Methadone maintenance and HIV risk in Ukraine

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DESCRIPTION (provided by applicant): Treatment of opioid dependence is an important way to reduce the spread of HIV and other infectious diseases, particularly in Ukraine since intravenous opioid use is the major way these infections are being spread. This proposal will be done at the Kiev City Narcology Hospital with collaborators from the University of Alabama and the University of Colorado. It will study the acceptability and impact of a 3-month course of methadone maintenance on 50 persons with opioid dependence, 25 who are HIV+ and 25 HIV-. The proposed work will build upon a relationship that was established with the Ukrainian Co-Principal Investigator, Sergiy Dvoryak, MD, during his Humphrey Fellowship at Johns Hopkins in 1999-2000 when he spent time with Drs. Woody and Metzger at the Penn Addiction Treatment and Research Center. It will also extend studies of pharmacologic treatment for opioid dependence and risk reduction behavioral interventions that are being done by Drs. Woody, Schumacher and Booth in Russia and Ukraine. Primary aims are to: 1) Measure the acceptability and compliance with a 3-month course of methadone maintenance in HIV+ and HIV- patients; and 2) Measure the impact of a 3-month course of methadone in reducing opioid use and HIV risk behavior. Secondary aims are to: 1) Assess the degree to which the investigative team obtains study outcome measures; 2) Assess the degree to which the 3-month course of methadone maintenance reduces illegal activities and improves employment and psychiatric symptoms; 3) Determine short term outcome after completion of methadone treatment; and 4) Obtain pilot data on the prevalence of hepatitis B and C among study patients. This proposal addresses two priority areas of NIH: HIV prevention and substance abuse. It will provide pilot data on the acceptability and efficacy of a short term course of methadone maintenance in a cultural setting where this treatment has not been evaluated, on the feasibility of conducting a pharmacological study of opioid dependent persons in Kiev, and will enhance research capabilities of Kiev investigators for future HIV prevention and treatment studies.