Expanding Medication Assisted Therapy in Ukraine (ExMAT)

在乌克兰扩大药物辅助治疗 (ExMAT)

基本信息

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
项目类别：
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

项目摘要

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不稳定且不断扩大，主要是阿片类药物依赖的注射吸毒者（PWID）的艾滋病毒流行加剧。注射吸毒者的比例为 21.3--41.8%，4 占累计感染的 70%，占使用阿片类激动剂治疗 (OAT) 的新感染的 56%。美沙酮 (MMT) 或丁丙诺啡 (BMT) 维持治疗被国际公认为是有效的艾滋病毒预防和治疗方法我们已经成功完成并超越了最初的 3 个目标，包括将 OAT 覆盖率从 1.5% 提高到为 310,000 名需要注射吸毒者提供 2.7% 首先，我们使用实施科学框架定性和定量地评估了这一情况。客户、项目和政策层面的 OAT 扩大障碍和促进因素，并有效地利用它们来改变 200 号令，该法律管理 OAT，因此 OAT 现在可以在成瘾专业环境之外开处方，包括按服务收费和药房开处方其次，正如在美国一样，我们了解到 OAT 可以让患者接受 10 天的药物治疗。扩大规模更多地受到道德偏见和偏见的限制，而不是科学证据的限制，需要创新的以患者为中心的策略例如共享决策 (SDM) 和用户友好的决策辅助工具，以促进 OAT 的输入和保留。第三，我们开发了国家数据。第四，监控所有 OAT 和 HIV 结果，使我们能够有效监控我们的实施策略。与未接受 OAT 的 HIV+ 注射吸毒者相比，接受 OAT 的 HIV+ 注射吸毒者更有可能达到 HIV 护理连续体的各个级别。第五，大多数注射吸毒者更喜欢 BMT 而不是 MMT，并且愿意为此付费，尤其是在药房提供的情况下。第六，燕麦剂量较高。是 OAT 保留的最重要因素（只有 24% 接受高剂量），但注射吸毒者 BMT 的保留率也更高。综合护理环境中的 OAT，并且因地区而异第七，我们为注射吸毒者开发了艾滋病毒传播模型。监禁和 OAT 覆盖——证明在监狱中扩大 OAT 并在释放后继续实施是最有效的艾滋病毒防治方法第八，也是实施辅导过程的核心，我们成功地培训和部署了囚犯预防策略。 NIATx治疗改进模式遍布全国，包括超过100个变革项目，并显着增加了OAT规模—— 通过克服组织障碍，这些站点相对于非 NIATx 站点有所提升。此更新应用程序建立在这些站点的基础上。通过开发和测试开放访问、两步 SDM 援助，直接解决 OAT 的客户级障碍，取得了成就重点关注 HIV+ 注射吸毒者，以促进以前或从未接受过 OAT 的注射吸毒者扩大 OAT 的范围，以克服计划层面的问题。障碍，我们建议通过创建“区域合作”（NIATx 创新）来扩展我们的 NIATx 计划，以创造改进的、可持续的 OAT 交付模式，重点关注三个具体实施变革项目：A) 充足的 OAT 剂量；B) 药房- 基于 OAT 处方；以及 C) HIV/OAT 综合服务提供最后，我们建议扩大吸毒者中的 HIV 传播模式。纳入 HCV 传播动态并更全面地模拟扩大规模的影响和成本效益该提案提出了旨在扩大 OAT 规模和改善乌克兰吸毒者艾滋病毒持续护理的干预措施。将艾滋病毒预防、传染病、成瘾、决策科学、NIATx 交付方面的研究实施和科学专家聚集在一起，数学和成本效益建模和实施科学，为 PEPFAR 在乌克兰的目标提供现实解决方案 – 有效减少艾滋病毒传播并改善全国艾滋病毒治疗的可及性，重点关注吸毒者。

项目成果

期刊论文数量（38）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

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
影响因子：
0
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
影响因子：
0
作者：
Azbel,Lyuba;Dvoryak,Sergey;Altice,FrederickL
通讯作者：
Altice,FrederickL

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
影响因子：
0
作者：
Polonsky,Maxim;Azbel,Lyuba;Wickersham,JeffreyA;Marcus,Ruthanne;Doltu,Svetlana;Grishaev,Evgeny;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.