title: Methadone maintenance for HIV positive and HIV negative patients in Kyiv: acceptability and treatment response.
abstract: BACKGROUND
  With up to 40% of opioid injectors infected with HIV, Ukraine has one of the most concentrated HIV epidemics in the world, mainly due to unsterile injection practices and a historical absence of effective prevention services. Harm reduction programs, including syringe exchange and a small buprenorphine treatment program, were introduced in 2004 and methadone maintenance was allowed in 2007. Despite an initial expansion, by 2009, only 3221 injectors were receiving methadone treatment. A growing body of research on methadone maintenance has found high retention rates with reduction in opioid use and HIV risk behaviors. We report on the acceptability and initial outcome of methadone treatment as a function of HIV status, an issue that has not yet been reported for injectors in Ukraine.
  
  
  METHODS
  Longitudinal observational study of a 12-week course of methadone treatment in 25 HIV+ and 25 HIV- opioid addicted individuals recruited from a harm reduction program and the city AIDS Center. Drug use and HIV risk were assessed at baseline and weeks 4, 8, 12 and 20; all patients were offered continued methadone maintenance in the Kyiv city program at the end of 12 weeks.
  
  
  RESULTS
  Fifty-four individuals were asked if they were interested in the study and 50, demographically similar to other samples of opioid addicted Ukrainians, agreed to participate. Two died of non-study related causes; the other 48 completed assessments at weeks 4, 8 and 12, and 47 completed followups at week 20. Significant reductions were seen in use of heroin (p<0.0001), other opiates/analgesics (p<0.0001), and HIV risk behaviors (drug, sex, total; all p<0.0001). All 48 patients chose to continue methadone after the 12-weeks of study medication ended. Unlike most opioid treatment studies, sexual risk was somewhat higher than injecting risk at study intake.
  
  
  CONCLUSIONS
  Methadone maintenance was well accepted by HIV+ and HIV- opioid dependent individuals and has the potential for significant public health impact if made more widely available with sustained access and support.
authors.affiliation: Director, Ukrainian Institute of Public Health Policy, 4 Malopidvalna Str. Of. 6 Kyiv, 01001 Kyiv, Ukraine.
authors.forename: Sergii
authors.initials: S
authors.lastname: Dvoriak
authors.affiliation: Department of Psychiatry and Drug Abuse, O.O. Bogomolets National Medical University, 34, Peremogy Avenue, 01601 Kyiv, Ukraine.
authors.forename: Andrey
authors.initials: A
authors.lastname: Karachevsky
authors.affiliation: Treatment Research Institute, Suite 600, 150 South Independence Mall (W), Philadelphia, PA 19106, United States.
authors.forename: Sumedha
authors.initials: S
authors.lastname: Chhatre
authors.affiliation: Department of Psychiatry, University of Colorado, 1741 Vine Street, Denver, CO 80206, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Booth
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania and Treatment Research Institute, Suite 600, 150 South Independence Mall (W), Philadelphia, PA 19106, United States.
authors.forename: David
authors.initials: D
authors.lastname: Metzger
authors.affiliation: School of Medicine, University of Alabama, 1530 3rd Avenue South, Birmingham, AL, United States.
authors.forename: Joseph
authors.initials: J
authors.lastname: Schumacher
authors.affiliation: Department of Veterans Affairs Medical Center, 39th & Woodland Avenues, Philadelphia, PA 19104, United States.
authors.forename: Nina
authors.initials: N
authors.lastname: Chychula
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania and Treatment Research Institute, Suite 600, 150 South Independence Mall (W), Philadelphia, PA 19106, United States.
authors.forename: Anna
authors.initials: A
authors.lastname: Pecoraro
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania and Treatment Research Institute, Suite 600, 150 South Independence Mall (W), Philadelphia, PA 19106, United States. Electronic address: woody@tresearch.org.
authors.forename: George
authors.initials: G
authors.lastname: Woody
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008691:Methadone / Q000008:administration & dosage*; D058850:Opiate Substitution Treatment / Q000523:psychology* / Q000639:trends; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D016896:Treatment Outcome; D014455:Ukraine / Q000453:epidemiology
chemical_list: D008691:Methadone
keywords: HIV risk; Methadone maintenance; PWID; Ukraine