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Table 2 Barriers to substance use treatment: key themes

From: Perspectives of clients and providers on factors influencing opioid agonist treatment uptake among HIV-positive people who use drugs in Indonesia, Ukraine, and Vietnam: HPTN 074 study

Themes PWID Providers
Structural level
 Complicated entry to MAT program All sites: limited number of treatment slots; waiting lists
Vietnam and Indonesia: procedural barriers; strict admission requirements
Vietnam: low capacity of MAT sites to accept new patients
Indonesia, Vietnam: strict admission requirements to start MAT
 Problematic clinic access Majority in Vietnam, some in Indonesia: long distance to MAT clinic
Ukraine, Vietnam: inflexible clinic hours; lines at MAT sites
All sites: long distance to MAT clinic; limited/inflexible clinic hours
Indonesia, Ukraine: daily visits to MAT site
 Financial barriers Costly examinations to start MAT (Indonesia, Ukraine); a need to pay for transportation and supporting services at MAT site (Vietnam) Most providers in Indonesia and a few in Ukraine and Vietnam: costly examinations to start MAT
Vietnam: a need to pay for MAT leads to patients skipping doses
Community level
 Social stigma toward PWID All sites: stigma toward PWID in the community rather than at health facilities
Vietnam: social stigma toward methadone clients
Indonesia, Ukraine: social stigma toward PWID
Ukraine: stigmatization of addiction treatment per se; negative image of narcology institutions
 Individual level
 Lack of information about substance use treatment Indonesia, Ukraine: lack of information about available substance use treatment All sites: PWID’ lack of information about available substance use treatment; lack of understanding of addiction and MAT in society
 Negative opinion of methadone treatment All sites—misconceptions of methadone: it is “drug given for free” (Ukraine, Vietnam) and “worse than street drugs” (Indonesia, Vietnam)
Ukraine: PWID would prefer buprenorphine
Ukraine: misconceptions and negative opinions of methadone among PWID; PWID would prefer buprenorphine
Some providers see MAT as a free substitution to a street drug
 Other barriers related to drug use Ukraine: most PWID are used to the drug user’s lifestyle
Ukraine, Vietnam: using other substances when on MAT as a barrier to adherence
Ukraine: PWID do not start MAT as they prefer a “drug user’s life” and demonstrate “lack of will” (lack of internal motivation)
 Drug interactions Ukraine, Vietnam: fear of ART and methadone interaction