Zahedul is the director of the Treatment, Procurement, and Supply division of the Alliance for Public Health. He manages treatment programs (HIV/OST/TB/HepC) and procurement for all Grants programs in Ukraine. Zahedul has over 20 years of experience working in developing countries with many organizations including MSF, MSH, and Handicap International.

Background: Ukraine has been constantly underachieving its national target since the initiation of OAT in 2004. As of August 2022, only 6.69% of the estimated 289,000 PWID received OAT. There is an urgent need for a rapid scale-up of OAT based on different treatment models to prevent further HIV epidemics.

Methods: A retrospective cohort study design is used to assess the effectiveness of different OAT services regarding admission and retention in treatment by comparing variables in four different models of OAT provision. Data were analyzed using the univariate, bivariate, and multinomial logistic regression models.

Results: The sample (N=16,478) was stratified into 4 groups following the OAT models: psychosocial support – PSS (n=4646), result-based-financing – RBF (n=1612), mixed-model (n=904), and no-additional services model (n=9316). The RBF model was associated with better admission (31.1%) than the PSS, mixed-model, and model with no-additional services (2.7,19.9, and 7.9%) respectively. The PSS and mixed-model observed the highest 6-month retention (94.3%,97%) while the RBF model constitutes 81.3% and 84.7% for the model with non-additional services. Older age was significantly associated with increased admission (95% CI:1.18-2.46) and better retention (95% CI:1.32-3.46). Females also significantly increased the odds of both, admission and retention (OR=1.39;95% CI:1.23-1.76, and OR=1.74;95% CI:1.21-1.92) compared to males. Home/hospice care form of OAT receipt increased the odds of both: 6-month admission (OR=1.48;95% CI:1.25-2.34) and 6-month retention (OR=1.90;95% CI:1.36-4.32). Living with HIV negatively affects the admission (OR=0.66;95% CI:0.32-0.87) but increased the odds of being retained in the OAT for at least 6 months (OR=1.76;95% CI:1.22-1.90).

Conclusions: The findings suggest that the RBF model has higher odds to increase admission to the OAT program and PSS and the mixed model with higher retention. Thus, the RBF model for increased admission and PSS and mixed model for retention can be adopted to increase nationwide OAT scale-up.