Boltaev Azizbek A, Deryabina Anna P, Kusainov Almas, Howard Andrea A
ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA.
Adv Prev Med. 2012;2012:308793. doi: 10.1155/2012/308793. Epub 2012 Dec 10.
Study Aims. Evaluate the quality and effectiveness of the medication-assisted therapy (MAT) pilot in Kazakhstan and review implementation context and related challenges. Methods. We performed a desk review of MAT policy and program documents and reviewed medical records at three MAT sites in Kazakhstan. MAT patients (n = 93) were interviewed to assess their perceptions of the program and its impact on their health, criminal, drug use, and HIV risk related behaviors as well as expenditures on nonprescribed psychoactive drugs. Persons injecting drugs who are not in treatment, MAT program staff, and other stakeholders were interviewed to obtain their perspectives on MAT. Results. Legislation supports introducing MAT as a standard of care for treatment of opioid dependence; however, its progress has been hampered by active opposition. Inadequate access and coverage, insufficient supply management, scarce infrastructure of narcological facilities, limited opportunities for staff development, and restrictive methadone dispensing policies compromise the quality of the intervention and limit its potential benefits. There were significant reductions in criminal, drug use, and HIV risk related behaviors in patients receiving MAT. Conclusions. The MAT pilot in Kazakhstan demonstrated its feasibility and effectiveness in the local context and is recommended for scaleup throughout the country.
研究目的。评估哈萨克斯坦药物辅助治疗（MAT）试点项目的质量和效果，并审视实施背景及相关挑战。方法。我们对MAT政策和项目文件进行了案头审查，并查阅了哈萨克斯坦三个MAT试点地点的医疗记录。对MAT患者（n = 93）进行了访谈，以评估他们对该项目的看法及其对他们的健康、犯罪、吸毒以及与艾滋病毒风险相关行为的影响，以及在非处方精神活性药物上的支出。对未接受治疗的注射吸毒者、MAT项目工作人员及其他利益相关者进行了访谈，以了解他们对MAT的看法。结果。立法支持将MAT作为阿片类药物依赖治疗的护理标准引入；然而，其进展受到了积极反对的阻碍。获取服务和覆盖范围不足、供应管理不善、麻醉学设施基础设施匮乏、工作人员发展机会有限以及美沙酮配给政策严格，损害了干预措施的质量并限制了其潜在益处。接受MAT治疗的患者在犯罪、吸毒以及与艾滋病毒风险相关行为方面有显著减少。结论。哈萨克斯坦的MAT试点项目在当地背景下证明了其可行性和有效性，建议在全国范围内扩大规模。
