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

2013; Elsevier BV; Volume: 134; Linguagem: Inglês

10.1016/j.drugalcdep.2013.09.020

1879-0046

Chethan Bachireddy, Michael Soule, Jacob M. Izenberg, Sergey Dvoryak, Konstantin Dumchev, Frederick L. Altice,

HIV Research and Treatment

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.