The impact of emergency guidance to the COVID-19 pandemic on treatment entry, retention and mortality among patients...

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Addiction Medicine

Background:

• Opioid agonist therapies (OAT), including methadone, are crucial for HIV prevention among people who inject drugs (PWID).
• Ukraine's Ministry of Health issued emergency COVID-19 guidelines enabling early take-home dosing (THD) for OAT.
• This policy aimed to maintain treatment access and continuity during the pandemic.

Purpose of the Study:

• To evaluate the impact of Ukraine's COVID-19 emergency guidance on OAT.
• Assessed changes in OAT enrollment, treatment retention, and mortality rates.
• Examined the role of THD and optimal methadone dosing in treatment outcomes.

Main Methods:

• A 12-month comparative prospective cohort survival analysis was performed.
• Data from Ukraine's national OAT registry (252 clinics) compared newly enrolled patients during the COVID-19 guidance period (COVID cohort) with the preceding year (pre-COVID cohort).
• Key outcomes included monthly enrollment, treatment retention, and mortality, analyzing predictors like THD and optimal methadone dosage.

Main Results:

• The COVID cohort showed statistically significant higher average monthly enrollment compared to the pre-COVID cohort (283.7 vs. 236.0).
• Patients in the COVID cohort were more likely to transition to THD (41% vs. 13%) and achieve optimal methadone dosing earlier (38% vs. 31%).
• Early THD and optimal dosing were significant predictors of treatment retention in both cohorts, with no significant difference in survival rates between cohorts.

Conclusions:

• Ukraine's rapid adoption of early take-home dosing for OAT during the COVID-19 pandemic increased patient enrollment.
• The policy also improved treatment retention for people who inject drugs.
• These positive outcomes were achieved without negatively impacting patient survival.