Scale-Up Of Access To Medication For Opioid Use Disorder For People Who Inject Drugs On Parole In Ukraine: A Modeling Analysis

Author

Brendan CaverFollow

Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Frederick Altice

Abstract

Background: Human Immunodeficiency Virus (HIV) and opioid-use disorder have long beendescribed as a syndemic; the two health issues go hand-in-hand to exacerbate each other (Perlman & Jordan, 2018). While the HIV pandemic has improved greatly in many regions such as the United States over the past several decades, it continues to become worse in Eastern Europe and Central Asia. HIV prevalence and opioid dependence are particularly high in carceral settings, but access to opioid agonist therapy (OAT) is extremely limited. This paper shows the results of a modeling analysis undertaken to see the impact of opioid agonist therapy (OAT) scale-up on deaths and HIV cases if implemented in a parole setting.

Methods: A compartmental model was created that stratifies by HIV status and OAT status.Parameters were obtained from previously published literature and existing data. These parameter estimates were then plugged into the model to see changes in health outcomes over a 25-year period. To account for uncertainty, bootstrapping was done with 1000 iterations using prior sampling distributions for most values. All analysis was performed in R.

Results: Results showed that increases in access to OAT in parole settings would likely result inreductions in both HIV cases and deaths. Due to wide sampling ranges, uncertainty intervals for all estimates included 0, suggesting that statistical significance was not reached. However, point estimates showed considerable reductions in HIV cases and deaths during the study period.

Conclusion: A more robust modeling analysis would be required to find results that reachstatistical significance, but primary findings suggest that scaling up OAT could result in reduction of morbidity and mortality (both related to HIV and to opioid-use disorder).

Comments

This is an Open Access Thesis.

Recommended Citation

Caver, Brendan, "Scale-Up Of Access To Medication For Opioid Use Disorder For People Who Inject Drugs On Parole In Ukraine: A Modeling Analysis" (2025). Public Health Theses. 2478.
https://elischolar.library.yale.edu/ysphtdl/2478