The role of access to integrated services at opioid agonist treatment sites in reaching 90-90-90 cascade in people who inject drugs in Ukraine: Country-level data. (1st November 2020)

• Record Type: Journal Article
• Authors: Meteliuk, Anna; Prokhorova, Tetiana; Filippovych, Sergii; Ompad, Danielle C.; Zaller, Nickolas
• Is Part Of: Drug and alcohol dependence. Volume 216(2020)
• Publication Date: 2020-11-01
• Subjects: People who inject drugs (PWID) -- HIV -- HIV care cascade -- Opioid agonist treatment (OAT) -- Ukraine; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2020.108216
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: All HIV + OAT patients were aware of their HIV status. Only 42 % of PWID not on OAT are aware of their HIV status. OAT/HIV integrated care sites had more patients on ART than OAT only sites. More OAT/HIV integrated care patients were virally suppressed than OAT only patients. Higher OAT dosages were associated with ART prescription and viral suppression. Abstract: Introduction: Opioid agonist treatment (OAT) is an effective means to prevent HIV transmission. Ukraine started integrating HIV services into OAT sites to improve people who inject drugs' (PWID) access to treatment. Methods: Data from the national registry of OAT patients (n = 9, 983) were analyzed. These data are collected from all 179 OAT sites countrywide. For the cascade, HIV-positive OAT patients (n = 4, 084) were stratified into two categories: OAT alone (received OAT at one site and antiretroviral therapy (ART) at different location, n = 1, 789) and integrated care (received OAT and ART at one location, n = 2, 295) for comparison. Results: Most HIV-positive OAT patients in Ukraine are male (85.6 %) and the mean age is 40.3 years old. The mean length of injecting before OAT is 17.2 years and the mean length on OAT is 4.2 years. All HIV-positive OAT clients are aware of their HIV status. The proportion of HIV-positive clients receiving ART was higher at integrated care sites compared to OAT alone sites (84.2 vs. 73.1 %, p- = 0.012); distribution of viral suppression among those receiving ART across the strata were 79.4 and 59.2 % for 'integrated care sites' vs. 'OAT only sites' respectively (p < 0.001). Conclusions: This analysis clearly demonstrates much better progress towards the 90−90-90 goals among those OAT patients who receive integrated care services (both OAT and ART) at one site at each stage of the HIV care cascade as compared to receiving OAT and ART at different sites. There is an urgent need to further expand the integration of OAT and HIV services in Ukraine.