Affiliations 

  • 1 APT Foundation, New Haven, CT, USA; Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA. Electronic address: LMadden@aptfoundation.org
  • 2 Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
  • 3 APT Foundation, New Haven, CT, USA
  • 4 ICF Alliance for Public Health, Kyiv, Ukraine
  • 5 APT Foundation, New Haven, CT, USA; Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
  • 6 Ukrainian Centers for Disease Control, Kyiv, Ukraine
  • 7 Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
  • 8 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
PMID: 28957756 DOI: 10.1016/j.drugpo.2017.07.025

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.

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