NIATx goes global: Learning collaboratives in Ukraine address opioid use and HIV

NIATx coaches Lynn Madden and Scott Farnum have been teaching the NIATx model to behavioral health and human services professionals in the U.S. for more than a decade. And since 2014, they’ve taken NIATx across the globe, coaching NIATx change teams in Ukraine.

They’re working on a project called “Expanding Medication Assisted Therapies in Ukraine,” led by Dr. Rick Altice of Yale University. This NIDA-funded research study aims to reduce HIV infections in Ukraine by increasing access to medication-assisted treatment (MAT).

“The rate of people positive for HIV in Ukraine is among the highest in Europe,” says Lynn, noting that increase in HIV infections is directly linked to the high number of opioid-dependent people who inject drugs. “MAT is considered to be one of the most effective ways to reduce HIV transmission and improve treatment outcomes,” she adds.

Lynn and Scott convened a NIATx learning collaborative in Kiev in the fall of 2014. Attendees included treatment providers and government officials representing 21 of Ukraine’s 24 regions. Representatives from Ukrainian Institute on Public Health Policy, the Ukraine Center for Disease Control, and Alliance for Public Health also attended and continue to be involved in the NIATx collaborative.

NIATx materials were translated into to Russian for the learning collaborative.  Scott and Lynn spoke into headsets to teach while an interpreter translated their presentations from English to Ukrainian.  In classic NIATx style, the coaches trained at that session are now leading other NIATx learning collaboratives in Ukraine. 

NIATx tools cross cultures

The collaboratives use NIATx tools such as the walk-through, flowcharting, and the nominal group technique (NGT) effectively. Lynn cites the use of NGT as going “amazingly well.”

“It’s remarkable how the Ukrainian collaborative members use NGT to debate and listen to others’ ideas,” comments Lynn. “This has been extremely helpful in terms of helping the groups work through difficult issues, such as how to get the medications paid for, and how to effectively advocate for an improved regulatory structure.”

A letter that one group wrote to the Ukrainian Ministry of Health as the result of an NGT exercise led to changes in the some of the country’s rules governing opioid replacement medication.  

Lynn and Scott convened learning collaboratives in Kiev three times for 10 days each—in April 2015, September 2015 and February 2016, with site visits to Poltava in April of 2015 and Dnipropetrovsk in February of 2016.

“In every follow up visit since the initial collaborative meeting in October of 2104, sites have presented 5 x 5’s, and all were excellent examples of good NIATx change projects,” says Lynn.

The Ukrainian coaches have developed a detailed spreadsheet of ongoing change cycles and have also formed a series of interest circles. 

“The collaborative has created a forum for people to talk with each other about their work in a way that was not available to them before the NIATx project,” says Lynn. “The result is that they now have a way of advocating for promising practices and new ideas to shape policies.”

So far, the NIATx Collaborative in Ukraine has helped to move medications for opioid replacement therapy into primary care, and people can now get a prescription to receive methadone or buprenorphine at a pharmacy.

“None of these medications were available in Ukraine until 2004,” comments Lynn. “It’s remarkable that the creative interventions coming from the NIATx collaborative are making them available in ways that don’t exist in the U.S.”

The NIATx projects in Ukraine have also examined ways to improve access. For example, people can now get HIV testing and substance use disorder treatment at the same location. Some sites have also chosen to deliver methadone to people in their homes.

Lynn and Scott will return to Ukraine in May 2016 for a whirlwind visit to both Kiev and Odessa.

The active study phase of the project will end in March of 2017 and the team is planning to apply for a competitive renewal.

The NIATx approach is also part of the organizational culture at the APT Foundation in New Haven, CT, where Lynn serves as President and CEO—NIATx change projects are ongoing.

For Lynn, working with change teams in Ukraine has reinforced her belief in the power of the NIATx approach.

“NIATx can be adapted to other cultures, since most of the techniques are a-cultural—they represent ways of identifying barriers and facilitators to a locally important aim,” says Lynn.

 “Working with the NIATx collaborative in Ukraine has reinforced for me that NIATx tools such as the walk-through, NGT, and rapid-cycle testing are universal, but the results they yield are unique to a change team’s location and culture.”