Methadone treatment improves tuberculosis treatment among hospitalized opioid dependent patients in Ukraine |
| |
| Authors: | Olga Morozova Sergii Dvoryak Frederick L. Altice |
| |
| Affiliation: | 1. Ukrainian Institute on Public Health Policy, 4 Malopidvalna Str., Office 6, Kyiv 01001, Ukraine;2. Yale University School of Medicine, New Haven, CT, USA;3. Yale University School of Public Health, 135 College Street, Suite 323, New Haven, CT 06510-2283, USA;1. Medical Students Research Center of International Campus, Tehran University of Medical Sciences, Tehran, Iran;2. University of Social Welfare and Rehabilitation Sciences, Tehran, Iran;1. University Centre of Legal Medicine of Geneva and Lausanne, 9, av. de Champel, 1211 Geneva 4, Switzerland;2. Unit for Dependency in Primary Care at the Department of Community Health and Primary Care, University Hospitals of Geneva, Faculty of Medicine, 1211 Geneva 4, Switzerland;3. Head of the Institute of Biomedical Ethics at the University of Basel, Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland;1. Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada;2. Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Canada;3. Department of Psychiatry, University of Toronto, Toronto, Canada;4. Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil;5. Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil;6. Infectious Diseases Division, University of Ottawa, Ottawa, Canada;1. Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran;2. Institute for Cognitive Science Studies, Tehran, Iran;3. School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran |
| |
| Abstract: | BackgroundUkraine's volatile syndemics of tuberculosis (TB) and HIV among people who inject drugs (PWIDs) introduces numerous treatment challenges for each condition, including high mortality and development of multi-drug resistant TB (MDR-TB).MethodsA prospective, non-randomized 90-day observational study was conducted in six Ukrainian TB treatment sites to assess the effectiveness of integrating methadone maintenance (MMT) with TB treatment using: (1) 90-day TB treatment retention; (2) time to treatment discontinuation; (3) TB medication adherence; and (4) subject disposition, including mortality. Of the 110 participants enrolled, 57 received MMT and 53 did not (non-MMT).ResultsAll of the primary outcomes were significantly better in MMT versus non-MMT groups, including 90-day TB treatment completion (89.5% versus 73.6%; p = 0.031), time to TB treatment discontinuation (p = 0.039) and TB medication adherence (97.1% versus 86.2%; p < 0.001) after controlling for death. The major reasons for treatment non-completion in the non-MMT group included death (N = 3), administrative discharge from the clinic (N = 5), loss to follow-up (N = 2), and arrest (N = 4). Overall, 90-day mortality was high (8.2%). After controlling for covariates differing between the two groups at baseline, the only independent predictor of completing 90 days of TB treatment was receipt of MMT in an integrated treatment setting (AOR = 3.05; 95% CI 1.08–8.66).ConclusionsMMT integrated into inpatient TB treatment significantly improves retention in TB treatment and TB medication adherence among PWIDs. These findings call for policy change to increase the number of MMT sites in TB facilities and make MMT a low-threshold treatment option for opioid dependence in Ukraine. |
| |
| Keywords: | Methadone maintenance Tuberculosis HIV/AIDS MDR-TB Treatment retention Adherence Substance Abuse Opioid dependence Ukraine |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
