In 2019 EHRA together with Support, Research and Development Centre (SRDP), the Ukrainian Network of People who use Drugs (VOLNA), Drug-users Ukraine, the Drop-in Centre and the ENEY developed the methodology to access the client satisfaction with opioid maintenance therapy and conducted the pilot study in Kyiv and Kyiv Oblast region. Our approach to this study was based on the principles of equal partnership with the community of people who inject drugs and/or receive opioid maintenance therapy (OMT).
Almost from their very first days, OMT programmes in Ukraine have come under close scrutiny from the international research community. We believe that attention has been drawn to OMT programmes in Ukraine because of the low annual numbers of new patients throughout the period of the OMT implementation projects. According to UNAIDS, the estimated number of people who inject drugs in Ukraine is 346,000 individuals, of whom only 11,853 (or less than 3.5%) currently receive OMT services. The lack of attention paid to treatment satisfaction in Ukraine can probably be attributed to a shift in emphasis towards the needs of increasing service coverage, even while the quality of service is seldom included in ongoing discussions. Since OMT programmes have been operating in Ukraine for more than 10 years, the study of patient satisfaction with treatment offers opportunities for a better understanding of OMT service development prospects in the long run and of treatment trajectories and changing needs at the patient level.
As the design of this study was based on qualitative and quantitative methodological components, it was implemented in the framework of the mixed–method approach. The protocol and tools of this study were reviewed by the Ethics Review Board of the Ukrainian Institute on Public Health Policy.
The quality component of this study was implemented through semi-structured interviews with patients of OMT programmes.Within the scope of the study, the main purpose of semi-structured interviews was to highlight various aspects and criteria of satisfaction with OMT services among patients in order to develop a data-based questionnaire tool.
376 OMT patients took part in the pilot assessment, 178 structured interviews were conducted with patients who get OMT for free at state-funded OMT sites, 198 interviews were conducted with patients who buy OMT drugs in pharmacies after getting prescription at OMT sites based in private clinics. An overall satisfaction with OMT treatment is assessed as high and very high in 72% OMT patients, but the particular aspects of OMT treatment are not that highly assessed. The quality of medical care at OMT site is assessed as satisfied by 49%, 42% are satisfied with the physical environment at OMT sites and only 34 % of survey participants assess the psycho-social support as satisfied. At the same time, 89% of respondents mentioned that OMT is a vital need for them.
Based on the results of this study, we can draw the following conclusions and make some recommendations for further advocacy:
- Studies like this conducted using a routine monitoring format as an integrated component of the monitoring and evaluation framework at OMT sites could help us understand the dynamics of satisfaction with treatment and treatment environment, interactions with OMT service providers and subjective treatment experiences. Which in turn could influence the long-term patient retention in OMT programmes.
- For an improved understanding of the goals and outcomes of the treatment of chronic diseases like drug addiction, we recommend considering the assessment of patient quality of life as an indicator of treatment efficiency.