"Bureaucracy & Beliefs": Assessing the Barriers to Accessing Opioid Substitution Therapy by People Who Inject Drugs in Ukraine.
"Bureaucracy & Beliefs": Assessing the Barriers to Accessing Opioid Substitution Therapy by People Who Inject Drugs in Ukraine.
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DOI：
10.3109/09687637.2015.1016397
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Altice FL
中科院分区：
文献类型：
--
作者：
Bojko MJ;Mazhnaya A;Makarenko I;Marcus R;Dvoriak S;Islam Z;Altice FL
阿片类药物替代疗法（OST）是一种针对注射吸毒者（PWID）的循证艾滋病毒预防策略。然而，尽管自2004年以来提供了免费治疗，但在乌克兰估计的31万名残疾人中，只有2.7%的人得到了治疗。在乌克兰，尚未审查阿片依赖性残疾人进入阿片类药物治疗的多层次障碍。一个多年期混合方法实施科学项目包括2013年与乌克兰5个主要城市的199名艾滋病毒感染者进行的重点小组讨论，内容涉及药物治疗态度和信念以及对开放源码软件的了解和经验。将数据转录、翻译成英文并编码。在41名有资格但从未接受过OST的PWID中分析了与OST访问、进入、知识、信仰和态度相关的编码段。与会者提到了一些方案性和结构性障碍，包括强制性吸毒者登记、等候名单和治疗名额有限等，这些都是进入开放源码软件的障碍。与会者还表达了对OST，特别是美沙酮的强烈负面态度和信念。他们对美沙酮副作用的看法以及作为美沙酮客户的耻辱表示为治疗的障碍。尽管对治疗表示出兴趣，但乌克兰未接受过OST的PWID由于可以通过改变方案一级和政府政策以及社会营销活动来解决的原因而逃避OST。公开的OST障碍可以有效地告知乌克兰与艾滋病毒预防和治疗有关的公共卫生和政策指令，以改善循证治疗的获得和提供。
Opioid substitution therapy (OST) is an evidence-based HIV prevention strategy for people who inject drugs (PWIDs). Yet, only 2.7% of Ukraine’s estimated 310,000 PWIDs receive it despite free treatment since 2004. The multi-level barriers to entering OST among opioid dependent PWIDs have not been examined in Ukraine. A multi-year mixed methods implementation science project included focus group discussions with 199 PWIDs in 5 major Ukrainian cities in 2013 covering drug treatment attitudes and beliefs and knowledge of and experiences with OST. Data were transcribed, translated into English and coded. Coded segments related to OST access, entry, knowledge, beliefs and attitudes were analyzed among 41 PWIDs who were eligible for but had never received OST. A number of programmatic and structural barriers were mentioned by participants as barriers to entry to OST, including compulsory drug user registration, waiting lists, and limited number of treatment slots. Participants also voiced strong negative attitudes and beliefs about OST, especially methadone. Their perceptions about methadone’s side effects as well as the stigma of being a methadone client were expressed as obstacles to treatment. Despite expressed interest in treatment, Ukrainian OST-naïve PWIDs evade OST for reasons that can be addressed through changes in program-level and governmental policies and social-marketing campaigns. Voiced OST barriers can effectively inform public health and policy directives related to HIV prevention and treatment in Ukraine to improve evidence-based treatment access and availability.