Collaborative learning and response to opioid misuse and HIV prevention in Ukraine during war.
Collaborative learning and response to opioid misuse and HIV prevention in Ukraine during war.
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DOI：
10.1016/s2215-0366(22)00318-2
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发表时间：
2022-11
影响因子：
64.3
通讯作者：
Madden, Lynn M.
中科院分区：
文献类型：
--
作者：
Altice, Frederick L.;Bromberg, Daniel J.;Klepikov, Adriy;Barzilay, Ezra J.;Islam, Zahedul;Dvoriak, Sergii;Farnum, Scott;Madden, Lynn M.
据估计，乌克兰有346 000名注射吸毒者，其中65 795人(19%)感染了艾滋病毒，1使乌克兰的阿片类药物和艾滋病毒相互交织在一起的流行成为全球最严重的流行病之一。扩大美沙酮和丁丙诺啡等阿片类激动剂疗法(OAT)的维持范围是控制乌克兰艾滋病毒流行的最有效战略。2到2022年2月24日，乌克兰有17232人参加OAT，目标是到年底注册25886人。自2014年俄罗斯首次入侵乌克兰以来，在乌克兰开展的几项活动帮助乌克兰这个医疗保健系统僵化的国家做好准备，以应对不断变化的艾滋病毒预防需求，包括2014年引入了改善成瘾治疗网络(NIATx)。NIATx是一种协作学习战略，支持成瘾治疗专家对燕麦片扩大规模的区域反应，是一套用于流程改进的实施工具，可快速确定障碍和促进者，创建协作学习小组，并通过快速周期变化项目促进效率。NIATx定期将当地和地区的燕麦片供应商聚集在一起，讨论他们在实践中发展起来的实时问题，并在出现问题时共同解决它们。到2016年，NIATx已经提高了燕麦片交付的效率，3通知乌克兰公共卫生中心建议对指导燕麦片交付的立法--第200号命令进行重大修订。3这些修订消除了许多治疗障碍，4放松了对症状稳定的患者进行10天的日常监督的要求，并允许在专科诊所以外的地方开燕麦片处方，包括初级保健5和非政府诊所。6当2020年新的国家医疗保健制度改革开始时，NIATx支持燕麦片提供者优化财务激励，这为提供燕麦片的诊所提供了巨大的经济激励。它还在新冠肺炎大流行期间支持燕麦片供应商，当时乌克兰公共卫生中心建议在带回家的剂量方面有更大的灵活性，这反过来又增加了工作人员招募新患者、使用远程医疗和避免带回家的剂量过量的临床时间。7.
An estimated 346 000 people who inject drugs reside in Ukraine, 65 795 (19%) of whom are infected with HIV, 1 making Ukraine’s intertwined opioid and HIV epidemics among the worst globally. Scale-up of maintenance with opioid agonist therapy (OAT), such as methadone and buprenorphine, is the most effective strategy for controlling Ukraine’s HIV epidemic. 2 ByFeb 24, 2022, Ukraine had 17 232 people on OAT, with targets set for 25 886 people being enrolled by the end of the year. Several activities in Ukraine since the first invasion by Russia in 2014 helped prepare Ukraine, a country with an inflexible health-care system, to respond to changing HIV prevention needs, including the introduction of the Network for the Improvement of Addiction Treatment (NIATx) in 2014. NIATx, a collaborative learning strategy that supports addiction treatment experts in their regional responses to OAT scale-up, is a bundle of implementation tools used for process improvement that rapidly identifies barriers and facilitators, creates collaborative learning groups, and facilitates efficiencies through rapidcycle change projects. NIATx regularly brings local and regional OAT providers together to discuss real-time issues, which evolve in their practice, and to jointly solve problems as they arise. By 2016, NIATx had created efficiencies in OAT delivery3 that informed Ukraine’s Public Health Centre to recommend major revisions to Order 200, the legislation that guides OAT delivery. 3 These revisions removed many treatment barriers, 4 loosened requirements from daily supervision to takehome doses for 10 days for patients whose symptoms had stabilised, and allowed OAT prescription outside of specialty clinics, including in primary care5 and nongovernmental clinics. 6 NIATx supported OAT providers to optimise financial incentives when the new National Health-care System reform started in 2020, which provided capitated economic incentives for clinics providing OAT. It also supported OAT providers during the COVID-19 pandemic when Ukraine’s Public Health Centre recommended greater flexibility with take-home dosing, which in turn increased clinical time for staff to enrol new patients, use telehealth, and avoid overdoses with take-home dosing. 7