# Developing, Implementing, and Pilot Testing an Informed Decision Aid for Opioid Agonist Therapies for Prisoners in Ukraine

> **NIH NIH F31** · YALE UNIVERSITY · 2021 · $46,036

## Abstract

Project Summary/Abstract
The Eastern European and Central Asian (EECA) region has the most rapidly growing HIV
epidemic world-wide, compounded by high rates of incarceration and drug injection. People who
inject drugs (PWID) are concentrated in prisons, a region with some of the highest rates of
incarceration, where 70% of PWID experience lifetime incarceration and 36% pass through
prisons annually. Opioid agonist therapies (OAT) with methadone or buprenorphine are evidence-
based practices (EBPs) that effectively reduce HIV and HCV transmission in PWID by 54% and
61%, respectively, and reduce death 3-fold. An OAT pilot of 38 prisoners started in Ukrainian
prisons in 2020, yet coverage and scale-up in prisons is low in EECA and modeling data from
Ukraine suggests that not only must coverage markedly increase in prisons, but PWID must be
retained on it post-release. The prison environment, however, influences decisions about OAT
due to within-prison contextual factors alongside misperceptions that incarceration is treatment.
Informed decision-making aids are evidence-based tools that may facilitate OAT implementation
and scale-up in prisons as they guide PWID in deciding whether or not to adopt OAT and what to
choose based on personal preferences. The proposed research seeks to understand the
treatment preferences of incarcerated PWID in Ukraine, adapt an informed decision-making aid
to these preferences and context, pilot test this aid, and build a mathematical model showing how
scale-up of the aid would impact HIV and HCV transmission over a 10-year horizon. I propose to:
1) Use conjoint-based choice with segmentation analysis with 600 prisoners with opioid use
disorder to understand the OAT preferences of prisoners with opioid use disorder in Ukraine.
These findings will guide adaptation of the informed decision-making aid where I will 2)
systematically adapt an existing informed decision-making aid for opioid use disorder to the
Ukrainian prison context by alpha and beta testing the adapted interactive protype with prisoners
(n=25) and providers (n=10), and assess the utility of this implementation tool in changing
decisions about OAT using a pre/post design pilot study (n=100); and 3) assess the effectiveness
of this informed decision-making aid to scale-up OAT in prisons and its hypothetical impact on
HIV and HCV transmission over a 10-year horizon in PWID in Ukraine, using a Markov-based
dynamic state-transition model. These findings, if the informed decision-making aid influences
OAT scale-up, can be used to guide adoption of this implementation strategy throughout Eastern
European and Central Asian prisons, which have similar structures due to vestiges of the prison
system of the former Soviet Union.

## Key facts

- **NIH application ID:** 10326960
- **Project number:** 1F31DA054861-01
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** Daniel J Bromberg
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $46,036
- **Award type:** 1
- **Project period:** 2022-01-16 → 2024-01-15

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10326960

## Citation

> US National Institutes of Health, RePORTER application 10326960, Developing, Implementing, and Pilot Testing an Informed Decision Aid for Opioid Agonist Therapies for Prisoners in Ukraine (1F31DA054861-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10326960. Licensed CC0.

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