Launching of a new 5 year Research project in partnership with Yale University School of Medicine on "Success and barriers of implementing Medicated Assisted Treatment (MAT) in UKraine"

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Implementation strategy
Zahedul Islam
Project Director
Partner agencies and funders meeting
January 30th, 2013

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Outline
Project team
Approach according to the main objectives of
the study
 Specific aim 1: formative research
 Specific aim 2: NIATx Rapid Change Model
 Specific aim 3: Extended Release Naltrexone Study

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Project team
Yale University
School of Medicine
• Frederick L. Altice
(Principal
Investigator)
• Sandra Springer
(Co-Investigator
• Jeff Wickersham
• Ruthanne Marcus
• Martha Bojko
ICF “International
HIV/AIDS Alliance in
Ukraine
• Zahedul Islam
(Project Director)
• Sergey Filippovych
(Co-Investigator)
• Alyona Mazhnaya
(Project Manager)
Ukrainian Institute
on Public Health
Policy
• Sergii Dvoryak
(Co-Investigator)
• Julia Makarenko
(Senior Research
Assistant)

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Study regions
Formative research and NIATx
model
 Selected big cities in 4
regions of Ukraine (East,
West, Center, South)
 Kyiv
 Lviv
 Odessa/Mykolaiv
 Donetsk/Dnipropetrovsk
Extended Release Naltrexone
Study
 Kyiv:
 Sociotherapy Narcological
Center
 AIDS Center Hospital

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Specific aim 1: formative research
February-April, 2013 (1)
Client-Level Assessment
of MAT Barriers and
Facilitators
Program-Level
Assessment of MAT
Barriers and
Facilitators
Establish Outcome
Indicators for ENTRY and
RETENTION
Create Matrix for Low ENTRY
and RETENTION Performance
Sites

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Specific aim 1: formative research
February-April, 2013 (2)
Themes of the study
 Access to Care and Social Assistance
 Health Beliefs About MAT
 Structural Factors Associated with Substance
Abuse
 Attitudes towards Alternative MAT Treatment (XR-
NTX)

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Specific aim 1: formative research
February-April, 2013 (3)
Focus Groups
 for those on OST
 for those previously on OST
but no longer
 for those never on OST
 that is mixed from each of
the above strata
 per region for women only
Key Informant Interview
 Head Narcologist for Oblast
 OST Site Narcologists
 OST Site Nurses
 OST Site Social
Workers/Psychologist

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Specific aim 1: formative research
February-April, 2013 (4)
Based on results of focus groups and key
informant interviews a structured survey will
be developed.
Structured survey will help to determine the
prevalence of common barriers and facilitators
in each region.

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PRE-INTERVENTION
ASSESSMENT (6 months)
Create NIATx Change Teams
and Train Ukrainian Experts
Collect MAT ENTRY &
RETENTION Indicators
POST-INTERVENTION
ASSESSMENT (12 months)
Collect MAT ENTRY &
RETENTION Indicators
Compare PRE- and POST-
NIATx Performance Indicators
Specific aim 2: NIATx Rapid Change Model
August 2013 - June 2015 (1)

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Specific aim 2: NIATx Rapid Change Model
August 2013 - June 2015 (2)
To train Ukrainian experts on the use of the
NIATx model, create NIATx change teams.
To conduct a study with analysis of MMT entry
and retention of opioid dependent patients
before and after implementation of the NIATx
Rapid Change Cycle Model.

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Evidence-Based Practice
NIATx Organizational Change Model
 An EBP of process improvement specifically for
behavioral health care settings to improve access and
retention in treatment.
 Aims to reduce waiting time to enter treatment,
decrease “no shows”, increase admissions, reduce
attrition.
 Five principles include: 1) understand and involve the
customer; 2) fix key problems; 3) pick a powerful change
leader; 4) get ideas from outside the organization or
field; & use rapid cycle testing to document changes.
See www.NIATX.net

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Reduce Waiting
Times
Reduce No
Shows
Increase Entry
into MAT
Reduce MAT
Attrition
Improved MAT
Outcomes
 1° & 2° HIV Prevention,  QoL,
 addiction severity,  drug use
NIATx and Proposed Outcomes

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Specific aim 3 : XR-NTR study
January 2014 – September 2016

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Dissemination plan
Annual stakeholders meeting to review the
findings from studies to determine the next
steps for expanding MAT in Ukraine.
Presentation of findings during different OST
partners meetings.

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Project timeline (short overview)
Year Year 1 Year 2 Year 3 Year 4 Year 5
Month/Quarter
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Jan
Apr
Jul
Oct
Jan
Apr
Jul
Oct
Jan
Apr
Jul
Oct
Jan
Aim 1 (Formative Research)
Finalize site selection X X
Conduct program-level assessment (FG&KI) X X X X
Interpret program-level data/Analyze FG&KI
data X X X X
Conduct client-level assessment (FG&KI) X X X X
Interpret client-level data/ /Analyze FG&KI data X X X X
Develop structured survey X X
Conduct survey in selected region X X X
Interpret/analyze survey data X X X
Aim 2 (Pre-Post Assessment of NIATx)
Pre-test assessment X X X
Train Ukrainian Colleagues on NIATx X X
Introduce NIATx and post-test assessments X X X X
Aim 3 ( XR-NTX)
Finalize study protocol and instruments X X X X X
Train Ukrainian physicians X X
XR-NTX Feasibility Study (N=25) X X X X
XR-NTX Longitudinal Study (N=75) X X X X X
Follow-up subjects X X X X X X X X
Dissemination and Implementation Plan
Meet with partner agencies and funders X X X X X X X X X X X X

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Thank you!