The Effect of Opioid Agonist Maintenance Therapy on Healthcare Utilization and Engagement among HIV-infected People Who Inject Drugs in Ukraine C. Bachireddy1, J. Izenberg2, M. Soule3, S. Dvoryak4, F. Altice5 1Harvard Medical School, Brigham and Women's Hospital, Internal Medicine, Boston, United States, 2University of California San Francisco, Psychiatry, San Francisco, United States, 3Harvard Medical School, Massachusetts General Hospital McLean, Psychiatry, Boston, United States, 4Ukrainian Institute on Public Health Policy, Kyiv, Ukraine, 5Yale University School of Medicine, Internal Medicine, New Haven, United States

No conflicts of interest to declare

Background Despite decreasing HIV incidence and mortality globally, Eastern Europe and Central Asia face an increasing HIV epidemic driven by injection drug use. Ukraine is home to Europe’s most volatile HIV epidemic with an adult HIV prevalence of 1.1% Both OAT and ART provision are essential to stemming the IDU-driven HIV epidemic. Despite the introduction of OAT in Ukraine in 2004, only 2.7% of PWID access OAT, and among HIV-infected PWID, only 5% receive ART. HIV-infected PWID are much less likely to be on ART and engaged in chronic care and much more likely to transmit HIV than their counterparts who do not suffer from addiction. Instead, PWID often inappropriately utilize acute emergency services for substance abuse-related complaints, a behavior that can strain resource-poor health systems. In this study, we evaluate the effect of OAT on utilization of medical services and engagement in HIV care.

Methods Cross-sectional study of healthcare utilization in the past six months among 296 randomly sampled HIV- infected opioid-dependent PWID in 9 clinics in 2010 across Ukraine. Therapeutic on OAT if on for at least 3 consecutive months prior to the past six months or as not taking OAT if not on any in the past nine months. Based on this criterion, 24 individuals were excluded. Table 1: Basic Characteristics

Results Substance Abuse Those on OAT had more years of opioid injection but were less likely to have injected in the past 30 days, to have engaged in poly- substance abuse, to have drug problems currently, or to have ever overdosed on drugs (p< 0.01). Table 2: Substance Abuse on OAT

Figure 1: Healthcare Utilization in the Prior 6 Months and OAT Figure 2: Patient-reported Outcomes and OAT

Results Despite higher rates of incarceration and more years of opioid injection, those therapeutic on OAT were less likely to engage in HIV risk behaviors or to seek emergency care than those not on OAT and more likely to engage in HIV care with fewer overall symptoms and improved quality of life. HIV Engagement Those on OAT and those on OAT for longer periods of time were more likely to be engaged in HIV care, as evidenced by higher rates of ART (37% v 26%, p=0.08), recent CD4 testing (82% v 60%, p< 0.01), and recent TB testing (95% v 71%, p< 0.01). Patient-reported Outcomes Those on OAT reported fewer symptoms (10.46 v 7.75, p< 0.01), improved depression scores (p<0.01) and improved quality of life (p<0.01). Limitations Cross-sectional design and potential for recall and social desirability biases. Conclusions