RecruitingNot ApplicableNCT05579470

Expanding Medication-Assisted Therapies in Central Asia

Sponsor

Yale University

Enrollment

900 participants

Start Date

Aug 7, 2023

Study Type

INTERVENTIONAL

Conditions

Opioid-use Disorder

Summary

Central Asia (CA) represents the most rapidly growing HIV epidemic region worldwide, concentrated in people who inject drugs (PWID) and their sexual partners, and scaling up opioid agonist therapies (OAT) in this region is the most cost-effective strategy to prevent new HIV infections, and more effective when combined with antiretroviral therapy (ART). The investigators propose to use the Network for the Improvement of Addiction Treatment (NIATx) implementation strategy to scale-up OAT in three diverse Central Asian countries (Kazakhstan, Kyrgyzstan, Tajikistan) and guided by the Exploration-Planning-Implementation-Sustainment (EPIS) framework. Understanding the trajectories of implementation and scale-up in this context may emerge through creating communities of practice, especially when cohesion and competence evolves, and may guide other healthcare delivery challenges in the region (e.g., HIV, TB); as well as build important regional expertise and understanding implementation trajectories should help support OAT program sustainability.

Eligibility

Min Age: 18 Years

Inclusion Criteria22

Quantitative surveys for PWID
years or older
Meeting DSM-V criteria for opioid dependence
Be either treatment naïve and seeking OAT or be on OAT for \< 90 days
Organizational Assessments for OAT Delivery Staff
years or older
Currently working as an OAT delivery professional at an OAT delivery site
Focus Groups (PWID on OAT)
years or older
Meeting DSM-V criteria for opioid dependence
Be either treatment naïve and seeking OAT or be on OAT for \< 90 days
Focus Groups (PWID not on OAT)
years or older
Meeting Diagnostic and Statistical Manual of Mental Disorders(DSM)-V criteria for opioid dependence
Be OAT naïve (defined as never having been on OAT or having not received treatment for \> 1 year)
Focus Groups (OAT delivery staff)
years or older
Currently working as an OAT delivery professional at an OAT delivery site
years or older
Currently assigned as a Chief Narcologist for an Oblast
years or older
Authorized as a professional to work at an OAT delivery site

Exclusion Criteria1

Not willing to provide consent

Interventions

BEHAVIORALNIATx

For each country, the learning collaborative will be comprised of a Chief Narcologist from each region where the investigators will initially train them and the coaches using all the tools from the NIATx Academy (2-3-day training). The national coach for each country will receive ongoing and in-depth coaching from a US-based super coach. A nationwide Nominal Group Technique (NGT) will be conducted to assess barriers and potential targets to guide decision-making about changes. At the end of the initial meeting, each Chief Narcologist (CN) will be able to identify a change target for Plan, Do, Study, Act (PDSA) (entry, retention) and create a Change Project Form to state what will be done (e.g. flowcharting), who is involved (team), what are the measures and timeframe (\<4 weeks).