APT Foundation, New Haven, CT, USA.
ICF Alliance for Public Health, Kyiv, Ukraine.
Addiction. 2021 Jan;116(1):83-93. doi: 10.1111/add.15115. Epub 2020 Aug 9.
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.
Observational longitudinal cohort study.
Patients (n = 15 290) prescribed OAT throughout Ukraine from 2004 through 2016.
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.
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).
Higher dosages of opioid agonist therapies, especially for methadone maintenance treatment patients, appear to be associated with higher levels of treatment retention in Ukraine.
乌克兰的艾滋病毒流行仍然集中在阿片类药物依赖的注射吸毒者（PWID）中，在这些人群中，美沙酮（MMT）和丁丙诺啡（BMT）维持治疗等阿片类激动剂疗法是最具成本效益的艾滋病毒预防策略，但这些治疗方法的规模仍然较小。本研究旨在衡量规定的阿片类激动剂治疗剂量和类型与治疗保留之间的关联。
观察性纵向队列研究。
2004 年至 2016 年期间，乌克兰各地接受 OAT 治疗的患者（n=15290）。
使用时间事件策略分析数据，以估计 OAT 停药的累积治疗保留率，定义为 OAT 停药时间。评估了 1、12 和 36 个月的治疗保留比例。Cox 回归和对数秩检验评估了治疗中断的独立预测因素。
规定高（MMT：>85mg；BMT：≥16mg）、中（MMT：>40-85mg；BMT：>6-15mg）和低（MMT：≤40mg；BMT：≤6mg）剂量的比例分别为 25%、43%和 32%。BMT 的保留率明显高于 MMT，12 个月时为 89%（75%）和 36 个月时为 80%（56%）。虽然 BMT 的剂量水平不影响保留率，但 MMT 的剂量增加与 1 个月（90、96、99%）、12 个月（59、78、91%）和 36 个月（34、59、79%）的保留率显著相关。与 12 个月 OAT 停药相关的独立预测因素包括中剂量（调整后的危险比[aHR]2.23；95%置信区间[95%CI]1.95-2.54）和低剂量（aHR 4.96；95%CI 4.37-5.63）与高剂量相比，男性（aHR 1.27；95%CI 1.14-1.41），与 BMT 处方相比，MMT（aHR 1.57；95%CI 1.32-1.87），以及一般接受 OAT（aHR 1.22；95%CI 1.02-1.46）或结核病（aHR 1.43；95%CI 1.10-1.85）医院，与专科成瘾治疗和艾滋病中心环境相比。较低的剂量尤其会导致更多的停药，特别是在 1 个月时（aHR 3.12；95%CI 2.21-4.41 和 aHR 7.71；95%CI 5.51-10.79，中剂量和低剂量）。仅在 36 个月时，年龄较小与 OAT 停药显著相关（aHR 1.08；95%CI 1.02-1.15）。
阿片类激动剂治疗剂量较高，特别是美沙酮维持治疗患者，似乎与乌克兰更高的治疗保留率相关。
