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      Retention in Georgia opioid substitution therapy program and associated factors

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          Abstract

          Background

          Substance abuse has been considered as a growing challenge in Georgia that is closely linked with human immune deficiency virus (HIV) and hepatitis C transmission due to unsafe injection and other uncontrolled behaviors. Methadone maintenance therapy is one of the major treatment options for opioid-dependent individuals. It has proven efficacy in decreasing illegal opioid consumption and criminal behavior as well as reducing the level of HIV infection, mortality, HCV infection, and increasing social functioning.

          Methods

          The data was initially extracted from the electronic database, as of October 30, 2015, for the patients undergoing methadone maintenance therapy in 2014 and 2015. We used two types of statistical analysis: binary regression and time-to-event analysis (Kaplan-Meier). For binary regression analysis, patients who initiated the treatment 12, 9, 6, and 3 months prior to October 30, 2015, respectively, were eligible for >12-, >9-, >6-, and >3-month retention analysis. We identified two types of the retention periods: (I) “the program specific retention period” (the time spent (uninterruptedly) in the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria (GFATM) opioid substitution treatment (OST) program after the clients’ last entry) and (II) “being on OST retention period” (the time spent (uninterruptedly) on OST since the clients’ last entry).

          For time-to-event analysis, the two different endpoints were investigated: (i) dropouts and (ii) being detained.

          Results

          The analysis showed that at each time point, “being on OST retention” rates are slightly higher than “program specific retention” rates. The percentages of patients retained in OST treatment after 3, 6, 9, and 12 months from the initiation of the treatment, respectively, were 89, 86, 85, and 83% and the percentages of patients retained in the GFATM program at the same time points were 88, 83, 82, and 80%. Patients older than 40 years are twice as likely to stay in the program compared to younger individuals. Gender is only associated with >9 and >12 months retention with approximately three times the odds for men compared to women. The strength of the association between hepatitis C status and “program specific” retention increases with time spent in the program as p values decrease from 0.07 for >3- and >6-month retention to 0.01 for >9- and >12-month retention. The younger age group was more likely to get dropouts and be detained. HIV status and social status did not show statistically significant association with retention.

          Conclusions

          These findings identify the need for more support for younger patients as they are more vulnerable to dropouts and detention compared to the older age group, especially during the early stage of treatment.

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          Most cited references6

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          Retention rate and substance use in methadone and buprenorphine maintenance therapy and predictors of outcome: results from a randomized study.

          This was a 6-month, randomized, flexible-dose study comparing the effects of methadone (Meth) and buprenorphine (Bup) on retention rate and substance use in a sample of 140 opioid-dependent, primarily heroin-addicted, patients who had been without opioid substitution therapy in the 4 weeks prior to the study. The major aims were to compare the efficacy of Bup and Meth in a flexible dosing regimen and to identify possible predictors of outcome. There were no major inhomogeneities between treatment groups. All patients also received standardized psychosocial interventions. Mean daily dosages after the induction phase were 44-50 mg for Meth and 9-12 mg for Bup. Results from this study indicate a favourable outcome, with an overall retention rate of 52.1% and no significant differences between treatment groups (55.3% vs. 48.4%). Substance use decreased significantly over time in both groups and was non-significantly lower in the Bup group. Predictors of outcome were length of continuous opioid use and age at onset of opioid use, although these were only significant in the Bup group. Mean dosage and other parameters were not significant predictors of outcome. Overall, the results of this study give further evidence that substitution treatment is a safe and effective treatment for drug dependence. Meth and Bup are equally effective. Duration of continuous opioid use and age at onset were found to have predictive value for negative outcome. The intensity of withdrawal symptoms showed the strongest correlation with drop-out. Future studies are warranted to further address patient profiles and outcome under different substitution regimens.
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            Retention in opioid substitution treatment: a major predictor of long-term virological success for HIV-infected injection drug users receiving antiretroviral treatment.

            The positive impact of opioid substitution treatment (OST) on opioid-dependent individuals with human immunodeficiency virus (HIV) infection is well documented, especially with regard to adherence to highly active antiretroviral therapy (HAART). We used the data from a 5-year longitudinal study of the MANIF 2000 cohort of individuals infected with HIV (as a result of injection drug use) and receiving HAART to investigate the predictors of long-term virological success. Design. Data were collected every 6 months from outpatient hospital services delivering HIV care in France. We selected all patients who were receiving HAART for at least 6 months (baseline visit) and who had indications for OST (ie, still dependent on opioids). We selected a total of 113 patients, accounting for a total of 562 visits for all the analyses. Long-term virological success was defined as an undetectable viral load after at least 6 months on HAART. Retention in OST was defined as the time interval between the last initiation or reinitiation of OST during HAART follow-up and any given visit on OST. A mixed logistic model was used to identify predictors of long-term virological success. At baseline, 53 patients were receiving buprenorphine, 28 patients were receiving methadone, and 32 patients were not on OST. The median duration of OST was 25 months (range, 3-42 months). In the multivariate analysis, after adjustment for significant predictors of long-term virological success such as adherence to HAART and early virological response, retention in OST was associated with long-term virological success (odds ratio, 1.20 per 6-month increase; 95% confidence interval, 1.09-1.32). Our study presents important evidence of the positive impact of retention in OST on HIV outcomes. Increasing access to OST based on a comprehensive model of care for HIV-infected patients who have indications for OST may foster adherence and ensure long-term response to HAART.
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              Feasibility of buprenorphine maintenance therapy programs in the Ukraine: first promising treatment outcomes.

              Opiate substitution therapy (OST) in the Ukraine was not provided until 2004. As part of the introduction of OST, the first feasibility study was conducted in 2007. Six clinics in 6 cities were involved in providing OST and collecting data. A total of 151 opiate-dependent patients were given buprenorphine as a substitute, and a survey of substance use, HIV transmission risks, and legal and social status was conducted at baseline and at 6 and 12-month follow-up. Illegal substance use and illegal activities and incomes were highly reduced, whereas employment rates and psychiatric problems improved. Retention was comparatively high (79.5%) after 12 months. No significant adverse events were reported. A successful implementation of OST in the Ukraine is feasible. Copyright 2009 S. Karger AG, Basel.
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                Author and article information

                Contributors
                eruadze@gmail.com , e.ruadze@ncdc.ge
                khatunatod3009@gmail.com
                Journal
                Harm Reduct J
                Harm Reduct J
                Harm Reduction Journal
                BioMed Central (London )
                1477-7517
                8 December 2016
                8 December 2016
                2016
                : 13
                : 35
                Affiliations
                [1 ]The National Center for Disease Control and Public Health, 9 Asatiani Street, Tbilisi, Georgia
                [2 ]Center for Mental Health and Prevention of Addiction, 21 Kavtaradze Street, Tbilisi, Georgia
                [3 ]Addiction Department, Tbilisi State Medical University, 7 Asatiani Street, Tbilisi, Georgia
                Author information
                http://orcid.org/0000-0003-3790-3804
                Article
                124
                10.1186/s12954-016-0124-z
                5146853
                27931232
                f87061ad-95eb-449a-a8ca-6077fba87cfb
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 17 May 2016
                : 29 November 2016
                Funding
                Funded by: GFATM GEO-H-NCDC
                Categories
                Research
                Custom metadata
                © The Author(s) 2016

                Health & Social care
                substance abuse,retention rate,opioid substitute treatment,detoxification
                Health & Social care
                substance abuse, retention rate, opioid substitute treatment, detoxification

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