Assessment of barrier severity and willingness to enter opioid agonist treatment among people who inject drugs in Ukraine. (1st September 2018)

• Record Type: Journal Article
• Authors: Zelenev, Alexei; Shea, Portia; Mazhnaya, Alyona; Rozanova, Julia; Madden, Lynn; Marcus, Ruthanne; Altice, Frederick L.
• Is Part Of: Drug and alcohol dependence. Volume 190(2018)
• Page Start: 82
• Page End: 88
• Publication Date: 2018-09-01
• Subjects: Addiction -- Opioid agonist treatment -- People who inject drugs -- Opioid substitution treatment -- Barriers to entry;; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2018.05.027
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Barriers to opioid agonist treatment entry tend to be cumulative and interrelated. Concerns over tolerability, safety + efficacy comprise the most prevalent barriers. Social stigma is the least prevalent, but likely to coincide with other barriers. Resistance to treatment is related to education, incarceration and overdose history. Analysis of barrier interlinkage can improve the rate of treatment expansion. Abstract: Background: Opioid agonist therapies (OAT) in Ukraine were first introduced in 2004 not as addiction treatment, but for HIV prevention. Numerous obstacles have thwarted OAT scale-up, including individual constraints and structural barriers. Methods: A cross-sectional survey of 1613 opioid dependent people who inject drugs (PWID) were recruited in 2014–2015 using stratified sampling in Kyiv, Odesa, Mykolayiv, Dnipro and Lviv. Analysis was restricted to a subset of 811 PWID who never received OAT. Barriers to OAT were assessed based on reasons why study participants were reluctant to enroll into OAT. A Rasch model from the Item Response Theory was applied to 24 potential barriers, used to score their severity and estimate a latent composite measure for each person's willingness and ability to participate in OAT. Results: The Rasch model confirmed the cumulative nature of barriers with concerns over treatment efficacy, safety and tolerability being more prevalent than barriers related to logistical constraints, opportunity costs and social stigma. If barriers related to treatment perception and logistics were eliminated, the average barrier number would decrease from 10 to 2.2. Participants were more likely to have a higher resistance to OAT entry if they experienced fewer overdoses, did not attain higher education, were not previously incarcerated and if their peers did not have a higher level of resistance to OAT. Conclusions: Understanding the interdependence of various barriers and attitudes toward OAT can improve the rate of OAT expansion and ameliorate entry into substance abuse treatment programs in Ukraine.