Expanding Medication Assisted Therapy in Ukraine (ExMAT)

在乌克兰扩大药物辅助治疗 (ExMAT)

• 批准号: 10197863
• 负责人: FREDERICK LEWIS ALTICE
• 金额: $ 61.56万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10197863
• 关键词: AIDS prevention; AIDS/HIV problem; Academy; Accounting; Achievement; Acquired Immunodeficiency Syndrome; Address; Administrator; Alcohol consumption; Attitude; Buprenorphine; Caring; Client; Clinic; Communicable Diseases; Conflict (Psychology); Continuity of Patient Care; Country; Data; Data Reporting; Decision Aid; Decision Making; Dissemination and Implementation; Dose; Drug abuse; Economics; Ensure; Epidemic; Evidence based practice; Fee-for-Service Plans; Funding; Goals; Government; HIV; HIV Infections; HIV risk; HIV/HCV; Health Personnel; Health Services Accessibility; Hepatitis C Transmission; Imprisonment; Improve Access; Incidence; Infection; Injecting drug user; International; Intervention; Interview; Joints; Laws; Maintenance; Manuscripts; Mathematics; Methadone; Modeling; Monitor; Morals; Naltrexone; Opiate Addiction; Opioid; Outcome; Patients; Pharmaceutical Preparations; Pharmacy Distributions; Pharmacy facility; Police; Policies; Politics; Prejudice; Prevalence; Prevention; Prevention strategy; Prisoner; Prisons; Process; Publishing; Research; Research Activity; Research Proposals; Risk Behaviors; Science; Self Administration; Site; Supervision; Surveys; System; Testing; Training; USSR; Ukraine; Work; addiction; antiretroviral therapy; base; cost effective; cost effectiveness; data repository; implementation framework; implementation research; implementation science; implementation strategy; improved; innovation; insight; medical specialties; meetings; next generation; opioid agonist therapy; parent grant; patient oriented; prescription opioid; prevent; probation; programs; recruit; scale up; service delivery; shared decision making; symposium; therapy adherence; transmission process; treatment strategy; user-friendly

Ukraine’s HIV epidemic is volatile and expanding, fueled primarily in opioid-dependent people who inject drugs (PWID). HIV prevalence in PWID ranges from 21.3--41.8%,4 accounting for 70% of cumulative and 56% of new infections. Opioid agonist treatments (OAT) using methadone (MMT) or buprenorphine (BMT) maintenance are internationally recognized as effective HIV prevention and treatment of opioid dependence. We have successfully completed and exceeded our original 3 aims, including increasing OAT coverage from 1.5% to 2.7% for the 310,000 PWID who need it. First, using an implementation science framework we qualitatively and quantitatively assessed the client-, program- and policy-level barriers and facilitators to OAT scale-up and effectively used them to change Order 200, the law that governs OAT, such that OAT can now be prescribed outside of addiction specialty settings, including as fee-for-service and pharmacy distribution where patients may receive 10 days of medication without daily supervision. Second, as in the U.S., we have learned that OAT scale-up has been restricted more by moral biases and prejudices than by scientific evidence, requiring innovative patient-centered strategies like shared decision-making (SDM) and user-friendly decision aids to facilitate OAT entry and retention. Third, we developed a national data repository (SyReX) that monitors all OAT and HIV outcomes, allowing us to effectively monitor our implementation strategies. Fourth, HIV+ PWID on OAT were significantly more likely to achieve each level of the HIV care continuum compared to those not on OAT. Fifth, most PWID prefer BMT over MMT and are willing to pay for it, especially if delivered in pharmacies. Sixth, higher OAT doses were the most important contributor to OAT retention (only 24% received high doses), but retention was also higher in PWID on BMT, received OAT in integrated care settings, and differed regionally. Seventh, we developed HIV transmission models for PWID that incorporated incarceration and OAT coverage – demonstrating that OAT scale-up in prison with continuation post-release was the most effective HIV prevention strategy for prisoners. Eighth, and central to the implementation coaching process, we successfully trained and deployed the NIATx treatment improvement model throughout the country, including over 100 change projects, and significantly increased OAT scale- up at these sites relative to non-NIATx sites by overcoming organizational barriers. This renewal application builds on these accomplishments by directly addressing client-level barriers to OAT by developing and testing an open access, two-step SDM aid, with a focus on HIV+ PWID, to promote OAT scale-up in PWID who have previously or never been on OAT. To overcome program-level barriers, we propose to expand our NIATx program by creating “regional collaboratives” (a NIATx innovation) to create improved, sustainable models of OAT delivery that focuses on three specific implementation change projects: A) adequate OAT dosing; B) pharmacy- based OAT prescription; and C) HIV/OAT integrated service delivery. Last, we propose to expand our HIV transmission model in PWID to incorporate HCV transmission dynamics and to more comprehensively model the impact and cost-effectiveness of scaling-up interventions to improve OAT scale-up and on improving the HIV continuum of care for PWID in Ukraine. The proposal brings together research and implementation science experts in HIV prevention, infectious diseases, addiction, decision science, NIATx delivery, mathematical and cost-effectiveness modeling and implementation science to provide real-world solutions for PEPFAR’s goals in Ukraine – to effectively reduce HIV transmission and improve access to HIV treatment nationally and with a focus on PWID.

