19 research outputs found
ExtramedicĂnskĂ© (zne)uĹľĂvánĂ buprenorfinu v Gruzii a efektivnĂ lĂ©ÄŤebná intervence
ExtramedicĂnskĂ© (zne)uĹľĂvánĂ buprenorfinu v Gruzii a efektivnĂ lĂ©ÄŤebná intervence MUDr. David Otiashvili Abstrakt Ăšvod JednĂm z nejdĹŻleĹľitÄ›jšĂch jevĹŻ drogovĂ© scĂ©ny v Gruzii je od počátku tisĂciletĂ nemedicĂnskĂ© (zne)uĹľĂvánĂ tablet buprenorfinu (vesmÄ›s ve formÄ› preparátu Subutex®), jeĹľ jsou podle pĹ™evaĹľujĂcĂho mĂnÄ›nĂ pašovány ze zemĂ EU. Pro zemi, kde je relativnÄ› vysoká prevalence injekÄŤnĂho uĹľĂvánĂ drog (cca 40 000 osob, tj. 1,5 % populace ve vÄ›ku 15-64 let; z nich zhruba 50 % uĹľĂvá buprenorfin) to pĹ™edstavuje zásadnĂ veĹ™ejnozdravotnĂ problĂ©m. K jeho zvládnutĂ je tĹ™eba podrobnĂ©ho popisu a vĂ˝voje komplexnĂ intervence. CĂle (i) Popsat rozsah nemedicĂnskĂ©ho uĹľĂvánĂ v Gruzii, charakteristiky uĹľivatelĹŻ a jejich motivaci k vyhledávánĂ a uĹľĂvánĂ buprenorfinu z ÄŤernĂ©ho trhu. NáslednÄ› (ii) vyvinout a pilotnÄ› otestovat lĂ©ÄŤebnou intervenci, jeĹľ by byla specifiÄŤtÄ›jšà a efektivnÄ›jšà neĹľ v zemi běžnÄ› dostupná prostá detoxifikace a/nebo intervence typu sniĹľovánà škod (harm reduction). GeografickĂ© pokrytĂ Do deskriptivnĂ fáze studie byla zaĹ™azena ÄŤtyĹ™i regionálnĂ centra: MÄ›sta Tbilisi, Gori, Zugdidi a Batumi. IntervenÄŤnĂ substudie probĂhala na jednĂ© z adiktologickĂ˝ch klinik v Tbilisi. VĂ˝zkumnĂ˝ vzorek a metody V deskriptivnà části studii vyplnilo 500 osob vybranĂ˝ch pomocĂ nenáhodnĂ©ho vyÄŤerpávajĂcĂho vĂ˝bÄ›ru dotaznĂk...ExtramedicĂnskĂ© (zne)uĹľĂvánĂ buprenorfinu v Gruzii a efektivnĂ lĂ©ÄŤebná intervence MUDr. David Otiashvili Abstrakt Background Since early 2000s, the nonmedical abuse of buprenorphine (Subutex®) tablets, presumably smuggled from EU countries, has represented major phenomena of the problem drug scene in the Republic of Georgia. In a country with relatively high level of injecting drug use (estimated 40,000 persons, i.e. 1.5 % of population aged 15-64, of whom over 50% inject buprenorphine), this represent a major public health problem that needs detailed description and comprehensive set of interventions. Aim (i) To describe the extent of nonmedical buprenorphine ab/use in the Republic of Georgia, the characteristics of the nonmedical ab/users and their motivations for seeking and using the black market buprenorphine. Subsequently, (ii) to plan and pilot-test a treatment intervention that would be more specific and effective than the simple detoxification and/or harm reduction modalities available in Georgian on a routine basis. Setting Four regional centres of Georgia were included into the descriptive part of the study: the cities of Tbilisi, Gori, Zugdidi, and Batumi. The intervention (sub)study was conducted in one Tbilisi addiction treatment clinic. Participants and methods For the descriptive part of the...Klinika adiktologie 1. LF UK a VFNDepartment of Addictology First Faculty of Medicine and General University HospitalFirst Faculty of Medicine1. lĂ©kaĹ™ská fakult
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Feasibility of needle and syringe programs in Tajikistan distributing low dead space needles
Background
In 2012, the World Health Organization recommended that needle and syringe programs offer their clients low dead space insulin syringes with permanently attached needles. However, in many countries, these syringes are not acceptable to a majority of people who inject drugs. This study assessed the feasibility of working with needle and syringe programs to implement the WHO recommendation using low dead space detachable needles. The study also assessed the acceptability of the needles.
