Key findings from the WHO collaborative study on substitution therapy for opioid dependence and HIV/AIDS.
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.
Lawrinson
Peter
P
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
Ali
Robert
R
Buavirat
Aumphornpun
A
Chiamwongpaet
Sithisat
S
Dvoryak
Sergey
S
Habrat
Boguslaw
B
Jie
Shi
S
Mardiati
Ratna
R
Mokri
Azarakhsh
A
Moskalewicz
Jacek
J
Newcombe
David
D
Poznyak
Vladimir
V
Subata
Emilis
E
Uchtenhagen
Ambrose
A
Utami
Diah S
DS
Vial
Robyn
R
Zhao
Chengzheng
C
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
D009294:Narcotics; D002047:Buprenorphine; D008691:Methadone