Intrinsic clustering of treatment outcome in recovery from opioid use disorder: Results from starting treatment with agonist replacement therapies

Abstract

s / Drug and Alcohol Dependence 156 (2015) e102–e182 e137 systems. This qualitative study aimed to investigate experiences with a peer delivered strengths-based case management (CM) program to link addiction patients to HIV services in St. Petersburg, Russia. Methods:We recruited 38HIV-infected addiction patients from LINC (Linking Infectious and Narcology Care), a randomized trial (n=350) testing a CM program. Using a semi-structured questionnaire, we conducted 6 focus groups (5 to 8 patients post-CM) in the Russian language. Discussions were audiorecorded, translated and transcribed into English. Two investigators coded transcriptions and analyzed data thematically using Nvivo. Results: Participants were 84% male, median age 36 years, 37% employed, median 14 years of drug use and 7 years since HIV diagnosis. Post-intervention linkage to HIV care was reported by 68%. Those who linked to HIV services embraced the concept of CM, preferably from a peer in recovery, as facilitating their navigation of HIV services in Russia’s fragmented health system. Some felt CM empowered their copingwithhealth systemchallenges and stigma. Among participants not connecting to HIV services, themes such as “lack of motivation”, “no need for HIV care” and “active drug use” emerged as major barriers both to engage with CM and to seek HIV care. Conclusions: Russian addiction patients who linked to HIV care credit CM for facilitating linkage,while those not linking attribute it to personal (rather than external) issues. Implementation of CM in Russia should focus on empowerment and support in addressing both personal and system factors such as stigmatization. Programs need to consider strategies to overcome barriers such as poormotivation. Financial support: Funded by NIDA, R01DA032082, R01DA032082-03S1. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.374 Intrinsic clustering of treatment outcome in recovery from opioid use disorder: Results from starting treatment with agonist replacement therapies Sean Luo1, Jeffery Goldsmith1, Richard Crist3, Wade Berritini3, Andrew Saxon4, Walter Ling5, Maureen P. Hillhouse2, Edward V. Nunes1 1 Columbia University, New York, NY, United States 2 Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles, CA, United States 3 Psychiatry, University of Pennsylvania, Philadelphia, PA, United States 4 Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States 5 UCLA, Integrated Substance Abuse, Los Angeles, CA,