“Bureaucracy & Beliefs”: Assessing the Barriers to Accessing Opioid Substitution Therapy by People Who Inject Drugs in Ukraine

Aims

Opioid substitution therapy (OST) is an evidence-based HIV prevention strategy for people who inject drugs (PWIDs). Yet, only 2.7% of Ukraine’s estimated 310,000 PWIDs receive it despite free treatment since 2004. The multi-level barriers to entering OST among opioid dependent PWIDs have not been examined in Ukraine.

Methods

A multi-year mixed methods implementation science project included focus group discussions with 199 PWIDs in 5 major Ukrainian cities in 2013 covering drug treatment attitudes and beliefs and knowledge of and experiences with OST. Data were transcribed, translated into English and coded. Coded segments related to OST access, entry, knowledge, beliefs and attitudes were analyzed among 41 PWIDs who were eligible for but had never received OST.

Findings

A number of programmatic and structural barriers were mentioned by participants as barriers to entry to OST, including compulsory drug user registration, waiting lists, and limited number of treatment slots. Participants also voiced strong negative attitudes and beliefs about OST, especially methadone. Their perceptions about methadone’s side effects as well as the stigma of being a methadone client were expressed as obstacles to treatment.

Conclusions

Despite expressed interest in treatment, Ukrainian OST-naïve PWIDs evade OST for reasons that can be addressed through changes in program-level and governmental policies and social-marketing campaigns. Voiced OST barriers can effectively inform public health and policy directives related to HIV prevention and treatment in Ukraine to improve evidence-based treatment access and availability.

Full article at:   http://goo.gl/53ASEL

By:  Martha J. Bojko,1 Alyona Mazhnaya,2 Iuliia Makarenko,3 Ruthanne Marcus,1 Sergii Dvoriak,3 Zahedul Islam,2 andFrederick L. Altice1,4

¹Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, USA

²ICF International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine

³Ukrainian Institute for Public Health Policy, Kyiv, Ukraine

⁴Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, Connecticut, USA

Correspondence: Martha J Bojko, PhD, Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases - AIDS Program, 135 College St., Suite 323, New Haven, CT 06510-2483, Mobile (U.S.): +1 (860) 729 04 80, Mobile (Ukraine): +38 (050) 723 15 53

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