乌克兰的艾滋病毒流行是挥发性和扩张的，主要是在注射药物（PWID）的阿片类药物依赖性人群中加油。艾滋病毒患病率 在21.3---41.8％的PWID范围内，4个占累积累积的70％和新感染的56％。阿片类药物激动剂治疗（OAT）使用 美沙酮（MMT）或丁丙诺啡（BMT）维持在国际上被认为是有效的HIV预防和治疗 阿片类药物依赖性。我们已经成功完成并超过了我们的最初3个目标，包括将燕麦覆盖范围从1.5％增加到 需要它的310,000个PWID的2.7％。首先，使用实施科学框架，我们定性和定量评估了 客户，计划和政策级别的障碍以及促进者的燕麦片扩展，并有效地使用它们来改变200号命令，这是法律 管理燕麦，以便现在可以在成瘾专业环境之外开处方燕麦，包括作为收费服务和药房 在没有日常监督的情况下，患者可能会接受10天的药物分布。第二，就像在美国一样，我们了解到燕麦 扩大规模受到道德偏见和偏见的限制，而不是科学证据，需要创新的以患者为中心的策略 就像共享的决策（SDM）和用户友好的决策辅助工具，以促进燕麦进入和保留。第三，我们开发了国家数据 监视所有燕麦和艾滋病毒结果的存储库（Syrex），使我们能够有效地监视我们的实施策略。第四， 燕麦上的HIV+ PWID更有可能达到每种HIV护理水平的可能性继续与不燕麦片相比。 第五，大多数PWID都比MMT更喜欢BMT，并且愿意为此付费，尤其是在药房交付时。第六，更高的燕麦剂量是 保留燕麦的最重要贡献者（只有24％的高剂量），但保留在BMT上的PWID也更高，接受 综合护理环境中的燕麦和区域不同。第七，我们开发了PWID的HIV传播模型 监禁和燕麦覆盖范围 - 证明在释放后继续监狱中的燕麦量表是最有效的艾滋病毒 囚犯的预防策略。第八，是实施教练过程的中心，我们成功培训并部署了 NIATX治疗改进模型，包括100多个变更项目，并显着提高燕麦量表 - 通过克服组织障碍，在这些站点相对于非NIATX站点。此更新应用程序以这些为基础 通过直接处理和测试开放访问的两步SDM AID，通过直接解决客户级障碍的成就，并 专注于HIV+ PWID，以促进以前或从未使用过燕麦的PWID的燕麦量表。克服程序级别 障碍，我们建议通过创建“区域协作”（A NIATX创新）来扩大NIATX计划，以创造改进， 燕麦交付的可持续模型，重点是三个特定的实施变更项目：a）适当的燕麦剂量； b）药房 - 基于燕麦处方； c）艾滋病毒/燕麦综合服务交付。最后，我们建议在PWID中扩展我们的HIV传播模型 结合HCV传输动力学并更全面地建模扩展的影响和成本效益 改善燕麦量扩大的干预措施，并改善乌克兰PWID的HIV持续护理。提案带来了 艾滋病毒预防，传染病，成瘾，决策科学，NIATX交付，研究和实施科学专家共同研究 数学和成本效益建模和实施科学，为乌克兰的目标提供现实世界的解决方案 - 有效地减少艾滋病毒传播并改善全国范围内对艾滋病毒治疗的机会，并重点关注PWID。

项目成果

Methadone treatment improves tuberculosis treatment among hospitalized opioid dependent patients in Ukraine.

• DOI: 10.1016/j.drugpo.2013.09.001
• 发表时间: 2013-11-01
• 期刊: The International journal on drug policy
• 作者: Morozova, Olga;Dvoryak, Sergii;Altice, Frederick L
• 通讯作者: Altice, Frederick L

Extending a lifeline to people with HIV and opioid use disorder during the war in Ukraine.

• DOI: 10.1016/s2468-2667(22)00083-4
• 发表时间: 2022-05
• 期刊: LANCET PUBLIC HEALTH
• 影响因子: 50
• 作者: Altice, Frederick L.;Bromberg, Daniel J.;Dvoriak, Sergii;Meteliuk, Anna;Pykalo, Iryna;Islam, Zahedul;Azbel, Lyu;Madden, Lynn M.
• 通讯作者: Madden, Lynn M.

'Krokodil' and what a long strange trip it's been.

“鳄鱼”，这是一次多么漫长而奇怪的旅程。

• DOI: 10.1016/j.drugpo.2013.06.004
• 发表时间: 2013
• 期刊: The International journal on drug policy
• 作者: Azbel,Lyuba;Dvoryak,Sergey;Altice,FrederickL
• 通讯作者: Altice,FrederickL

Impact of HCV Testing and Treatment on HCV Transmission Among Men Who Have Sex With Men and Who Inject Drugs in San Francisco: A Modelling Analysis.

• DOI: 10.1093/infdis/jiad169
• 发表时间: 2023-09-15
• 期刊: JOURNAL OF INFECTIOUS DISEASES
• 影响因子: 6.4
• 作者: Artenie, Adelina;Stone, Jack;Facente, Shelley N.;Fraser, Hannah;Hecht, Jennifer;Rhodes III, Perry;McFarland, Willi;Wilson, Erin;Hickman, Matthew;Vickerman, Peter;Morris, Meghan D.
• 通讯作者: Morris, Meghan D.

Accessing methadone within Moldovan prisons: Prejudice and myths amplified by peers.

在摩尔多瓦监狱内获取美沙酮：同行放大的偏见和神话。

• DOI: 10.1016/j.drugpo.2015.12.016
• 发表时间: 2016
• 期刊: The International journal on drug policy
• 作者: Polonsky,Maxim;Azbel,Lyuba;Wickersham,JeffreyA;Marcus,Ruthanne;Doltu,Svetlana;Grishaev,Evgeny;Dvoryak,Sergey;Altice,FrederickL
• 通讯作者: Altice,FrederickL