Integration of health services improves multiple healthcare outcomes among HIV-infected people who inject drugs in Ukraine

• Published in: Drug and alcohol dependence Vol. 134; pp. 106 - 114
• Main Authors: Bachireddy, Chethan, Soule, Michael C., Izenberg, Jacob M., Dvoryak, Sergey, Dumchev, Konstantin, Altice, Frederick L.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.01.2014
• Subjects: Addiction; Adult; Buprenorphine; Cross-Sectional Studies; Delivery of Health Care - methods; Delivery of Health Care, Integrated - methods; Female; Health care; Health services delivery; Health status; HIV; HIV Infections - diagnosis; HIV Infections - epidemiology; HIV Infections - therapy; HIV/AIDS; Humans; Integrated healthcare; International health; Male; Methadone; Mycobacterium; Opioid substitution therapy; Psychiatry; Quality healthcare indicators; Quality of Life; Substance abuse; Substance Abuse, Intravenous - diagnosis; Substance Abuse, Intravenous - epidemiology; Substance Abuse, Intravenous - therapy; Treatment Outcome; Ukraine; Ukraine - epidemiology; Ukraine; Asia; Europe; HIV/AIDS; Quality healthcare indicators; International health; Integrated healthcare; Buprenorphine; Health services delivery; Substance abuse; Methadone; Opioid substitution therapy
• ISSN: 0376-8716; 1879-0046; 1879-0046
• DOI: 10.1016/j.drugalcdep.2013.09.020

People who inject drugs (PWID) experience poor outcomes and fuel HIV epidemics in middle-income countries in Eastern Europe and Central Asia. We assess integrated/co-located (ICL) healthcare for HIV-infected PWID, which despite international recommendations, is neither widely available nor empirically examined. A 2010 cross-sectional study randomly sampled 296 HIV-infected opioid-dependent PWID from two representative HIV-endemic regions in Ukraine where ICL, non-co-located (NCL) and harm reduction/outreach (HRO) settings are available. ICL settings provide onsite HIV, addiction, and tuberculosis services, NCLs only treat addiction, and HROs provide counseling, needles/syringes, and referrals, but no opioid substitution therapy (OST). The primary outcome was receipt of quality healthcare, measured using a quality healthcare indicator (QHI) composite score representing percentage of eight guidelines-based recommended indicators met for HIV, addiction and tuberculosis treatment. The secondary outcomes were individual QHIs and health-related quality-of-life (HRQoL). On average, ICL-participants had significantly higher QHI composite scores compared to NCL- and HRO-participants (71.9% versus 54.8% versus 37.0%, p<0.001) even after controlling for potential confounders. Compared to NCL-participants, ICL-participants were significantly more likely to receive antiretroviral therapy (49.5% versus 19.2%, p<0.001), especially if CD4≤200 (93.8% versus 62.5% p<0.05); guideline-recommended OST dosage (57.3% versus 41.4%, p<0.05); and isoniazid preventive therapy (42.3% versus 11.2%, p<0.001). Subjects receiving OST had significantly higher HRQoL than those not receiving it (p<0.001); however, HRQoL did not differ significantly between ICL- and NCL-participants. These findings suggest that OST alone improves quality-of-life, while receiving care in integrated settings collectively and individually improves healthcare quality indicators for PWID.