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The effect of opioid agonist therapy on HIV care cascade among PWID in Ukraine

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BACKGROUND: People who inject drugs (PWID) constitute more than 50% of all people living with HIV in Ukraine, and most of them were using opioids. Opioid agonist therapy (OAT) is known to reduce risks associated with injecting drug use, improve access to ART and adherence. OAT in Ukraine is expanding gradually, currently reaching >17,000 patients. In this study we assessed the effect of OAT on HIV care cascade outcomes.
METHODS: A cross-sectional survey was conducted in 6 regions of Ukraine in 2021, with half of participants recruited using simple random sampling among OAT patients and another half using respondent driven sampling among out-of-treatment PWID. PWID seeds were selected from clients of harm reduction programs. The survey questionnaire administered anonymously, and included questions on HIV and OAT treatment history, adherence, barriers to care, and mental health. HIV care cascade outcomes were compared using Chi-square tests.
RESULTS: The survey recruited 652 OAT patients (17% women) and 650 PWID (25% women). Ever tested for HIV were 632(96.9%) among OAT patients and 516(79.4%) among PWID (p<0.001). Of those tested, 217(35.2%) of OAT patients and 84(17.2%) of PWID disclosed their HIV positive status. HIV care cascade for two groups is presented in Figure 1. All indicators, including having confirmatory testing and being registered in HIV care, being prescribed ART, currently taking ART, and ART adherence were significantly higher in the OAT group (p=0.002, p=0.007, p<0.001, p<0.001, respectively).


CONCLUSIONS: ART uptake was relatively high in OAT patients and out-of-treatment PWID in Ukraine. Despite the limitations of cross-sectional design, the study confirmed the significant positive effect of OAT on HIV treatment engagement and adherence. ART adherence remains suboptimal in both groups. Further analysis will identify factors associated with OAT engagement and adherence to ART to inform strategies to reach 95-95-95 goals in this population.