Methadone maintenance and HIV risk in Ukraine

Sergii Dvoriak

S. Dvoriak1,2, G. Woody2, J. Schumacher3, A. Pecoraroi2. 1Ukrainian Institute on Public Health Policy, Ukraine; 2University of Pennsylvania, United States; 3University of Alabama-Birmingham, United States

Background: Opioid abuse remains a serious problem and primary driver of the HIV epidemic in Ukraine. Methadone maintenance therapy started in the country in 2008 but has been investigated limitedly. This study provides preliminary data on the acceptability and impact of methadone in reducing opioid use and HIV risk in a Ukrainian cultural setting.

Method: We treated 50 heroin addicts, 25 HIV+ and 25 HIV–, with a 12-week course of methadone and individual and group drug counseling, followed by a 3-week dose taper and one follow-up 20 weeks after the start of the treatment. We used a set of instruments for evaluation of opioid use, risky behavior, and psychiatric assessment: urine drug tests, Addiction Severity Index, Timeline Followback, opioid craving visual scale, Risk Assessment Battery, Brief Psychiatric Rating Scale, and Beck Depression Inventory. All patients were evaluated in the beginning and at 1, 4, 8, 12, and 20 weeks.

Results: Retention in treatment was very high—94% after 20 weeks. No one decided to stop treatment after 3 months. Average days of self-reported opiate use in the past 30 days was more than a 90% reduction in use from baseline to any follow-up point. Urine tests were positive from 5% (week 7) to 23% (week 16) with the average point 8.2%. Injection risk reduction was more than 75% at the 8-, 12-, and 20-week points. Sexual risk reduction was much less (about 20%). There was improvement in global functioning, depression, and psychological symptoms.

Conclusion: Opiate use was reduced during methadone treatment. HIV risky injection practices were reduced, but sex risk was less affected. Criminal, psychological, and global functioning improved.

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