Leveraging existing provider networks in Europe to eliminate barriers to accessing opioid agonist maintenance therapies for Ukrainian refugees.
Leveraging existing provider networks in Europe to eliminate barriers to accessing opioid agonist maintenance therapies for Ukrainian refugees.
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DOI：
10.1371/journal.pgph.0002168
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发表时间：
2023
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俄罗斯入侵乌克兰引发了一场严重的难民危机，特别是对中欧和东欧的影响。乌克兰是欧洲阿片类药物使用障碍（OUD）流行率最高的国家之一，这增加了由于注射吸毒而传播艾滋病毒的风险。阿片类激动剂维持治疗（OAMT）是OUD和预防HIV传播的金标准治疗。在乌克兰流离失所并以前依靠OAMT维持的难民需要可靠的护理连续性，但OAMT往往受到高度管制，难以获得。使用实施科学透镜，我们试图了解可能阻碍OAMT连续性的障碍和促进因素。我们进行了23个半结构化的访谈与OUD和OAMT和减少伤害的供应商流离失所的患者。访谈参与者被有目的地抽样，包括来自受影响最严重的国家的个人：波兰，德国，捷克，斯洛伐克，罗马尼亚和匈牙利。访谈的重点是现有的供应商网络和OAMT难民在流离失所期间面临的障碍。虽然存在网络，但提供者与非政府组织等主要利益攸关方之间在克服障碍方面很少合作。此外，没有利用现有的正式网络迅速解决问题。我们发现，尽管现有的网络，供应商遇到了巨大的障碍，成功地协调访问和保留OAMT的难民。由于提供者之间的协调没有得到充分利用，诊所经常因能力不足、语言障碍和财务覆盖问题而拒绝病人。在波兰和德国等较大的国家，诊所的地理分布有限，进一步阻碍了难民获得和继续接受治疗。为了支持各国和提供者应对迅速演变的危机，可以部署协作学习与改善成瘾治疗网络模式所使用的快速周期变化项目相结合，以促进国家和整个欧洲联盟提供者之间的合作，以指导OAMT的连续性。
Russia’s invasion of Ukraine caused a major refugee crisis, particularly impacting Central and Eastern Europe. Ukraine has one of the highest prevalence rates of opioid use disorder (OUD) in Europe, which increases the risk of HIV spread due to injection drug use. Opioid agonist maintenance therapies (OAMT) are a gold standard treatment for OUD and the prevention of HIV spread. Refugees who were displaced and previously maintained on OAMT in Ukraine require reliable care continuity, but OAMT is often highly regulated making it difficult to access. Using an implementation science lens, we sought to understand the barriers and facilitators that might impede OAMT continuity. We performed 23 semi-structured interviews with displaced patients with OUD and providers of OAMT and harm reduction. Interview participants were purposively sampled to include individuals from the highest-impacted countries: Poland, Germany, Czechia, Slovakia, Romania, and Hungary. Interviews focused on existing provider networks and barriers that refugees on OAMT faced during displacement. Though networks existed, there was little collaboration between providers and key stakeholders, such as NGOs, in overcoming barriers. Moreover, existing formal networks were not leveraged for rapid problem-solving. We found that despite existing networks, providers encountered substantial barriers to successfully coordinating access and retention in OAMT for refugees. Owing to insufficiently leveraged coordination between providers, clinics frequently turned patients away due to insufficient capacity, language barriers, and financial coverage issues. The limited geographic distribution of clinics in larger countries, such as Poland and Germany, further inhibited refugees from accessing and remaining on treatment. To support countries and providers in responding to a rapidly evolving crisis, collaborative learning combined with rapid cycle change projects used by the Network for the Improvement of Addiction Treatment (NIATx) model could be deployed to promote collaboration between providers both nationally and throughout the European Union to guide continuity of OAMT.