based integrated care; and 3) pre/post analysis of attitudes toward PWID and HIV patients by PHC staff (N=26).

Results: Among 755 OAT patients, 53.5% preferred receiving OAT at PHCs, which was independently correlated with convenience, trust in physician, and treatment with methadone (vs. buprenorphine). In 107 PWID observed over 6 months, retention in treatment was high: 89% in PWID continuing OAT in specialty addiction treatment settings (standard of care) vs 94% in PWID transitioning to PHCs; and 80% among PWID newly initiating OAT in PHCs. Overall, satisfaction with treatment, subjective self-perception of well-being, and trust in physician significantly increased in patients prescribed OAT in PHCs. Among PHC staff, attitudes towards PWID and HIV patients significantly improved over time.

Conclusions: OAT can be successfully integrated into primary care in low and middle-income countries and improves outcomes in both patients and clinicians while potentially scaling-up OAT for PWID.

Keywords: HIV/AIDS; Integrated care; Methadone; Patient preferences; Primary care; Retention; Ukraine.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest

None.

Figures

Fig. 1
Fig. 1
Demographics and Treatment Retention for the Observational Cohort of Opioid Agonist Treatment Patients.
Fig. 2
Fig. 2
Changes in Primary Care Medical Staff Attitudes Toward the Three Types of Patients.
See this image and copyright information in PMC

References

    1. Altice FL, Kamarulzaman A, Soriano VV, Schechter M, Friedland GH. Treatment of medical, psychiatric, and substance-use comorbidities in people infected with HIV who use drugs. Lancet. 2010;376:367–387. - PMC - PubMed
    1. Altice FL, Bruce RD, Lucas GM, Lum PJ, Korthuis PT, Flanigan TP, Cunningham CO, Sullivan LE, Vergara-Rodriguez P, Fiellin DA, Cajina A, Botsko M, Nandi V, Gourevitch MN, Finkelstein R Collaborative B. HIV treatment outcomes among HIV-infected, opioid-dependent patients receiving buprenorphine/naloxone treatment within HIV clinical care settings: results from a multisite study. J. Acquir. Immune Defic. Syndr. 2011;56(Suppl. 1): S22–S32. - PMC - PubMed
    1. Alwin DF. Feeling thermometers versus 7-point scales – which are better? Soc. Method Res. 1997;25:318–340.
    1. Anderson LA, Dedrick RF. Development of the Trust in Physician scale: a measure to assess interpersonal trust in patient-physician relationships. Psychol. Rep. 1990;67:1091–1100. - PubMed
    1. Arora S, Thornton K, Murata G, Deming P, Kalishman S, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N. Engl. J. Med. 2011;364(23):2199–2207. - PMC - PubMed

Publication types

MeSH terms