Drug use and HIV risk outcomes in opioid-injecting men in the Republic of Georgia: Behavioral treatment+naltrexone compared to usual care

Background: To test the initial feasibility of a novel 22-week comprehensive intervention pairing behavioral treatment with naltrexone that aimed at engaging, retaining, and treating opioid-injecting men in the Republic of Georgia. Methods: Forty opioid-injecting male and their drug-free female partners participated in a two-group randomized clinical trial at the field site of the Union Alternative Georgia, in Tbilisi, Republic of Georgia. The comprehensive intervention that paired behavioral treatment with naltrexone for the male participants (n = 20) included counseling sessions using Motivational Interviewing for both the male participant and the couple, monetary incentives for drug abstinence, and research-supported detoxification followed by naltrexone treatment. Male participants in the usual care condition (n = 20) had the opportunity to attend once-a-week individualized education sessions and upon request receive referrals to detoxification programs and aftercare that could or could not have included naltrexone. Outcome measures included entry into inpatient detoxification and naltrexone treatment, urine drug screening, reduction in illicit substance use, use of benzodiazepines, injection of buprenorphine, and needle and syringe sharing. Results: The comprehensive intervention condition showed significantly more weekly urine samples negative for illicit opioids during weeks 1-22 (7.0 vs. 1.4; p< .001) and reported significant declines in use of benzodiazepines and injection of buprenorphine (both ps < .004). Conclusions: The first behavioral treatment randomized clinical trial in the Republic of Georgia found that the use of tailored behavioral therapy paired with naltrexone is both feasible and efficacious for treating drug use and reducing HIV drug-risk behavior in Georgian men.