Methods
Two needle and syringe programs in Tajikistan—one in Kulob and one in Khudjand—received 25,000 low dead space detachable needles each. The programs distributed low dead space detachable needles and a marketing flyer that emphasized the relative advantages of the needles. Each program also enrolled 100 participants, and each participant completed a baseline interview and a 2-month follow-up interview.
Results
At follow-up, 100% of participants reported trying the low dead space detachable needles, and 96% reported that they liked using the needles. Both needle and syringe programs distributed all their needles within the first 60Â days of the project indicating use of the needles, even among clients who did not participate in the study.
Conclusions
This project demonstrates that it is feasible for needle and syringe programs to offer and promote low dead space needles to their clients. The findings indicate that low dead space needles are acceptable to needle and syringe program clients in these Tajikistan cities. To reduce HIV and hepatitis C virus transmission, needle and syringe programs should offer low dead space needles, low dead space insulin syringes in addition to standard needles, and syringes to their clients
The Effects of Drug User Registration Laws on People's Rights and Health: Key Findings From Russia, Georgia, and Ukraine
Synthesizes research on how drug user registration leads to unfair restrictions on users' human rights and access to drug treatment. Recommends educating law enforcement and others on regulations, prosecuting rights violations, and system reform
Feasibility and initial efficacy of a culturally sensitive women-centered substance use intervention in Georgia: Sex risk outcomes
This paper reports on the feasibility and initial efficacy of a culturally sensitive, comprehensive women-centered substance use intervention for women who inject drugs in Georgia in terms of the primary and secondary sex risk outcomes. The hypothesis under examination was that, relative to case management participants, participants in a culturally sensitive, comprehensive women-specific and -centered intervention would, on average, show significant decreases in past-30-day frequency of unprotected sex, unprotected sex at the last sexual encounter, and increases in condom use and safer sex actions. The study was a two-arm randomized trial, in which 173 potentially eligible women were screened, and those 128 women determined to be eligible were assigned at random to either Reinforcement-based Treatment plus Women’s Co-Op (RBT + WC) or case management (CM). RBT + WC participants received 12 sessions of a structured intervention with the goal of reducing risky sex and substance use and improving physical and mental health. CM participants received 12 sessions of case management and informational brochures that focused on the same issues on which RBT + WC focused. Participants were assessed at baseline, post-treatment, and 3 months following treatment enrollment. Analyses revealed case management having significantly overall higher Safer Sex action scores than RBT + WC, and a significant decrease over time for past 30-day number of unprotected sex acts. Unprotected sex at the last encounter and Condom Use action scores were nonsignificant. Women who inject drugs in Georgia are engaging in risky sexual practices, and are in need of an intervention that addresses these risky behaviors. Reasons for the failure to find differences between a culturally sensitive, comprehensive women-centered intervention and case management tailored to the needs of women who inject drugs in Georgia may have been the result of inadequate power to detect an effect in a sample whose drug use was not as serious as warranted by the intervention. (ClinicalTrials.gov Identifier: NCT01331460)https://doi.org/10.1186/s13011-015-0043-
Non-medical use of buprenorphine in Georgia: prevalence, socio-demographic and environmental correlates, treatment and policy options
ExtramedicĂnskĂ© (zne)uĹľĂvánĂ buprenorfinu v Gruzii a efektivnĂ lĂ©ÄŤebná intervence MUDr. David Otiashvili Abstrakt Background Since early 2000s, the nonmedical abuse of buprenorphine (Subutex®) tablets, presumably smuggled from EU countries, has represented major phenomena of the problem drug scene in the Republic of Georgia. In a country with relatively high level of injecting drug use (estimated 40,000 persons, i.e. 1.5 % of population aged 15-64, of whom over 50% inject buprenorphine), this represent a major public health problem that needs detailed description and comprehensive set of interventions. Aim (i) To describe the extent of nonmedical buprenorphine ab/use in the Republic of Georgia, the characteristics of the nonmedical ab/users and their motivations for seeking and using the black market buprenorphine. Subsequently, (ii) to plan and pilot-test a treatment intervention that would be more specific and effective than the simple detoxification and/or harm reduction modalities available in Georgian on a routine basis. Setting Four regional centres of Georgia were included into the descriptive part of the study: the cities of Tbilisi, Gori, Zugdidi, and Batumi. The intervention (sub)study was conducted in one Tbilisi addiction treatment clinic. Participants and methods For the descriptive part of the..
Female partners of opioid-injecting men in the Republic of Georgia: an initial characterization
Background
HIV and Hepatitis C virus (HCV) infections are strongly related to injection drug use in the Republic of Georgia. Little information is available about HIV and HCV status, sexual risk, support for their partner, and risk for physical violence among the female partners of opioid-injecting men in the Republic of Georgia, many of whom may not be using drugs, yet may be at high risk of being infected with HIV and HCV from their drug-using partners.
