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Key findings from the WHO collaborative study on substitution therapy for opioid dependence and HIV/AIDS

Authors

  • Peter Lawrinson,

    1. Discipline of Pharmacology, The University of Adelaide, World Health Organization Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems, Australia
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  • Robert Ali,

    1. Discipline of Pharmacology, The University of Adelaide, World Health Organization Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems, Australia
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  • Aumphornpun Buavirat,

    1. Discipline of Pharmacology, The University of Adelaide, World Health Organization Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems, Australia
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  • Sithisat Chiamwongpaet,

    1. Discipline of Pharmacology, The University of Adelaide, World Health Organization Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems, Australia
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  • Sergey Dvoryak,

    1. Discipline of Pharmacology, The University of Adelaide, World Health Organization Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems, Australia
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  • Boguslaw Habrat,

    1. Discipline of Pharmacology, The University of Adelaide, World Health Organization Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems, Australia
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  • Shi Jie,

    1. Discipline of Pharmacology, The University of Adelaide, World Health Organization Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems, Australia
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  • Ratna Mardiati,

    1. Discipline of Pharmacology, The University of Adelaide, World Health Organization Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems, Australia
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  • Azarakhsh Mokri,

    1. Discipline of Pharmacology, The University of Adelaide, World Health Organization Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems, Australia
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  • Jacek Moskalewicz,

    1. Discipline of Pharmacology, The University of Adelaide, World Health Organization Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems, Australia
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  • David Newcombe,

    1. Discipline of Pharmacology, The University of Adelaide, World Health Organization Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems, Australia
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  • Vladimir Poznyak,

    1. Discipline of Pharmacology, The University of Adelaide, World Health Organization Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems, Australia
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  • Emilis Subata,

    1. Discipline of Pharmacology, The University of Adelaide, World Health Organization Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems, Australia
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  • Ambrose Uchtenhagen,

    1. Discipline of Pharmacology, The University of Adelaide, World Health Organization Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems, Australia
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  • Diah S. Utami,

    1. Discipline of Pharmacology, The University of Adelaide, World Health Organization Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems, Australia
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  • Robyn Vial,

    1. Discipline of Pharmacology, The University of Adelaide, World Health Organization Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems, Australia
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  • Chengzheng Zhao

    1. Discipline of Pharmacology, The University of Adelaide, World Health Organization Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems, Australia
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Peter Lawrinson, Discipline of Pharmacology, The University of Adelaide, World Health Organization Collaborating Centre for Research in the Treatment of Drug and Alcohol Problems, Room S337, Level 3, Medical School South, Adelaide, SA 5005, Australia. E-mail: peter.lawrinson@adelaide.edu.au

ABSTRACT

Aims  Opioid substitution treatment has been studied extensively in industrialized countries, but there are relatively few studies in developing/transitional countries. The aim of this study was to examine the effectiveness of opioid substitution treatment (OST) in less resourced countries.

Design  Longitudinal cohort study.

Setting  Purposively selected OST sites in Asia (China, Indonesia, Thailand), Eastern Europe (Lithuania, Poland, Ukraine), the Middle East (Iran) and Australia.

Participants  Seven hundred and twenty-six OST entrants.

Measurements  Participants were interviewed at treatment entry, 3 and 6 months. Standardized instruments assessed drug use, treatment history, physical and psychological health, quality of life, criminal involvement, blood-borne virus (BBV) risk behaviours and prevalence of human immunodeficiency virus (HIV) and hepatitis C.

Findings  Participants were predominantly male, aged in their early 30s and had attained similar levels of education. Seroprevalence rates for HIV were highest in Thailand (52%), followed by Indonesia (28%) and Iran (26%), and lowest in Australia (2.6%). Treatment retention at 6 months was uniformly high, averaging approximately 70%. All countries demonstrated significant and marked reductions in reported heroin and other illicit opioid use; HIV (and other BBV) exposure risk behaviours associated with injection drug users (IDU) and criminal activity, and demonstrated substantial improvement in their physical and mental health and general wellbeing over the course of the study.

Conclusions  OST can achieve similar outcomes consistently in a culturally diverse range of settings in low- and middle-income countries to those reported widely in high-income countries. It is associated with a substantial reduction in HIV exposure risk associated with IDU across nearly all the countries. Results support the expansion of opioid substitution treatment.

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