Expanding Medication Assisted Therapies in Ukraine

在乌克兰扩大药物辅助治疗

• 批准号: 8310687
• 负责人: FREDERICK LEWIS ALTICE
• 金额: $ 58.76万
• 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 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8310687
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Adherence; Administrator; Adopted; Alcohol consumption; Anti-Retroviral Agents; Area; Buprenorphine; Caring; Centers for Disease Control and Prevention (U.S.); Client; Collaborations; Comorbidity; Complement; Complex; Country; Disadvantaged; Documentation; Drug usage; Effectiveness; Emergency Situation; Ensure; Epidemic; Europe; Evidence based intervention; Evidence based treatment; Foundations; Funding; Goals; Government; HIV; HIV Infections; Health; Health Policy; Health system; Healthcare; Institutes; International; Intervention; Lead; Licensing; Maintenance Therapy; Medical; Modeling; Naltrexone; Narcotic Antagonists; Observational Study; Operations Research; Opiate Addiction; Opioid; Opioid Rotation; Outcome; Patients; Persons; Pharmaceutical Preparations; Pilot Projects; Prevalence; Prevention; Prevention strategy; Process; Program Development; Program Sustainability; Public Health; Relapse; Reporting; Research; Research Proposals; Resources; Risk Behaviors; Services; Site; Statutes and Laws; Substance abuse problem; Techniques; Testing; Time; Training; Training Support; Treatment outcome; USAID; Ukraine; Universities; addiction; antiretroviral therapy; base; clinical care; cohort; cost effective; cost effectiveness; dissemination research; evidence base; expectation; forging; frontier; global health; health care delivery; implementation research; implementation science; improved; innovation; mathematical model; meetings; methadone maintenance; post intervention; programs; research study; response; scale up; therapy design; transmission process; treatment center; treatment strategy; trend

DESCRIPTION (provided by applicant): Ukraine's HIV epidemic, fueled primarily among opioid-dependent people who inject drugs (PWIDs), remains volatile despite gains achieved elsewhere. PWIDs account for ~70% of cumulative and >56% of new HIV infections. Despite Ukraine's HIV epidemic transition toward a generalized epidemic, empiric and mathematical modeling suggest that medication-assisted therapy (MAT) is the most effective and cost-effective approach to reverse this trend. MAT is associated with reduced HIV transmission and improved HIV treatment outcomes including engagement in care and antiretroviral medication access and adherence. Though MAT is free and capacity has increased from 120 to ~8,000 sub sized slots since 2004, <2% of PWIDs receive it. MAT scale-up is complex, poorly understood and has been fraught with low entry and high attrition. By 2011, only ~6100 slots remain filled - a number that has not increased appreciably in 12 months. Corrective interventions that facilitate MAT entry and retention are therefore crucial for HIV prevention and treatment efforts in Ukraine. We propose to improve MAT scale-up and build regional capacity in two distinct ways. In addition to examining client- and program-level facilitators and barriers to MAT, we will train and support Ukrainian experts in implementing an evidence-based and sustainable intervention, the Network for the Improvement of Addiction Treatment (NIATx) Model of Rapid Change Cycle, to improve MAT entry and retention. We will then evaluate the impact of the NIATx approach on MAT programs across Ukraine, using a pre/post intervention design to assess programmatic changes that promote MAT entry and retention. Second, we will create a new healthcare delivery model by integrating extended release naltrexone (XR-NTX) into HIV clinical care settings as a means to increase MAT access among HIV+ PWIDs. Administered only once-monthly, XR-NTX is a newly available and safe non-narcotic MAT that does not require narcological registration or have to be dispensed solely in licensed centers. Using implementation science techniques, we will examine both HIV (linkage to and retention in HIV care, initiation of and adherence with antiretroviral therapy) and substance abuse (time to opioid relapse, percent of days opioid free, retention on XR-NTX) treatment outcomes among an observational cohort of HIV+ PWIDs. The research and dissemination plan, consistent with PEPFAR's goals, expands sustainable treatment and prevention strategies and strengthens government partner relations by convening stakeholder meetings (e.g. Alliance Ukraine, Narcology and AIDS Center Directors, Ministry of Health, CDC, USAID, WHO, UNODC, Global Fund, Clinton Foundation, NGOs, etc) to facilitate NIATx implementation. By introducing evidence-based strategies and newly available medications that can forge new frontiers in HIV prevention and treatment, this project also builds local capacity and expertise in these innovative areas. Ukrainian HIV/AIDS programs also become better integrated and aligned with broader global health goals to improve health systems and maximize treatment capacity for multiple related and overlapping medical and psychiatric co-morbidities. PUBLIC HEALTH RELEVANCE: Ukraine's explosive HIV epidemic, the most devastating in Europe, is primarily fueled by people who inject drugs (PWIDs). Despite medication-assisted therapy (MAT) being the most effective and cost-effective approach to reversing the epidemic, MAT scale-up in Ukraine has been hindered by poor MAT entry and retention. The proposed research identifies the barriers and facilitators to MAT, introduces an evidence-based intervention (NIATx) to promote sustainable MAT scale-up as well as innovatively introduces a new form of MAT, extended release naltrexone, to be integrated into HIV clinical care settings. This project meets PEPFAR's objectives to: 1) transition from an emergency response to HIV/AIDS to promotion of sustainable country programs; 2) strengthen partner government capacity to lead the response to this epidemic and other health demands; 3) expand prevention, care, and treatment in concentrated and generalized epidemics; 4) integrate and coordinate HIV/AIDS programs with broader global health and development programs to maximize impact on health systems; and 5) invest in innovation and operations research to evaluate existing programs, improve service delivery and maximize program outcomes.

