Sergii Dvoriak

Opioid use disorder (OUD) drives high morbidity and mortality, but access to opioid agonist therapy (OAT) is limited in low- and middle-income countries. Integrating OAT into primary care may expand access and improve comorbidity management, although provider discomfort remains a barrier. To compare health care use among persons with OUD receiving methadone in specialty clinics versus primary care centers in Ukraine (January 2018 to December 2023). Two-group randomized controlled trial with 2:1 allocation to intervention and control. (ClinicalTrials.gov: NCT04927091). Thirteen cities in Ukraine: Cherkasy, Dnipro, Kramatorsk, Kropyvnytskyi, Kryvyi Rih, Kyiv, Lviv, Mariupol, Mykolaiv, Odesa, Rivne, Sloviansk, and Zhytomyr. A total of 1459 adults with OUD (950 intervention, 509 control) initiating or receiving methadone. Methadone delivered in primary care aided with telementoring, an Extension for Community Healthcare Outcomes-like model that is adapted to the Ukraine context, versus standard specialty clinic care. Primary outcome: difference in composite quality health indicator (QHI) scores between groups at 24 months, representing access to 17 guideline-concordant services (9 primary care and 8 specialty care) received, assessed through surveys and ranging from 0 to 100. Secondary outcomes: domain-specific QHI scores and methadone treatment indicators. Participants in primary care settings achieved higher composite QHI scores than those in specialty clinics, with a mean difference of 9.1 percentage points (95% CI, 6.9 to 11.2 percentage points) at 24 months. Results were similar for primary care QHI (12.3 percentage points [CI, 9.0 to 15.6 percentage points]) and specialty care QHI (5.2 percentage points [CI, 0.2 to 10.3 percentage points]). Methadone retention among new patients at 24 months was 67.2% in primary care versus 64.7% in specialty clinics. Quality health indicators reflect health care use rather than health outcomes. Quality health indicators were equally weighted despite differing clinical significance. Integrating methadone treatment into primary care settings improves adherence to guideline-concordant health care without compromising methadone retention and treatment quality. National Institute on Drug Abuse.

Background Most national programmes of opioid agonist therapy (OAT) in Eastern Europe and Central Asia are at a critical juncture for building their sustainability due to decreasing support from the Global Fund and other international HIV funders. Therefore, it is timely to identify the status, trends, opportunities and risk factors of OAT preparedness in the face of donor transition. Methods The study assessed the OAT sustainability progress in 4 countries: Belarus, the Republic of Moldova, Tajikistan and Ukraine. The national assessments were conducted in 2020 and repeated during 2022–2023. In total, 363 sources were reviewed and used, 83 interviews with key informants and 13 focus groups were conducted with clients, using a joint methodology and a defined Framework with three dimensions: ‘Policy & Governance’; ‘Finance & Resources’; and, ‘Services’. Results All four countries have made improvements to increase OAT sustainability, though it varied. In 2022, Ukraine had a substantial degree of sustainability, followed by Belarus and Moldova with a moderate degree, while Tajikistan’s sustainability was at moderate-to-high risk. No country achieved a high degree of OAT sustainability in any of the three dimensions measured. However, a high degree of sustainability was reported for at least one indicator in Belarus, Moldova and Ukraine: ‘Medicines’; ‘Financial resources’; ‘Evidence and information systems’; ‘Service Accessibility’; or, ‘Service integration & quality’. On average, the greatest improvement between 2020 and 2022 was seen for ‘Availability & coverage’; ‘Financial resources’; ‘Service quality & integration’; and, ‘Service accessibility’. The highest risks across the countries, notably in Belarus and Tajikistan, were recorded for the indicator, ‘Availability and coverage’. Of concern is that the least progress, or even a decline, was found in ‘Human resources’ within the sustainability indicator. Conclusions OAT sustainability in 4 analysed countries remains at risk, although those countries are at a different point of donor transition. OAT resilience and ability to scale up depend upon multiple factors. Political will and continued funding are two of them, as demonstrated by Ukraine’s progress despite challenges posed by Russia’s full-scale invasion in 2022. The results show that both financial and programmatic areas are at risk and stagnating progress requires collective efforts.

Background: Efficient and linguistically appropriate instruments are needed to assess response to addiction treatment, including severity of addiction/mental health status. This is critical for Russian-speaking persons in Eastern Europe and Central Asia (EECA) where Medications for Opioid Use Disorder (MOUD) remain underscaled to address expanding and intertwined opioid, HIV, HCV and tuberculosis epidemics. We developed and conducted a pilot validation of a Russian version of the 24-item Behavior and Symptom Identification Scale (BASIS-24), an addiction/mental health severity instrument with six subscales, previously validated in English. Methods: Using the Mapi approach, we reviewed, translated, and back-translated the content to Russian, pilot-tested the Russian-version (BASIS-24-R) among new MOUD patients in Ukraine (N = 283). For a subset of patients (n = 44), test-rest was performed 48 h after admission to reassess reliability of BASIS-24-R. Exploratory principal component analysis (PCA) assessed underlying structure of BASIS-24-R. Results: Cronbach alpha coefficients for overall BASIS-24-R and 5 subscales exceeded 0.65; coefficient for Relationship subscale was 0.42. The Pearson correlation coefficients for overall score and all subscales on the BASIS-24-R exceeded 0.8. Each item loaded onto factors that corresponded with English BASIS-24 subscales ≥ 0.4 in PCA. Conclusion: Initial version of BASIS-24-R appears statistically valid in Russian. Use of the BASIS-24-R has potential to guide MOUD treatment delivery in the EECA region and help to align addiction treatment with HIV prevention goals in a region where HIV is concentrated in people who inject opioids and where healthcare professionals have not traditionally perceived MOUD as effective treatment, particularly for those with mental health co-morbidities.

