HIV treatment access and scale-up for delivery of opiate substitution therapy with buprenorphine for IDUs in Ukraine - programme description and policy implications
HIV treatment access and scale-up for delivery of opiate substitution therapy with buprenorphine for IDUs in Ukraine - programme description and policy implications
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DOI：
10.1016/j.drugpo.2006.12.011
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发表时间：
2007-08-01
影响因子：
4.4
通讯作者：
Altice, Frederick L.
中科院分区：
文献类型：
--
作者：
Bruce, R. Douglas;Dvoryak, Sergey;Altice, Frederick L.
背景：注射吸毒（IDU）占乌克兰艾滋病毒病例的70%。在引入丁丙诺啡维持疗法（BMT）之前，很少有旨在减少非法药物使用的有效战略可作为注射吸毒者抗逆转录病毒治疗（ARV）的渠道。2005年10月，利用全球基金资源在乌克兰的六个地区扩大了BMT的规模。入组标准包括阿片类药物依赖，HIV-1血清阳性，年龄bb0 = 18岁，报告对BMT有兴趣。所有地点都包括一个多学科小组。迄今为止，已有207名患者开始接受BMT治疗。经验教训：现有的基础设施允许进一步扩大和管理BMT以及与ARV共同管理的可能性。丁丙诺啡和抗逆转录病毒药物的处方和施用过程有时十分繁琐，而且受到现行法规的限制。建议：更多的IDU需要BMT来改善整体健康结果。扩大获取的核心将是对现有药物政策进行立法改革。此外，丁丙诺啡的价格贵得令人望而却步。乌克兰的可持续替代疗法要求降低丁丙诺啡、美沙酮的谈判价格，或在现有的艾滋病毒阳性吸毒者处方中加入这两种价格。(C) 2006 Elsevier B.V.版权所有
Background: Injection drug use (IDU) accounts for 70 percent of HIV cases in Ukraine. Until buprenorphine maintenance therapy (BMT) was introduced, few effective strategies aimed at achieving reduction in illicit drug use were available as a conduit to anti-retroviral therapy (ARV) among IDUs.Description: In October 2005, BMT was scaled-up using Global Fund resources in six regions within Ukraine. Entry criteria included opioid dependence, HIV-1 seropositivity, age >= 18 years and reported interest in BMT. All sites included a multidisciplinary team. To date, 207 patients have been initiated on BMT.Lessons learned: The existing infrastructure allows for further scale-up of and administration of BMT and the possibility of co-administration with ARV. The process for prescription and administration of buprenorphine and ARV is at times cumbersome and constrained by current regulations.Recommendations: More IDU need BMT to improve overall health outcomes. Central to expanding access will be legislative changes to existing drug policy. Moreover, the cost of buprenorphine is prohibitively expensive. Sustainable substitution therapy in Ukraine requires lower negotiated prices for buprenorphine, the addition of methadone, or both to the existing formulary for HIV+ drug users. (C) 2006 Elsevier B.V. All rights reserved.