描述（由申请人提供）：乌克兰的艾滋病毒流行病主要是在阿片类药物依赖性的人中注射药物（PWID），尽管在其他地方取得了成就，但仍在挥发性。 PWIDS占累积累积的70％，> 56％的新艾滋病毒感染。尽管乌克兰的HIV流行向普遍流行，经验性和数学模型表明，药物辅助治疗（MAT）是扭转这一趋势的最有效和成本效益的方法。 MAT与HIV传播减少和改善HIV治疗结果有关，包括参与护理和抗逆转录病毒药物的访问和依从性。尽管MAT是自由的，并且自2004年以来的容量已从120次增加到8,000个次级插槽，但<2％的PWID会收到它。 MAT缩放是复杂的，理解不足，并且散发出低水平和高水分流量。到2011年，只有〜6100个插槽仍然填充 - 这个数字在12个月内没有明显增加。因此，促进MAT进入和保留的纠正措施对于乌克兰的艾滋病毒预防和治疗工作至关重要。 我们建议以两种不同的方式提高垫子规模并建立区域能力。除了检查客户和程序级的促进者和垫子的障碍外，我们还将培训和支持乌克兰专家实施基于证据和可持续的干预措施，改善成瘾治疗的网络（NIATX）的快速变化周期模型，以改善MAT进入和保留。然后，我们将使用前/后干预设计设计来评估NIATX方法对乌克兰MAT计划的影响，以评估促进MAT进入和保留的程序化更改。其次，我们将通过将扩展释放纳曲酮（XR-NTX）集成到HIV临床护理环境中来创建一个新的医疗保健交付模型，以增加HIV+ PWID之间的MAT访问。 XR-NTX每月仅管理一次，是一种新的可用且安全的非麻醉垫，不需要麻醉登记或仅在许可中心中分配。使用实施科学技术，我们将检查HIV（与抗逆转录病毒疗法的艾滋病毒护理，启动和依从性的联系和保留率）和药物滥用（时间是阿片类药物复发的时间，阿片类药物的百分比，无XR-NTX上的保留率，XR-NTX上的保留率）。与PEPFAR的目标一致的研究和传播计划通过召集利益相关者会议扩大可持续治疗和预防策略，并加强了政府合作伙伴关系（例如，乌克兰联盟，纳学学和艾滋病中心董事，卫生部，CDC，USAID，USAID，USAID，WHO，WHO，WHO，WHO，WO，UNODC，GLOBLEC FUNDIC，CLINTON FUNDIC，CLINTON FUNDICE，CLINTON基金会，NGOS等。通过引入基于证据的策略和新近可用的药物，可以在艾滋病毒预防和治疗方面构成新的领域，该项目还在这些创新地区建立了当地的能力和专业知识。乌克兰的艾滋病毒/艾滋病计划也变得更好地融合并与更广泛的全球卫生目标保持一致，以改善卫生系统，并最大程度地提高多种相关和重叠的医学和精神病研究的治疗能力。 公共卫生相关性：乌克兰的爆炸性艾滋病毒流行病是欧洲最具毁灭性的艾滋病毒，主要是由注射毒品（PWID）的人推动的。尽管药物辅助疗法（MAT）是逆转流行病的最有效和成本效益的方法，但乌克兰的MAT扩大受到垫子的进入和保留率不佳的阻碍。拟议的研究确定了MAT的障碍和促进者，引入了基于证据的干预措施（NIATX），以促进可持续的MAT扩大规模，并创新地引入了一种新形式的MAT，扩展释放Naltrexone，以集成到HIV临床护理环境中。该项目符合PEPFAR的目标：1）从紧急回应艾滋病毒/艾滋病的过渡到促进可持续国家计划； 2）增强伴侣政府领导对这种流行病和其他健康需求的反应的能力； 3）扩大集中和广义流行病的预防，护理和治疗； 4）将艾滋病毒/艾滋病计划与更广泛的全球卫生和发展计划整合在一起，以最大程度地影响卫生系统； 5）投资创新和运营研究以评估现有计划，改善服务交付并最大化计划成果。