В межах теоретико-аналітичного дослідження визначено, що соціальна сфера в Україні залучає до розв’язання різних професійних завдань чимало парапрофесіоналів, тобто тих, хто не має фахової освіти із соціальної роботи, але пройшли певне навчання, переважно неформальне, і виконують функції соціальних працівників. Окреслено розуміння поняття «компетентність» як здатності до виконання певних трудових функцій. На прикладі консультантів за принципом «рівний-рівному», громадських радників та батьків-вихователів у сімейних формах виховання дітей-сиріт та дітей, позбавлених батьківського піклування, розглянуто зміст діяльності парасоціальних працівників та специфіку їхньої підготовки. Запропоновано перелік тих загальних компетентностей, на формування яких мають бути спрямовані програми формального та неформального навчання цієї категорії працівників (гендерна компетентність, цифрові компетентності, етичні компетентності, компетентності міжпрофесійної взаємодії тощо).

The paper reviews the development of new research methods in the context of digitalisation of many spheres of life, which has accelerated especially due to the COVID-19 pandemic. The paper reveals the possibilities and limitations of using digital technologies to collect information in social work research. The study employed the methods of systematic analysis of data from academic publications and reflection of the authors’ own experience of collecting information using online technologies within research projects focused on the development of various socio-psychological services. The main groups of online methods and means of data collection implemented in quantitative and qualitative research are described. The advantages of online data collection are highlighted, including its use under conditions of limited movement, greater coverage of respondents and territories, relative economy, greater ability to control the flow of surveys, data entries and storage. A number of problems and challenges of using new methods have been identified, in particular, the complexity of sampling; lack of research resources in the case of collecting information about people who do not have a proper access to modern means of communication or skills to use them, etc. Mandatory procedures for such research, due to ethical requirements (guaranteeing anonymity and confidentiality, obtaining informed consent to participate in the study) are outlined. Some examples of problem-solving within the surveys of the women infected with HIV and the projects aimed at assisting the persons taking drugs by means of injecting are provided. The immediate prospects for the development of this topic are defined as the encouragement of Internet users to participate in research on social work, the development of communication skills between researchers and participants in online research alongside facilitation of virtual discussions during online focus groups.

Introduction: People who inject drugs (PWID) experience high HIV incidence and face significant barriers to engagement in HIV care and substance use treatment. Strategies for HIV treatment as prevention and substance use treatment present unique challenges in PWID that may vary regionally. Understanding differences in the risk structure for HIV transmission and disease progression among PWID is essential in developing and effectively targeting intervention strategies of HIV treatment as prevention.Methods: We present a baseline analysis of HIV Prevention Trials Network (HPTN) 074, a two‐arm, randomized controlled trial among PWID in Indonesia (n = 258), Ukraine (n = 457) and Vietnam (n = 439). HPTN 074 was designed to determine the feasibility, barriers and uptake of an integrated intervention combining health systems navigation and psychosocial counselling for the early engagement of antiretroviral therapy (ART) and substance use treatment for PWID living with HIV. Discordant PWID networks were enrolled, consisting of an HIV‐positive index and their HIV‐negative network injection partner(s). Among the enrolled cohort of 1154 participants (502 index participants and 652 network partners), we examine regional differences in the baseline risk structure, including sociodemographics, HIV and substance use treatment history, and injection and sexual risk behaviours.Results: The majority of participants were male (87%), with 82% of the enrolled females coming from Ukraine. The overall mean age was 34 (IQR: 30, 38). Most commonly injected substances included illegally manufactured methadone in Ukraine (84.2%), and heroin in Indonesia (81.8%) and Vietnam (99.5%). Injection network sizes varied by region: median number of people with whom participants self‐reported injecting drugs was 3 (IQR: 2, 5) in Indonesia, 5 (IQR: 3, 10) in Ukraine and 3 (IQR: 2, 4) in Vietnam. Hazardous alcohol use, assessed using the Alcohol Use Disorders Identification Test – Alcohol Consumption Questions (AUDIT‐C), was prominent in Ukraine (54.7%) and Vietnam (26.4%). Reported sexual risk behaviours in the past month, including having two or more sex partners and giving/receiving money or drugs in exchange for sex, were uncommon among all participants and regions.Conclusions: While regional differences in risk structure exist, PWID particularly in Ukraine need immediate attention for risk reduction strategies. Substantial regional differences in risk structure will require flexible, tailored treatment as prevention interventions for distinct PWID populations.