Abstract
BackgroundOpioid agonist treatment (OAT) is an effective method of addiction treatment and HIV prevention. However, globally, people who inject drugs (PWID) have insufficient OAT uptake. To expand OAT access and uptake, policymakers, program developers and healthcare providers should be aware of barriers to and facilitators of OAT uptake among PWID.MethodsAs a part of the HPTN 074 study, which assessed the feasibility of an intervention to facilitate HIV treatment and OAT in PWID living with HIV in Indonesia, Ukraine, and Vietnam, we conducted in-depth interviews with 37 HIV-positive PWID and 25 healthcare providers to explore barriers to and facilitators of OAT uptake. All interviews were audio-recorded, transcribed, translated into English, and coded in NVivo for analysis. We developed matrices to identify emergent themes and patterns.ResultsDespite some reported country-specific factors, PWID and healthcare providers at all geographic locations reported similar barriers to OAT initiation, such as complicated procedures to initiate OAT, problematic clinic access, lack of information on OAT, misconceptions about methadone, financial burden, and stigma toward PWID. However, while PWID reported fear of drug interaction (OAT and antiretroviral therapy), providers perceived that PWID prioritized drug use over caring for their health and hence were less motivated to take up ART and OAT. Motivation for a life change and social support were reported to be facilitators.ConclusionThese results highlight a need for support for PWID to initiate and retain in drug treatment. To expand OAT in all three countries, it is necessary to facilitate access and ensure low-threshold, financially affordable OAT programs for PWID, accompanied with supporting interventions. PWID attitudes and beliefs about OAT indicate the need for informational campaigns to counter misinformation and stigma associated with addiction and OAT (especially methadone).
Highlights
Opioid agonist treatment (OAT) is an effective Human immunodeficiency virus (HIV) prevention and treatment engagement strategy for opioid-dependent people who inject drugs (PWID) in Eastern Europe and Southeast Asia, where the HIV epidemic is still significantly driven by injection drug use [1, 2]
For PWID living with HIV, OAT improves linkage to HIV care, adherence to antiretroviral therapy (ART), and HIV treatment outcomes [10,11,12,13,14,15]
To evaluate the feasibility of the HPTN 074 integrated intervention, two rounds of in-depth interviews were conducted with study participants (PWID living with HIV) randomized to the intervention group and their healthcare providers across three study sites (Kyiv, Ukrainian Institute on Public Health Policy (Ukraine); Thai Nguyen, Vietnam; and Jakarta, Indonesia) [31]
Summary
Opioid agonist treatment (OAT) is an effective HIV prevention and treatment engagement strategy for opioid-dependent people who inject drugs (PWID) in Eastern Europe and Southeast Asia, where the HIV epidemic is still significantly driven by injection drug use [1, 2]. Integrated provision of OAT and HIV care was found beneficial for both treatments in multiple settings and was recognized as a priority strategy by WHO [16]. Despite these well-documented benefits of OAT, poor scale-up, low coverage, and poor retention diminish its potential benefits. To expand OAT access and uptake, policymakers, program developers and healthcare providers should be aware of barriers to and facilitators of OAT uptake among PWID
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