title: "Bureaucracy & Beliefs": Assessing the Barriers to Accessing Opioid Substitution Therapy by People Who Inject Drugs in Ukraine.
abstract: OBJECTIVE
  Opioid substitution therapy (OST) is an evidence-based HIV prevention strategy for people who inject drugs (PWIDs). Yet, only 2.7% of Ukraine's estimated 310,000 PWIDs receive it despite free treatment since 2004. The multi-level barriers to entering OST among opioid dependent PWIDs have not been examined in Ukraine.
  
  
  METHODS
  A multi-year mixed methods implementation science project included focus group discussions with 199 PWIDs in 5 major Ukrainian cities in 2013 covering drug treatment attitudes and beliefs and knowledge of and experiences with OST. Data were transcribed, translated into English and coded. Coded segments related to OST access, entry, knowledge, beliefs and attitudes were analyzed among 41 PWIDs who were eligible for but had never received OST.
  
  
  RESULTS
  A number of programmatic and structural barriers were mentioned by participants as barriers to entry to OST, including compulsory drug user registration, waiting lists, and limited number of treatment slots. Participants also voiced strong negative attitudes and beliefs about OST, especially methadone. Their perceptions about methadone's side effects as well as the stigma of being a methadone client were expressed as obstacles to treatment.
  
  
  CONCLUSIONS
  Despite expressed interest in treatment, Ukrainian OST-naïve PWIDs evade OST for reasons that can be addressed through changes in program-level and governmental policies and social-marketing campaigns. Voiced OST barriers can effectively inform public health and policy directives related to HIV prevention and treatment in Ukraine to improve evidence-based treatment access and availability.
authors.affiliation: Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, USA.
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Bojko
authors.affiliation: ICF International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine.
authors.forename: Alyona
authors.initials: A
authors.lastname: Mazhnaya
authors.affiliation: Ukrainian Institute for Public Health Policy, Kyiv, Ukraine.
authors.forename: Iuliia
authors.initials: I
authors.lastname: Makarenko
authors.affiliation: Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, USA.
authors.forename: Ruthanne
authors.initials: R
authors.lastname: Marcus
authors.affiliation: Ukrainian Institute for Public Health Policy, Kyiv, Ukraine.
authors.forename: Sergii
authors.initials: S
authors.lastname: Dvoriak
authors.affiliation: ICF International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine.
authors.forename: Zahedul
authors.initials: Z
authors.lastname: Islam
authors.affiliation: Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, USA; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, Connecticut, USA.
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
keywords: Substance abuse; Ukraine; buprenorphine; health beliefs; methadone; opioid substitution therapy; people who inject drugs; qualitative research; treatment barriers