Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA.
APT Foundation, New Haven, CT, USA.
Addiction. 2024 Sep;119(9):1585-1596. doi: 10.1111/add.16565. Epub 2024 May 28.
Ukraine's Ministry of Health released urgent COVID-19 guidelines, allowing for early implementation of take-home dosing (THD) for opioid agonist therapies (OAT) such as methadone. Enrollment in OAT and retention in the program are the most effective HIV prevention strategies for people who inject drugs (PWID). This study aimed to evaluate the impact of Ukraine's COVID-19 emergency guidance on OAT treatment enrollment, retention on treatment and mortality.
Using Ukraine's national OAT registry for 252 governmental clinics across 25 regions, we conducted a 12-month comparative prospective cohort survival analysis. This study compared newly enrolled methadone patients within the initial 6 months following the COVID-19 guidance (COVID) with patients from the preceding year (pre-COVID) in a country with high adult HIV prevalence (1.2%) that is concentrated in PWID.
In the nation-wide sample of newly enrolled PWID in Ukraine, comprising 2798 individuals, 1423 were in the COVID cohort and 1375 were in the pre-COVID cohort. The majority were male (86.7%), with an average age of 39.3 years.
Primary outcomes were average monthly enrollment per cohort, treatment retention and mortality, with internal time-dependent predictors, including THD and optimal (> 85 mg) methadone dosing.
Relative to the pre-COVID period, the monthly average patient enrollment was statistically significantly higher during the COVID period (283.7 versus 236.0; P < 0.0001), where patients were more likely to transition to THD and achieve optimal dosing earlier. Significant differences were observed in the proportions of person-months on THD (41 versus 13%, P < 0.0001) and optimal dosing (38 versus 31%, P < 0.0001) between the COVID and pre-COVID cohorts. Predictors of treatment retention, expressed as adjusted hazard ratios (aHR), included early THD [aHR = 1.90, 95% confidence interval (CI) = 1.47-2.45], early optimal dosing (aHR = 1.71, 95% CI = 1.37-2.13) and prior methadone treatment (aHR = 1.39, 95% CI = 1.15-1.68). These factors persisted, respectively, in the pre-COVID (aHR = 2.28, 95% CI = 1.41-3.70; aHR = 1.84, 95% CI = 1.32-2.56; and aHR = 1.36, 95% CI = 1.06-1.74) and COVID (aHR = 1.91, 95% CI = 1.40-2.59; aHR = 1.61, 95% CI = 1.20-2.16; and aHR = 1.49, 95% CI = 1.08-1.94) cohorts. Survival did not differ significantly between the two prospective cohorts.
Ukraine's prompt adoption of early take-home dosing for opioid agonist therapies, such as methadone, following the emergency COVID-19 guidance appears to have increased enrollment into methadone and improved treatment retention for people who inject drugs without adverse effects on patient survival.
乌克兰卫生部发布了紧急 COVID-19 指南，允许早期实施阿片类激动剂治疗（OAT）的家庭用药（THD），例如美沙酮。在注射毒品的人群（PWID）中，OAT 的注册和保留是预防 HIV 最有效的策略。本研究旨在评估乌克兰 COVID-19 紧急指南对 OAT 治疗注册、治疗保留和死亡率的影响。
利用乌克兰全国 25 个地区 252 家政府诊所的 OAT 登记处，我们进行了为期 12 个月的前瞻性队列生存分析。这项研究比较了在 COVID-19 指南发布后的最初 6 个月内新注册的美沙酮患者（COVID 队列）与前一年（COVID 前）的患者，研究对象是一个成人 HIV 患病率高（1.2%）且集中在 PWID 中的国家。
在乌克兰全国新登记的 PWID 样本中，包括 2798 人，其中 1423 人在 COVID 队列中，1375 人在 COVID 前队列中。大多数人是男性（86.7%），平均年龄为 39.3 岁。
主要结果是每个队列的平均每月注册人数、治疗保留率和死亡率，包括内部时间依赖性预测因素，包括 THD 和最佳（>85mg）美沙酮剂量。
与 COVID 前时期相比，COVID 时期每月平均患者注册人数显著增加（283.7 比 236.0；P<0.0001），患者更有可能过渡到 THD 并更早达到最佳剂量。在 COVID 和 COVID 前队列中，THD（41%比 13%，P<0.0001）和最佳剂量（38%比 31%，P<0.0001）的比例存在显著差异。治疗保留的预测因素，以调整后的危险比（aHR）表示，包括早期 THD[aHR=1.90，95%置信区间（CI）=1.47-2.45]、早期最佳剂量（aHR=1.71，95% CI=1.37-2.13）和以前的美沙酮治疗（aHR=1.39，95% CI=1.15-1.68）。这些因素在 COVID 前（aHR=2.28，95% CI=1.41-3.70；aHR=1.84，95% CI=1.32-2.56；aHR=1.36，95% CI=1.06-1.74）和 COVID（aHR=1.91，95% CI=1.40-2.59；aHR=1.61，95% CI=1.20-2.16；aHR=1.49，95% CI=1.08-1.94）队列中分别持续存在。两个前瞻性队列之间的生存情况没有显著差异。
乌克兰在 COVID-19 紧急指南后迅速采用美沙酮等阿片类激动剂治疗的早期家庭用药，似乎增加了美沙酮的注册，并提高了治疗保留率，而对注射毒品患者的生存没有不良影响。
