The real‐world impact of dosing of methadone and buprenorphine in retention on opioid agonist therapies in Ukraine.
Background and Aims: Ukraine's HIV epidemic remains concentrated among opioid‐dependent people who inject drugs (PWID) where opioid agonist therapies (OAT) like methadone (MMT) and buprenorphine (BMT) maintenance treatments are the most cost‐effective HIV prevention strategies, but remain under‐scal...
| Publicado en: | Addiction Vol. 116; no. 1; pp. 83 - 94 |
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| Autores principales: | , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Jan2021
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=147905374&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 147905374 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09652140 AIO jtl: Addiction issn: 09652140 maglogo: Y pubinfo: dt: Jan2021 vid: 116 iid: 1 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 147905374 145837898 147905374 147905374 10.1111/add.15115 147905374 ppf: 83 ppct: 11 formats: fmt: – @attributes: type: T – @attributes: type: C – @attributes: type: P tig: atl: The real‐world impact of dosing of methadone and buprenorphine in retention on opioid agonist therapies in Ukraine. aug: au: Farnum, Scott O. Makarenko, Iuliia Madden, Lynn Mazhnaya, Alyona Marcus, Ruthanne Prokhorova, Tanya Bojko, Martha J. Rozanova, Julia Dvoriak, Sergii Islam, Zahedsul Altice, Frederick L. affil: APT Foundation, New Haven CT,, USA sug: subj: Substance Dependence Drug Therapy Methadone Administration and Dosage Buprenorphine Administration and Dosage Decision Making Prescribing Patterns Human Ukraine Female Male Prospective Studies Nonexperimental Studies Time Factors Cox Proportional Hazards Model Regression Log-Rank Test Descriptive Statistics Odds Ratio Confidence Intervals Implementation Science Female Male ab: Background and Aims: Ukraine's HIV epidemic remains concentrated among opioid‐dependent people who inject drugs (PWID) where opioid agonist therapies (OAT) like methadone (MMT) and buprenorphine (BMT) maintenance treatments are the most cost‐effective HIV prevention strategies, but remain under‐scaled. This study aimed to measure the association between dose and type of OAT prescribed and treatment retention. Design Observational longitudinal cohort study. Participants and Setting: Patients (n = 15 290) prescribed OAT throughout Ukraine from 2004 through 2016. Measurements Data were analyzed using time–event strategies to estimate cumulative treatment retention, defined as time to OAT discontinuation. Cumulative retention proportions at 1, 12 and 36 months were assessed for outcomes. Cox regression with log‐rank likelihood assessed independent predictors of treatment discontinuation. Findings The proportion prescribed high (MMT: > 85 mg; BMT: ≥ 16 mg), medium (MMT: > 40–85 mg; BMT: > 6–15 mg) and low (MMT: ≤ 40 mg; BMT: ≤ 6 mg) dosages was 25, 43 and 32%, respectively. Retention was significantly higher for BMT than MMT both at 12 (89 versus 75%) and 36 months (80 versus 56%). Although dosing levels for BMT did not influence retention, increasing dosages for MMT were significantly associated with higher retention rates at 1 (90, 96, 99%), 12 (59, 78, 91%) and 36 (34, 59, 79%) months, respectively. Independent predictors associated with 12‐month OAT discontinuation were medium [adjusted hazard ratio (aHR) = 2.23; 95% confidence limit (CL) = 1.95–2.54] and low (aHR = 4.96; 95% CL = 4.37–5.63) OAT dosage relative to high dosage, male sex (aHR = 1.27; 95% CL = 1.14–1.41), MMT relative to BMT prescription (aHR = 1.57; 95% CL = 1.32–1.87) and receiving OAT in general (aHR = 1.22; 95% CL = 1.02–1.46) or tuberculosis (aHR = 1.43; 95% CL = 1.10–1.85) hospitals, relative to specialty addiction treatment and AIDS center settings. Lower dosages contributed more to dropout especially at 1 month (aHR 3.12; 95% CL = 2.21–4.41 and aHR 7.71; 95% CL = 5.51–10.79 for medium and low dosages, respectively). Younger age was significantly associated with OAT discontinuation only at 36 months (aHR = 1.08; 95% CI = 1.02–1.15). Conclusions: Higher dosages of opioid agonist therapies, especially for methadone maintenance treatment patients, appear to be associated with higher levels of treatment retention in Ukraine. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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