People Who Inject Drugs and have tuberculosis: Opioid Substitution Therapy improves treatment outcomes in Ukraine

Introduction: Opioid substitution therapy (OST) is one of the pillars of harm reduction strategies for People Who Inject Drugs (PWID). It should be an integral part of tuberculosis (TB) care to increase the uptake, compliance and effectiveness of treatment and also curtail risk behaviors. We aimed to compare TB treatment outcomes in relation to OST among PWID in six regions of Ukraine.

Methodology: A retrospective cohort study using routine programmatic data from centers offering integrated TB and OST (December 2016 - May 2020). OST involved use of methadone or buprenorphine. TB treatment outcomes were standardized.

Results: Of 228 PWID (85% male) diagnosed with TB, 104 (46%) had drug-sensitive and 124 (64%) drug-resistant TB. The majority had pulmonary TB (95%), 64 (28%) were HCV-positive and 179 (78%) were HIV-positive, 91% of the latter were also on antiretroviral therapy. There were 114 (50%) PWID with TB on OST. For drug-sensitive TB (n=104), treatment success was significantly higher (61%) in those on adjunctive OST than those not on OST (42%, P<0.001). Similarly, for drug-resistant TB (n=124) treatment success was also significantly higher when individuals were on OST (43%) compared to when not on OST (26%, P<0.001).

Conclusions: This operational research study shows that OST is associated with significantly improved treatment success in PWID and can contribute to achieving Universal Health Coverage and the WHO Flagship Initiative "Find.Treat.All. #End TB". We advocate for the scale-up of this intervention in Ukraine.