Format

Send to

Choose Destination
Drug Alcohol Depend. 2018 Sep 1;190:82-88. doi: 10.1016/j.drugalcdep.2018.05.027. Epub 2018 Jun 30.

Assessment of barrier severity and willingness to enter opioid agonist treatment among people who inject drugs in Ukraine.

Author information

1
Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA. Electronic address: alexei.zelenev@yale.edu.
2
Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
3
ICF Alliance for Public Health in Ukraine. 5 Dilova str. Building 10A, Kyiv 03150, Ukraine; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society. 624 N Broadway, Baltimore, MD 21205, USA.
4
Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; APT Foundation, New Haven, CT, USA.
5
Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA.

Abstract

BACKGROUND:

Opioid agonist therapies (OAT) in Ukraine were first introduced in 2004 not as addiction treatment, but for HIV prevention. Numerous obstacles have thwarted OAT scale-up, including individual constraints and structural barriers.

METHODS:

A cross-sectional survey of 1613 opioid dependent people who inject drugs (PWID) were recruited in 2014-2015 using stratified sampling in Kyiv, Odesa, Mykolayiv, Dnipro and Lviv. Analysis was restricted to a subset of 811 PWID who never received OAT. Barriers to OAT were assessed based on reasons why study participants were reluctant to enroll into OAT. A Rasch model from the Item Response Theory was applied to 24 potential barriers, used to score their severity and estimate a latent composite measure for each person's willingness and ability to participate in OAT.

RESULTS:

The Rasch model confirmed the cumulative nature of barriers with concerns over treatment efficacy, safety and tolerability being more prevalent than barriers related to logistical constraints, opportunity costs and social stigma. If barriers related to treatment perception and logistics were eliminated, the average barrier number would decrease from 10 to 2.2. Participants were more likely to have a higher resistance to OAT entry if they experienced fewer overdoses, did not attain higher education, were not previously incarcerated and if their peers did not have a higher level of resistance to OAT.

CONCLUSIONS:

Understanding the interdependence of various barriers and attitudes toward OAT can improve the rate of OAT expansion and ameliorate entry into substance abuse treatment programs in Ukraine.

KEYWORDS:

Addiction; Barriers to entry;; Opioid agonist treatment; Opioid substitution treatment; People who inject drugs

PMID:
29990648
PMCID:
PMC6292439
DOI:
10.1016/j.drugalcdep.2018.05.027
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center