BACKGROUND: Central Asia (EECA) remains one of few regions where HIV incidence and mortality continue to increase, and this epidemic is concentrated among people who inject drugs (PWID). In Kazakhstan, the prevalence of HIV among PWID (9.2%) is higher than for any other key population. Opioid agonist therapies (OAT) like methadone or buprenorphine are evidence-based treatment for opioid use disorder (OUD) and crucial primary and secondary HIV prevention. Though methadone has been provided for free in Kazakhstan since 2008 through support from international donors, there are currently only approximately 340 (<1%) people on OAT among the estimated 90,000 PWID.
METHODS: To assess barriers and facilitators to methadone uptake for HIV prevention, we conducted nominal group technique (NGT) focus groups (FGs) with people with OUD in four cities in Kazakhstan. Among the 8 FGs, 4 included people currently on methadone, while the other 4 included people who had never received methadone. Additionally, we conducted 2 focus groups with local doctors and in-depth interviews with the directors at the four OAT sites and with several political figures who shape methadone policy in Kazakhstan.
RESULTS: Multi-level barriers included: Policy (e.g., required national registration as a “drug user” to access addiction treatment services); Structural (e.g., inaccessible locations of clinics, rigid enrollment requirements); Clinician (e.g., viewing potential methadone program participants as undisciplined, and therefore not ready for treatment); and Patient (e.g., too many logistical requirements). A detailed rank-ordered list of barriers and facilitators will be expanded below.
CONCLUSIONS: Findings from this study identify many opportunities for potential methadone scale-up, which is required to control the HIV epidemic in Kazakhstan and throughout Central Asia.