Opioid Agonist Treatment and Improved Outcomes at Each Stage of the HIV Treatment Cascade in People Who Inject Drugs in Ukraine
Opioid Agonist Treatment and Improved Outcomes at Each Stage of the HIV Treatment Cascade in People Who Inject Drugs in Ukraine
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DOI：
10.1097/qai.0000000000001827
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发表时间：
2018-11-01
影响因子：
3.6
通讯作者：
Altice, Frederick L.
中科院分区：
文献类型：
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作者：
Mazhnaya, Alyona;Marcus, Ruthanne;Altice, Frederick L.
背景：艾滋病毒治疗级联是指导艾滋病毒预防和治疗策略的重要工具。美沙酮和丁丙诺啡等阿片类激动剂治疗 (OAT) 对这一级联反应的影响程度在一项针对乌克兰注射吸毒者 (PWID) 的全国性研究中得到了检验。背景：对注射吸毒者进行横断面分层调查，然后在乌克兰 5 个城市进行艾滋病毒和丙型肝炎病毒检测。方法：从 2014 年 1 月至 3 月对阿片类药物依赖型注射吸毒者 (N = 1613) 进行抽样调查2015 年。分析仅限于 520 名 HIV 感染者，其中 184 名 (35.4%) 服用了 OAT。使用加权逻辑回归模型来评估与 HIV 治疗级联中 5 个步骤相关的独立因素。结果：与未服用 OAT 的注射吸毒者 (N = 336) 相比，服用 OAT 的参与者 (N = 184) 被诊断（91% vs. 71%）、关联（81% vs. 52%）和保留（69% vs. 35%）接受 HIV 护理和处方（56% vs. 56%）的可能性显着更高。 31%）和最佳（>95%的剂量）坚持抗逆转录病毒治疗（41% vs. 22%）。接收 OAT 作为级联每一步的独立因素贡献最大。 HIV 治疗级联中的其他步骤受到年龄、抑郁症和地域差异的影响。结论：OAT 仍然是一种重要且有效的策略，不仅可以治疗阿片类药物使用障碍患者，而且也是让吸毒者参与护理以实现 UNAIDS 90-90-90 目标的关键策略。地理差异表明了当地的结构性障碍。乌克兰估计有 347,000 名吸毒者，其中 2.9% 的 OAT 覆盖率较低，因此 OAT 的扩张需要针对个人、临床护理环境、政策和资金的战略干预措施。
Background: The HIV treatment cascade is a crucial tool to guide HIV prevention and treatment strategies. The extent to which opioid agonist treatments (OATs) such as methadone and buprenorphine influence this cascade was examined in a nationwide study of people who inject drugs (PWID) in Ukraine.Setting: Cross-sectional stratified survey of PWID followed by HIV and hepatitis C virus testing in 5 Ukrainian cities.Methods: Opioid-dependent PWID (N = 1613) were sampled from January 2014 to March 2015. Analysis was confined to 520 participants with HIV, with 184 (35.4%) prescribed OAT. Weighted logistic regression models were used to assess independent factors associated with the 5 steps in the HIV treatment cascade.Results: Compared with PWID not on OAT (N = 336), participants who prescribed OAT (N = 184) were significantly more likely to be diagnosed (91% vs. 71%), linked (81% vs. 52%), and retained (69% vs. 35%) in HIV care, and prescribed (56% vs. 31%) and optimally (>95% of doses) adherent to antiretroviral therapy (41% vs. 22%). Receiving OAT contributed most as an independent factor with every step of the cascade. Other steps in the HIV treatment cascade were influenced by age, depression, and geographical variability.Conclusions: OAT remains an essential and effective strategy to not only treat patients with opioid use disorder, but also a crucial strategy to engage PWID in care to meet UNAIDS 90-90-90 targets. Geographical differences suggest local structural impediments. With low OAT coverage prescribed for 2.9% of the estimated 347,000 PWID in Ukraine, OAT expansion requires strategic interventions that target the individual, clinical care settings, policies, and funding.