title: The Future of Opioid Agonist Therapies in Ukraine: A Qualitative Assessment of Multilevel Barriers and Ways Forward to Promote Retention in Treatment.
abstract: Opioid agonist therapies (OAT) to treat opioid addiction in people who inject drugs (PWID) began in Ukraine in 2004. Scale-up of OAT, however, has been hampered by both low enrollment and high attrition. To better understand the factors influencing OAT retention among PWID in Ukraine, qualitative data from 199 PWIDs were collected during 25 focus groups conducted in five Ukrainian cities from February to April 2013. The experiences of PWID who were currently or previously on OAT or currently trying to access OAT were analyzed to identify entry and retention barriers encountered. Transcribed data were analyzed using a grounded theory approach. Individual beliefs about OAT, particularly misaligned treatment goals between clients and providers, influenced PWID's treatment seeking behaviors. Multiple programmatic and structural issues, including inconvenient hours and treatment site locations, complicated dosing regimens, inflexible medication dispensing guidelines, and mistreatment by clinic and medical staff also strongly influenced OAT retention. Findings suggest the need for both programmatic and policy-level structural changes such as revising legal regulations covering OAT dispensing, formalizing prescription dosing policies and making OAT more available through other sites, including primary care settings as a way to improve treatment retention. Quality improvement interventions that target treatment settings could also be deployed to overcome healthcare delivery barriers. Additional patient education and medical professional development around establishing realistic treatment goals as well as community awareness campaigns that address the myths and fears associated with OAT can be leveraged to overcome individual, family and community-level barriers.
authors.affiliation: Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA. Electronic address: martha.bojko@yale.edu.
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Bojko
authors.affiliation: ICF Alliance for Public Health, Kyiv, Ukraine.
authors.forename: Alyona
authors.initials: A
authors.lastname: Mazhnaya
authors.affiliation: Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
authors.forename: Ruthanne
authors.initials: R
authors.lastname: Marcus
authors.affiliation: ICF Alliance for Public Health, Kyiv, Ukraine.
authors.forename: Iuliia
authors.initials: I
authors.lastname: Makarenko
authors.affiliation: Management Sciences for Health, Dhaka, Bangladesh.
authors.forename: Zahedul
authors.initials: Z
authors.lastname: Islam
authors.affiliation: ICF Alliance for Public Health, Kyiv, Ukraine.
authors.forename: Sergey
authors.initials: S
authors.lastname: Filippovych
authors.affiliation: Ukrainian Institute on Public Health Policy, Kyiv, Ukraine.
authors.forename: Sergii
authors.initials: S
authors.lastname: Dvoriak
authors.affiliation: Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA; Centre of Excellence on Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D003695:Delivery of Health Care / Q000592:standards; D005260:Female; D017144:Focus Groups; D066296:Grounded Theory; D006801:Humans; D008297:Male; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D010342:Patient Acceptance of Health Care / Q000523:psychology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D058996:Quality Improvement; D015819:Substance Abuse, Intravenous / Q000188:drug therapy*; D014455:Ukraine
chemical_list: D000701:Analgesics, Opioid
keywords: Addiction treatment retention; Buprenorphine; HIV prevention; Implementation science; Methadone; Ukraine