{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T05:25:40Z","timestamp":1780377940465,"version":"3.54.1"},"reference-count":55,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T00:00:00Z","timestamp":1708387200000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Stigma has undermined the scale\u2010up of evidence\u2010based HIV prevention and treatment. Negative beliefs influence clinicians\u2019 discriminatory behaviour and ultimately have wide\u2010ranging effects across the HIV prevention and treatment continuum. Stigma among clinicians can be mitigated in several ways, including through interpersonal contact. In this study, we test whether interactions with people who inject drugs (PWID) influence attitudes of both direct and indirect providers of opioid agonist therapies (OATs) within the same primary care clinics (PCCs) where OAT is newly introduced.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a cluster randomized controlled trial integrating OAT and HIV care into PCCs in Ukraine, clinicians at 24 integrated care sites (two sites in 12 regions) from January 2018 to August 2022 completed a structured survey at baseline, 12 and 24 months. The survey included feeling thermometers and standardized scales related to clinician attitudes towards patients and evidence\u2010based care. Nested linear mixed\u2010effects models were used to examine changes in mean scores over three timepoints for both direct and indirect clinicians.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were fewer significant changes in any of the scales for direct providers (<jats:italic>n<\/jats:italic> = 87) than for indirect providers (<jats:italic>n<\/jats:italic> = 155). Direct providers became less tough\u2010minded about substance use disorders (<jats:italic>p<\/jats:italic> = 0.002), had less negative opinions about PWID (<jats:italic>p<\/jats:italic> = 0.006) and improved their beliefs regarding OAT maintenance (<jats:italic>p<\/jats:italic>&lt;0.001) and medical information (<jats:italic>p<\/jats:italic> = 0.004). Indirect providers reported improvements in most stigma constructs, including a significant decrease in prejudice (<jats:italic>p<\/jats:italic>&lt;0.001), discrimination (<jats:italic>p<\/jats:italic> = 0.001), shame (<jats:italic>p<\/jats:italic> = 0.007) and fear (<jats:italic>p<\/jats:italic> = 0.001) towards PWID.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Integrating OAT services within primary settings was associated with significantly reduced stigma constructs and improved attitudes towards PWID, possibly through increased intergroup contact between PWID and general clinical staff. Unlike most stigma reduction interventions, re\u2010engineering clinical processes so that PWID receive their care in PCCs emerges as a multilevel stigma reduction intervention through the integration of specialized services in PCCs. Integration influences different types of stigma, and has positive effects not only on health outcomes, but also improves clinician attitudes and efficiently reduces clinician stigma.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26202","type":"journal-article","created":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T05:12:57Z","timestamp":1708492377000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Integrating methadone into primary care settings in Ukraine: effects on provider stigma and knowledge"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0584-7238","authenticated-orcid":false,"given":"Daniel J.","family":"Bromberg","sequence":"first","affiliation":[{"name":"Yale School of Public Health, Yale University  New Haven Connecticut USA"},{"name":"Center for Interdisciplinary Research on AIDS, Yale University  New Haven Connecticut USA"},{"name":"Yale School of Medicine, Yale University  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eteri","family":"Machavariani","sequence":"additional","affiliation":[{"name":"Yale School of Medicine, Yale University  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn M.","family":"Madden","sequence":"additional","affiliation":[{"name":"Yale School of Medicine, Yale University  New Haven Connecticut USA"},{"name":"APT Foundation  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2862-4977","authenticated-orcid":false,"given":"Konstantin","family":"Dumchev","sequence":"additional","affiliation":[{"name":"Ukrainian Institute on Public Health Policy  Kyiv Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"LaMonaca","sequence":"additional","affiliation":[{"name":"Yale School of Medicine, Yale University  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie A.","family":"Earnshaw","sequence":"additional","affiliation":[{"name":"University of Delaware  Newark Delaware USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iryna","family":"Pykalo","sequence":"additional","affiliation":[{"name":"Ukrainian Institute on Public Health Policy  Kyiv Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myroslava","family":"Filippovych","sequence":"additional","affiliation":[{"name":"Ukrainian Institute on Public Health Policy  Kyiv Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwan S.","family":"Haddad","sequence":"additional","affiliation":[{"name":"Center for Key Populations, Community Health Center, Inc.  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