Affiliations 

  • 1 Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, New Haven, CT, United States; Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States. Electronic address: eteri.machavariani@yale.edu
  • 2 Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States; Yale School of Public Health, New Haven, CT, United States
  • 3 Ukrainian Institute of Public Health Policy, Kyiv, Ukraine
  • 4 Yale School of Public Health, New Haven, CT, United States
  • 5 Department of Human Development and Family Sciences, University of Delaware, Newark, DE, United States
  • 6 Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, New Haven, CT, United States; Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States
  • 7 Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, New Haven, CT, United States
  • 8 Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, New Haven, CT, United States; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • 9 Center for Key Populations, Community Health Centers, Inc., Middletown, CT, United States
  • 10 Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, New Haven, CT, United States; Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; APT Foundation, Inc, New Haven, CT, United States
  • 11 Yale School of Medicine, Department of Medicine, Section of Infectious Diseases, New Haven, CT, United States; Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States; Yale School of Public Health, New Haven, CT, United States; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; APT Foundation, Inc, New Haven, CT, United States
Int J Drug Policy, 2024 Dec 19;136:104682.
PMID: 39705875 DOI: 10.1016/j.drugpo.2024.104682

Abstract

INTRODUCTION: People who inject drugs experience poor health and social outcomes which improve with opioid agonist therapies like methadone, yet provider stigma may influence healthcare utilization. In Ukraine, integrating methadone into primary care centers (PCCs) provides an opportunity to examine provider stigma and its impact on patient outcomes.

METHODS: This sub-analysis included patients randomized to receive methadone in PCCs as part of an implementation trial in which the control group received methadone in specialty addiction clinics in Ukraine. Methadone integration in PCCs was supported through continuous tele-education for providers. Provider stigma towards people who inject drugs, methadone, and attitudes towards evidence-based practices were assessed at baseline, 12, and 24 months using standardized scales (range 1-10). Patient-level outcomes were measured bi-annually over 24 months using a quality health indicator (QHI) score, a percentage of guideline-concordant primary and specialty health services accessed. Linear mixed-effects models examined the changes in provider stigma and attitudes, and the association of these measures with patient outcomes.

RESULTS: The sample included 583 patients and the 112 providers in 24 clinics. Provider fear and stereotypes toward people who inject drugs improved significantly, by 0.6 (95 % CI 0.2-1.1) and 0.4 points (95 % CI 0.1-0.8), respectively, as did preference for methadone over abstinence-based treatment (0.7 points, 95 % CI 0.2-1.1). A 1-point improvement in provider prejudice correlated with a 7.0-point increase (95 % CI: 1.1-13.0) in patient primary care QHI scores at 12 months, while improved attitudes towards evidence-based practices were associated with an 8.3-point increase (95 % CI: 1.1-13.0). Preference for methadone maintenance over abstinence was associated with a 3.7-point increase (95 % CI: 0.6-6.7) in specialty care QHI scores at 12 months, and reduced stereotypes were associated with a 10.9-point increase (95 % CI: 1.2-20.7) at 24 months.

CONCLUSIONS: Integrating methadone into PCCs with the support of provider tele-education may reduce provider stigma, particularly fear and stereotypes, toward people who inject drugs and methadone maintenance. Reducing provider stigma has the potential to improve patient outcomes through increased access to preventive care and screenings.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.