Title

Integrating HIV, tuberculosis and addiction treatment services in primary care clinics in Ukraine: two-year outcomes from a randomized controlled trial

Presenter

Eteri Machavariani

Authors

E. Machavariani¹, K. Dumchev², D. Esserman³, I. Pykalo⁴, M. Filippovych², R. Ivasiy¹, D.J Bromberg³, L. Madden¹, M. Haddad⁵, B. Ahmad¹, D. Oliveros¹, S. Dvoriak², F. Altice¹

Institutions

¹Yale School of Medicine, New Haven, United States, ²Ukrainian Institute of Public Health, Kyiv, Ukraine, ³Yale School of Public Health, New Haven, United States, ⁴European Institute of Public Health, Kyiv, Ukraine, ⁵Community Health Center Inc, Middletown, United States

BACKGROUND: Ukraine’s HIV epidemic is concentrated among people who inject drugs (PWID). As Ukraine prioritized primary care (PCC) over specialty addiction centers (SAC), we compared quality health indicators (QHIs) in individuals receiving opioid agonist therapies (OAT) in SAC (standard-of-care) and PCCs.
METHODS: Starting in 2018, we conducted a multi-phase, Type-2 hybrid implementation trial comparing QHI outcomes (percentage) in participants prescribed OAT in SACs and PCCs in 13 cities. PCC:SAC allocation was 2:1 and PCC-allocated participants were stratified in clinics receiving pay-for-performance (P4P) or not. QHIs were measured every 6 months over 24 months and included standardized measures for specialty (HIV, TB, OAT) and primary care (i.e., recommended screening for prostate/cervical cancers, etc.) outcomes. To increase confidence in providing specialty services in PCCs, clinicians participated in weekly tele-education training sessions. QHI outcomes were compared between PCC and SAC using likelihood-based mixed models with missing at random assumptions.
RESULTS: Among 1,459 participants enrolled, there were no differences in sex (male=83%), age (mean=39 years), HIV (41.9%) and HCV (57.0%) prevalence in those in SAC (N=509) or PCC (N=950) participants. At baseline, composite mean QHIs did not differ between arms, however, mean QHIs were consistently higher at PCC vs SAC at 6 (5.7; 95%CI 1.5-9.9; p= 0.010), 12 (9.1; 95%CI 4.8-13.4; p< 0.001), 18 (10.2; 95%CI 5.9-14.5; p<0.001), and 24 (9.0; 95%CI 4.6-13.3; p< 0.001) months. The composite QHIs were further divided into primary and specialty care outcomes, with primary care QHIs significantly higher at all follow-up timepoints and specialty QHI scores higher later at 18 and 24 months. Composite and specialty QHIs were significantly higher for P4P versus non-P4P PCCs only at 24 months.

CONCLUSIONS: Integrating services in PCCs resulted in better comprehensive outcomes relative to SACs for PWID confirming the need to integrate care for PWID with or at high risk for HIV and TB.

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