Patient preferences and extended-release naltrexone: A new opportunity to treat opioid use disorders in Ukraine

Background: Scaling up HIV prevention for people who inject drugs (PWID) using opioid agonist therapies (OAT) in Ukraine has been restricted by individual and structural factors. Extended-release naltrexone (XR-NTX), however, provides new opportunities for treating opioid use disorders (OUDs) in this region, where both HIV incidence and mortality continue to increase. Methods: Survey results from 1613 randomly selected PWID from 5 regions in Ukraine who were currently, previously or never on OAT were analyzed for their preference of pharmacological therapies for treating OUDs. For those preferring XR-NTX, independent correlates of their willingness to initiate XR-NTX were examined. Results: Among the 1613 PWID, 449 (27.8%) were interested in initiating XR-NTX. Independent correlates associated with interest in XR-NTX included: being from Mykolaiv (AOR = 3.7, 95% CI = 2.3-6.1) or Dnipro (AOR = 1.8, 95% CI = 1.1-2.9); never having been on OAT (AOR = 3.4, 95% CI = 2.1-5.4); shorter-term injectors (AOR = 0.9, 95% CI 0.9-0.98); and inversely for both positive (AOR = 0.8, CI = 0.8-0.9), and negative attitudes toward OAT (AOR = 1.3, CI = 1.2-1.4), respectively. Conclusions: In the context of Eastern Europe and Central Asia where HIV is concentrated in PWID and where HIV prevention with OAT is under-scaled, new options for treating OUDs are urgently needed. Findings: here suggest that XR-NTX could become an option for addiction treatment and HIV prevention especially for PWID who have shorter duration of injection and who harbor negative attitudes to OAT. Decision aids that inform patient preferences with accurate information about the various treatment options are likely to guide patients toward better, patient-centered treatments and improve treatment entry and retention.