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Opioid Substitution Therapy (OST) with buprenorphine in Ukraine – way to prevent HIV/AIDS among IDUs
Presented by Sergii Dvoriak, Ukraine.
Dvoriak S.1
1Ukrainian Institute on Public Health Policy, Research, Kyiv, Ukraine
Objectives: Ukraine still is an epicenter of HIV epidemic in Eastern Europe. IDUs accounts for 70% of HIV cases. OST was unavailable in Ukraine until 2004 and still is at issue.Buprenorphine is only medication which available for OST in the country.
The purpose of the study to confirm an idea that OST is effective measure for HIV prevention and expansion of ARV therapy among IDUs.
Methods: The National buprenorphine maintenance therapy project began in October 2005 and this study details lessons learned over the first 16 months. There are 525 patients on BMT. Approximately 65% are HIV-infected with approximately 25% of them on ARVs. Addiction Severity Index (ASI), Blood Born Virus Assessment Questionnaires (BBV-Traq) and WHO Qality of Life Questionnaire were used for evaluation of effectiveness of treatment.
Results: It was proved BMT improves retention in drug treatment and linkage to health care to improve overall health outcomes. After 6 months, retention is approximately 70%. Average score of drug use by ASI at baseline was 0.3238±0.1208 and in 6 months – 0.0944±0.0866. Injection behavior according to BBV-Traq at baseline was – 12,8±14,5 and in 6 month 0,7±4,9. Additionally, clients have experienced other personal successes: weight gain, improvements in interpersonal relationships, obtaining and keeping employment.
Individuals on ARV-therapy demonstrated higher level of retention in BMT. There were no remarkable interactions between ARV medications and buprenorphine.
Conclusions: BMT in Ukraine, with high levels of retention in treatment and dramatic decreasing of injection behavior, remains promising. There is obvious necessity for expansion of OST to allow GPs to be allowed to prescribe buprenorphine. Additionally, the availability of methadone must be addressed. Both are desperately needed if OST is to expand from 525 to 6,000 by the end of 2007 and, most importantly, the estimated goal of 60,000 necessary to impact the HIV epidemic in Ukraine.
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