title: Key findings from the WHO collaborative study on substitution therapy for opioid dependence and HIV/AIDS.
abstract: OBJECTIVE
  Opioid substitution treatment has been studied extensively in industrialized countries, but there are relatively few studies in developing/transitional countries. The aim of this study was to examine the effectiveness of opioid substitution treatment (OST) in less resourced countries.
  
  
  METHODS
  Longitudinal cohort study.
  
  
  METHODS
  Purposively selected OST sites in Asia (China, Indonesia, Thailand), Eastern Europe (Lithuania, Poland, Ukraine), the Middle East (Iran) and Australia.
  
  
  METHODS
  Seven hundred and twenty-six OST entrants.
  
  
  METHODS
  Participants were interviewed at treatment entry, 3 and 6 months. Standardized instruments assessed drug use, treatment history, physical and psychological health, quality of life, criminal involvement, blood-borne virus (BBV) risk behaviours and prevalence of human immunodeficiency virus (HIV) and hepatitis C.
  
  
  RESULTS
  Participants were predominantly male, aged in their early 30s and had attained similar levels of education. Seroprevalence rates for HIV were highest in Thailand (52%), followed by Indonesia (28%) and Iran (26%), and lowest in Australia (2.6%). Treatment retention at 6 months was uniformly high, averaging approximately 70%. All countries demonstrated significant and marked reductions in reported heroin and other illicit opioid use; HIV (and other BBV) exposure risk behaviours associated with injection drug users (IDU) and criminal activity, and demonstrated substantial improvement in their physical and mental health and general wellbeing over the course of the study.
  
  
  CONCLUSIONS
  OST can achieve similar outcomes consistently in a culturally diverse range of settings in low- and middle-income countries to those reported widely in high-income countries. It is associated with a substantial reduction in HIV exposure risk associated with IDU across nearly all the countries. Results support the expansion of opioid substitution treatment.
authors.affiliation: Discipline of Pharmacology, The University of Adelaide, World Health Organization Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems, Medical School South, Adelaide, SA 5005, Australia. peter.lawrinson@adelaide.edu.au
authors.forename: Peter
authors.initials: P
authors.lastname: Lawrinson
authors.forename: Robert
authors.initials: R
authors.lastname: Ali
authors.forename: Aumphornpun
authors.initials: A
authors.lastname: Buavirat
authors.forename: Sithisat
authors.initials: S
authors.lastname: Chiamwongpaet
authors.forename: Sergey
authors.initials: S
authors.lastname: Dvoryak
authors.forename: Boguslaw
authors.initials: B
authors.lastname: Habrat
authors.forename: Shi
authors.initials: S
authors.lastname: Jie
authors.forename: Ratna
authors.initials: R
authors.lastname: Mardiati
authors.forename: Azarakhsh
authors.initials: A
authors.lastname: Mokri
authors.forename: Jacek
authors.initials: J
authors.lastname: Moskalewicz
authors.forename: David
authors.initials: D
authors.lastname: Newcombe
authors.forename: Vladimir
authors.initials: V
authors.lastname: Poznyak
authors.forename: Emilis
authors.initials: E
authors.lastname: Subata
authors.forename: Ambrose
authors.initials: A
authors.lastname: Uchtenhagen
authors.forename: Diah S
authors.initials: DS
authors.lastname: Utami
authors.forename: Robyn
authors.initials: R
authors.lastname: Vial
authors.forename: Chengzheng
authors.initials: C
authors.lastname: Zhao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002047:Buprenorphine / Q000008:administration & dosage*; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage*; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage*; D009293:Opioid-Related Disorders / Q000150:complications / Q000534:rehabilitation*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D009294:Narcotics; D002047:Buprenorphine; D008691:Methadone