Preferences and decisional considerations relating to opioid agonist therapy among Ukrainian people who use drugs: A conjoint analysis survey.
Preferences and decisional considerations relating to opioid agonist therapy among Ukrainian people who use drugs: A conjoint analysis survey.
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DOI：
10.1371/journal.pgph.0002725
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发表时间：
2024
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扩大阿片类激动剂疗法是控制艾滋病毒和阿片类药物混合流行的最有效战略，特别是在艾滋病毒发病率和死亡率持续上升的东欧和中亚。然而，患者对燕麦片的担忧破坏了扩大规模。本研究的目的是了解乌克兰阿片使用障碍患者对燕麦片的偏好，以指导临床决策的循证决策辅助工具的开发。我们进行了基于联合选择(CBC)的调查。参与者被问及他们对燕麦片的7个属性(成本、剂量频率、对戒断症状的担忧、不良副作用、生活质量的改善、戒断的沉淀和登记为药物依赖者的立法要求)以及在不同潜在治疗限制下接受燕麦片的20个属性水平的偏好。使用分层贝叶斯模型对数据进行分析。采用受访者驱动抽样和随机抽样，我们招募了2028名注射阿片类药物使用障碍的人。使用相对重要性(RIS)和部分价值效用分数(PWUS)来评估对属性的偏好和每个属性内的阈值。费用和用药频率是潜在患者最重要的因素(RIS=39.2%和RIS=25.2%)，其次是对戒断症状(RIS=10.8%)、不良反应(RIS=9.0%)、生活质量改善(RIS=7.5%)、快感消失(5.2%)和要求登记为药物依赖者(RIS=3.1%)的担忧。每月支付意愿的费用门槛是1900 Uah(70美元)。在乌克兰，政府和私人燕麦片诊所都出现了，提供了截然不同的提供策略，尽管许多患者愿意为燕麦片付费，但人们的偏好主要是由自付费用驱动的。程序性需求(药物的灵活性和易得性)仍然是一个重要的考虑因素，而对于少数人来说，对戒断症状、不良副作用和燕麦片对生活影响的临床担忧起到的作用较小。
Scaling up opioid agonist therapies (OAT) is the most effective strategy to control combined HIV and opioid epidemics, especially in Eastern Europe and Central Asia (EECA), where HIV incidence and mortality continue to increase. Patient concerns about OAT, however, have undermined scale-up. The objective of this study is to understand Ukrainian opioid use disorder patient preferences about OAT to guide the development of an evidence-informed decision aid for clinical decision-making. We conducted a conjoint-based choice (CBC) survey. Participants were asked to about their preferences relating to 7 attributes of OAT (cost, dosing frequency, concerns about withdrawal symptoms, adverse side effects, improvements in quality of life, precipitation of withdrawal and legislative requirements to be registered as a drug dependent person) and 20 attribute levels for receiving OAT under differing potential treatment constraints. Data were analyzed using Hierarchical Bayesian models. Using respondent-driven sampling and random sampling, we recruited 2,028 people who inject drugs with opioid use disorder. Relative importance (RIS) and partial-worth utility scores (PWUS) were used to assess preferences for attributes and thresholds within each attribute. Cost and dosing frequency were the most important attributes (RIS = 39.2% and RIS = 25.2%, respectively) to potential patients, followed by concerns about withdrawal symptoms (RIS = 10.8%), adverse side effects (RIS = 9.0%), quality-of-life improvement (RIS = 7.5%), precipitation of euphoria (5.2%) and requirement to be registered as a drug- dependent person (RIS = 3.1%). The monthly cost-threshold for willingness-to-pay was 1,900 UAH ($70 USD). In Ukraine, where both governmental and private OAT clinics have emerged and provide markedly different delivery strategies, preferences are mostly driven by out-of-pocket expenses, despite many patients being willing to pay for OAT. Programmatic demands (flexibility and ease of acquiring medications) remain an important consideration while for a minority, clinical concerns about withdrawal symptoms, adverse side effects and OAT impact on life play a smaller role.