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Retention on treatment and mortality of methadone maintenance therapy patients before and after take-home dosing policy change during COVID-19 pandemic in Ukraine

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BACKGROUND: The aim of this research is to assess the effect of the expansion of methadone maintenance treatment(MMT) take-home dosing, a drug dispensing policy relaxation implemented due to the COVID-19 pandemic, on retention and mortality of patients who inject drugs(PWID) in Ukraine.
METHODS: A prospective quasi-experimental Kaplan-Meier survival analysis was applied to compare MMT retention and mortality between OUD patients enrolled in treatment during the year before the take-home dosing regulation update (03/18/2020), induced by COVID-19 restrictions, and those enrolled during the year following the policy change. Age, sex, HIV status, methadone dosing, take-home dispensing, and previous MMT experience were assessed for their effect on treatment retention and death using Cox multivariate regression models.
RESULTS: Among the pre-(N=3,350) and post-(N=3,775) COVID policy change cohorts, 26% and 55% of patients were transferred to take-home dosing within 365 days, respectively. Patients enrolled in treatment post-COVID had significantly (p<0.0001) higher retention at 1(98%vs.96%) and 12(82%vs.78%) months (Fig.1); and higher (p<0.0001) survival probability at 1(99.6% vs. 99.2%) and 12(97.9%vs.95.1%) months(Fig.2). Patients enrolled post-COVID had 29%(p<0.0001) lower risk for dropout and 30%(p=0.03) lower risk of death at 12 months controlling for methadone dose, HIV-status. MMT retention and patient mortality didn''t differ after controlling for take-home dosing, indicating that take-home dosing is significantly associated with higher treatment retention and survival in a post-COVID group(Table1).



Table 1. Cox regression model of factors associated dropout and death on opioid agonist therapy, N = 7,125

CrudeAdjusted for dose and HIV statusAdjusted for dose, HIV-status, and
Take-Home Dosing

cHR95% CLp-val.aHR95% CLp-val.aHR95% CLp-val.
Risk of Drop-Out in the Pre-COVID Cohort Compared to the Post-COVID Cohort
12 months0.640.56-0.73<.00010.700.61-0.80<.00010.900.83-1.250.158
Risk of Death in the Pre-COVID Cohort Compared to the Post-COVID Cohort
12 months0.720.49-0.910.010.700.52-0.960.030.800.60-1.10.168
Legend: cHR: crude hazard ratio; aHR: adjusted hazard ratio; CL: confidence limits;

CONCLUSIONS: The proportion of patients transferred to take-home dosing during the post-COVID period was more than double compared to pre-COVID period. Take-home dosing contributed to higher retention and survival in the post-COVID group, presenting further opportunity for the treatment scale-up as cost-effective HIV-prevention strategy in Ukraine.