%0 Journal Article
%T Evaluation of a Pilot Medication-Assisted Therapy Program in Kazakhstan: Successes, Challenges, and Opportunities for Scaleup
%A Azizbek A. Boltaev
%A Anna P. Deryabina
%A Almas Kusainov
%A Andrea A. Howard
%J Advances in Preventive Medicine
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/308793
%X Study Aims. Evaluate the quality and effectiveness of the medication-assisted therapy (MAT) pilot in Kazakhstan and review implementation context and related challenges. Methods. We performed a desk review of MAT policy and program documents and reviewed medical records at three MAT sites in Kazakhstan. MAT patients were interviewed to assess their perceptions of the program and its impact on their health, criminal, drug use, and HIV risk related behaviors as well as expenditures on nonprescribed psychoactive drugs. Persons injecting drugs who are not in treatment, MAT program staff, and other stakeholders were interviewed to obtain their perspectives on MAT. Results. Legislation supports introducing MAT as a standard of care for treatment of opioid dependence; however, its progress has been hampered by active opposition. Inadequate access and coverage, insufficient supply management, scarce infrastructure of narcological facilities, limited opportunities for staff development, and restrictive methadone dispensing policies compromise the quality of the intervention and limit its potential benefits. There were significant reductions in criminal, drug use, and HIV risk related behaviors in patients receiving MAT. Conclusions. The MAT pilot in Kazakhstan demonstrated its feasibility and effectiveness in the local context and is recommended for scaleup throughout the country. 1. Introduction Kazakhstan faces a concentrated HIV epidemic, with drug use being the most important risk factor for HIV transmission [1, 2]. The country is located on a major drug trafficking route from Afghanistan, resulting in the availability of inexpensive heroin and a high prevalence of drug use in the country, an environment that is increasingly conducive to the spread of HIV and other blood-borne infections. According to the national HIV integrated biobehavioral surveillance data from 2010, the estimated number of people who injected drugs (PWID) during the last 12 months was 119,140, which is 3.5-times higher than the number of PWID officially registered with the drug addiction treatment service. Medication-assisted therapy (MAT), more widely known in the region as opioid substitution therapy (OST), is a rigorously evaluated and evidence-based medical intervention to treat opioid dependence that consists of prescription of methadone or buprenorphine as a replacement for illicit street opioid narcotics such as heroin. Research conducted to date has generated a great amount of evidence demonstrating that MAT in combination with psychosocial support produces the best outcomes in
%U http://www.hindawi.com/journals/apm/2012/308793/