Abstract
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.
Highlights
Kazakhstan faces a concentrated HIV epidemic, with drug use being the most important risk factor for HIV transmission [1, 2]
Kazakhstan leadership demonstrates strong support for Medication-assisted therapy (MAT): in 2005, President Nazarbayev urged Kazakh healthcare to introduce innovative methods of HIV prevention, including the use of methadone to treat drug users [10, 11], and MAT was included in the National Healthcare Program “Salamatty Kazakhstan” and budget [12] as a measure to prevent HIV among people who injected drugs (PWID)
Clinical staff at all three MAT sites indicated that all patients undergo review by all specialists and urine toxicology tests are performed on a quarterly basis and that the results of these reviews are communicated within the MAT team and to the patient
Summary
Kazakhstan faces a concentrated HIV epidemic, with drug use being the most important risk factor for HIV transmission [1, 2]. Medication-assisted therapy (MAT), more widely known in the region as opioid substitution therapy (OST), is a rigorously evaluated and evidence-based medical intervention to treat opioid dependence that consists of prescription of methadone or buprenorphine as a replacement for illicit street opioid narcotics such as heroin. Research conducted to date has generated a great amount of evidence demonstrating that MAT in combination with psychosocial support produces the best outcomes in terms of reduced frequency of illicit drug use and injections, decreased criminal behavior, and improved social functioning [3]. By March 2012, MAT was implemented at three sites (Pavlodar, Temirtau, and Ust-Kamenogorsk), with a cumulative enrollment of 265 patients, of whom 118 were still actively enrolled in the program
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