Evidence map›Paper›PMID 39265780›Full record

Trial reportContemporary clinical trials2024

Design and implementation of a Type-2 hybrid, prospective randomized trial of opioid agonist therapies integration into primary care clinics in Ukraine.

Eteri Machavariani, Kostyantyn Dumchev, Iryna Pykalo, Myroslava Filippovych, Roman Ivasiy, Denise Esserman, Lynn M Madden, Daniel J Bromberg, Marwan Haddad, Olga Morozova and 5 more

Abstract readMulticenter StudyRandomized Controlled Trial
In one paragraph

Trial report in Contemporary clinical trials, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Trial
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Eteri MachavarianiSection of Infectious Diseases, Yale School of Medicine, Yale University, New Haven, CT, United States of America. Electronic address: eteri.machavariani@yale.edu.
Kostyantyn DumchevUkrainian Institute on Public Health Policy, Kyiv, Ukraine.
Iryna PykaloEuropean Institute of Public Health Policy, Kyiv, Ukraine.
Myroslava FilippovychUkrainian Institute on Public Health Policy, Kyiv, Ukraine.
Roman IvasiySection of Infectious Diseases, Yale School of Medicine, Yale University, New Haven, CT, United States of America.
Denise EssermanDepartment of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, United States of America.
Lynn M MaddenSection of Infectious Diseases, Yale School of Medicine, Yale University, New Haven, CT, United States of America; APT Foundation, New Haven, CT, United States of America.
Daniel J BrombergDepartment of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States of America; Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States of America; Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany; Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.
Marwan HaddadCenter for Key Populations, Community Health Center Inc, Middletown, CT, United States of America.
Olga MorozovaDepartment of Public Health Sciences, University of Chicago, Chicago, IL, United States of America.
Bachar AhmadSection of Infectious Diseases, Yale School of Medicine, Yale University, New Haven, CT, United States of America.
David Oliveros GómezSection of Infectious Diseases, Yale School of Medicine, Yale University, New Haven, CT, United States of America.
Scott O FarnumAPT Foundation, New Haven, CT, United States of America.
Sergii DvoriakUkrainian Institute on Public Health Policy, Kyiv, Ukraine.
Frederick L AlticeSection of Infectious Diseases, Yale School of Medicine, Yale University, New Haven, CT, United States of America; Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States of America; Division of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States of America.

Funding

Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9M
Integrating Addiction Treatment and HIV Services into Primary Care Clinics in UkraineR01DA043125 · NIDA · YALE UNIVERSITY · PI ALTICE, FREDERICK LEWIS · 2016 to 2021
$4.4M
NCATS NIH HHS UL1 TR001863NIDA NIH HHS R01 DA043125
6 · The paper itself

Abstract

introductionUkraine has high HIV prevalence, concentrated among people who inject drugs (PWID), mostly of opioids. Maintenance on opioid agonist therapies (OAT) is the most effective evidence-based treatment for opioid use disorder. As PWID experience high morbidity and mortality from preventable and treatable non-communicable diseases, international agencies recommend integrating OAT into primary care centers (PCC).

methodsA randomized, type-2 hybrid implementation trial was carried out to compare outcomes of OAT integration in PCC to OAT delivery at specialty treatment centers (STC) - standard-of-care. Tele-education supporting PCC providers in managing OAT, HIV, tuberculosis and non-communicable diseases along with pay-for-performance incentives were used to facilitate implementation. Consenting patients underwent 1:2 randomization to either STC or PCC. Quality health indicators (QHIs), a composite percentage of recommended primary and specialty services accessed by patients (blood/urine tests, cancer screenings, etc.), were defined as efficacy outcomes and were assessed by participant self-report at baseline and every 6 months over 24 months and electronic chart reviews after the completion of the follow-up. The primary outcome is defined as the difference in composite QHI scores at 24 months, in which a repeated measures likelihood-based mixed model with missing at random assumptions will be used. Providers at PCC completed surveys at baseline, 12 and 24 months to assess implementation outcomes including changes in stigma and attitudes towards OAT and PWID. PRELIMINARY

resultsAmong the 1459 participants allocated to STC (N = 509) or PCC (N = 950), there were no differences in clinical and demographic characteristics. Self-reported prevalences were available for HIV (42 %), HCV (57 %), and prior tuberculosis (17 %). Study retention at 6, 12, 18, and 24 months was as 91 %, 85 %, 80 %, and 74 %, respectively.

conclusionPWID have a high prevalence of medical comorbidities and integrating OAT into primary care settings has the potential to improve the health of PWID. Findings from this study can help guide implementation of integrated care in Ukraine and throughout similar low-resource, high-burden countries in the Eastern European and Central Asian region.

Indexed as

Opiate Substitution TreatmentOpioid-Related DisordersPrimary Health CareAdultBuprenorphineFemaleHIV InfectionsHumansMaleMethadoneMiddle AgedProspective StudiesUkraineBuprenorphineMethadoneImplementation scienceIntegrated careOpioid agonist therapies (OAT)OpioidsPeople who inject drugs (PWID)Ukraine

Identifiers

PMID39265780
PMCPMC11531372

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.