Citation

Madden L, Bojko MJ, Farnum S, Mazhnaya A, Fomenko T, Marcus R, Barry D, Ivanchuk I, Kolomiets V, Filippovych S, Dvoryak S, Altice FL. Int. J. Drug Policy 2017; 49: 48-53.

Affiliation

APT Foundation, New Haven, CT, USA; Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA; Centre of Excellence on Research in AIDS (CERiA), University of Malaysia, Kuala Lumpur, Malaysia.

Copyright

(Copyright © 2017, Elsevier Publishing)

DOI

10.1016/j.drugpo.2017.07.025

PMID

28957756

Abstract

BACKGROUND: Opioid agonist therapies (OAT) like methadone and buprenorphine maintenance treatment remain markedly under-scaled in Ukraine despite adequate funding. Clinicians and administrators were assembled as part of an implementation science strategy to scale-up OAT using the Network for Improvement of Addiction Treatment (NIATx) approach.

METHODS: Nominal Group Technique (NGT), a key ingredient of the NIATx toolkit, was directed by three trained coaches within a learning collaborative of 18 OAT clinicians and administrators to identify barriers to increase OAT capacity at the regional "oblast" level, develop solutions, and prioritize local change projects. NGT findings were supplemented from detailed notes collected during the NGT discussion.

RESULTS: The top three identified barriers included: (1) Strict regulations and inflexible policies dictating distribution and dispensing of OAT; (2) No systematic approach to assessing OAT needs on regional or local level; and (3) Limited funding and financing mechanisms combined with a lack of local/regional control over funding for OAT treatment services.

CONCLUSIONS: NGT provides a rapid strategy for individuals at multiple levels to work collaboratively to identify and address structural barriers to OAT scale-up. This technique creates a transparent process to address and prioritize complex issues. Targeting these priorities allowed leaders at the regional and national level to advocate collectively for approaches to minimize obstacles and create policies to improve OAT services.

Copyright © 2017 Elsevier B.V. All rights reserved.

Language: en

Keywords

Buprenorphine; Implementation science; Methadone; NIATx; Nominal group technique; Opioid agonist treatment (OAT); People who inject drugs (PWID); Structural barriers; Ukraine