Methods
In order to better understand the risks for females whose partners are injecting drugs, the present study conducted an initial investigation of the non-substance-using female partners of 40 opioid-injecting men who were participating in a clinical trial examining the feasibility and efficacy of a 22-week comprehensive intervention that paired behavioral treatment with naltrexone. The 40 female partners were assessed at their male partners’ study intake.
Results
The female sample was 32.3 years old (SD=6.7), 37 (93%) were married, with 15.5 years of education. A majority reported at least partial employment the majority of the time during the past 3 years, with only one woman reported being unemployed most of the time during the past 3 years. They self-reported they were 3% HIV-positive and 8% HCV-positive. Their HIV sex risk scores indicated a relatively low risk. However, only 4 (10%) women reported using a condom most of the time while having sex and 15 (38%) report not having had sex during the last 30 days. Experiences of interpersonal violence were common, with 42% reporting physical abuse by their partner during the last year and 48% reporting feeling unsafe in their current relationship.
Conclusions
The alarmingly high rate of failure to use barrier protection methods, together with the high percentage who did not know their HIV and HCV status, suggest that it may be beneficial to include non-substance-using female partners in prevention programs along with their partners to reduce the risk of HIV and HCV spreading from the population of injection-drug–using males into the general population. [This secondary analysis study was funded by an international supplement to the parent randomized clinical trial “Treating the Partners of Drug Using Pregnant Women: Stage II (HOPE)”. ClinicalTrials.gov Identifier: NCT00496990.
Female partners of opioid-injecting men in the Republic of Georgia: an initial characterization
Abstract Background HIV and Hepatitis C virus (HCV) infections are strongly related to injection drug use in the Republic of Georgia. Little information is available about HIV and HCV status, sexual risk, support for their partner, and risk for physical violence among the female partners of opioid-injecting men in the Republic of Georgia, many of whom may not be using drugs, yet may be at high risk of being infected with HIV and HCV from their drug-using partners. Methods In order to better understand the risks for females whose partners are injecting drugs, the present study conducted an initial investigation of the non-substance-using female partners of 40 opioid-injecting men who were participating in a clinical trial examining the feasibility and efficacy of a 22-week comprehensive intervention that paired behavioral treatment with naltrexone. The 40 female partners were assessed at their male partners’ study intake. Results The female sample was 32.3 years old (SD=6.7), 37 (93%) were married, with 15.5 years of education. A majority reported at least partial employment the majority of the time during the past 3 years, with only one woman reported being unemployed most of the time during the past 3 years. They self-reported they were 3% HIV-positive and 8% HCV-positive. Their HIV sex risk scores indicated a relatively low risk. However, only 4 (10%) women reported using a condom most of the time while having sex and 15 (38%) report not having had sex during the last 30 days. Experiences of interpersonal violence were common, with 42% reporting physical abuse by their partner during the last year and 48% reporting feeling unsafe in their current relationship. Conclusions The alarmingly high rate of failure to use barrier protection methods, together with the high percentage who did not know their HIV and HCV status, suggest that it may be beneficial to include non-substance-using female partners in prevention programs along with their partners to reduce the risk of HIV and HCV spreading from the population of injection-drug–using males into the general population. [This secondary analysis study was funded by an international supplement to the parent randomized clinical trial “Treating the Partners of Drug Using Pregnant Women: Stage II (HOPE)”. ClinicalTrials.gov Identifier: NCT00496990.]</p
Process and Product in Cross-Cultural Treatment Research: Development of a Culturally Sensitive Women-Centered Substance Use Intervention in Georgia
Women who inject drugs (WID) are highly marginalized and stigmatized and experience ongoing discrimination in Georgia. Few opportunities exist for WID to receive publicly funded treatment for substance use disorders. The IMEDI (Investigating Methods for Enhancing Development in Individuals) project was developed in response to the need for women-specific and women-centered treatment services. This paper described our approach to understanding the Georgian culture—and WID within that culture—so that we could integrate two interventions for substance use found effective in other Western and non-Western cultures and to outline how we refined and adapted our integrated intervention to yield a comprehensive women-centered intervention for substance use. Reinforcement Based Treatment (RBT) and the Women’s CoOp (WC) were adapted and refined based on in-depth interviews with WID (N=55) and providers of health services (N=34) to such women and focus groups [2 with WID (N=15) and 2 with health service providers (N=12)]. The resulting comprehensive women-centered intervention, RBT+WC, was then pretested and further refined in a sample of 20 WID. Results indicated positive pre-post changes in urine screening results and perceived needs for both RBT+WC and a case management control condition. The approach to treatment adaptation and the revised elements of RBT+WC are presented and discussed