Expanding Medication-Assisted Therapies in Central Asia (ExMAT-CA)


Center of Scientific-Practical Initiatives has started a new study with Yale University (PIs: Dr. Frederick Altice (https://ysph.yale.edu/profile/frederick-altice/) and Dr. Lynn Madden (https://medicine.yale.edu/profile/lynn-madden/, https://aptfoundation.org/about-us/bios/).

OBJECTIVE: To scale-up opioid agonist treatments (OAT) in Kazakhstan, Kyrgyzstan, and Tajikistan by training, coaching, facilitating and supporting national narcology experts (CNs) on the use of The Network for the Improvement of Addiction Treatment (NIATx) and create national NIATx collaboratives and a 3-country learning collaborative.

BACKGROUND: The NIATx collaborative is a group of CNs involved in the provision of OAT who seek to increase the number of patients receiving OAT by improving the care processes in their clinics via coaching linked to rapid-change cycles, within the existing legal framework. We will include all of the Oblast CNs to create learning collaboratives at the oblast-level, which will then be replicated at the country, and regional levels.

OUTCOMES: Our primary outcome will be total scale-up of patients on OAT nationally and per oblast. Because patient census is a function of patients entering and dropping out of OAT, these will be our secondary outcomes.


The team at Yale University will:

  • Create and distribute protocols for client and program-level assessments;
  • Train and hire local experts who will be conducting all day-to-day research activities in each country;
  • Obtain approvals from al ethics committees to ensure all activities are ethical and appropriate;
  • Communicate frequently with stakeholders to inform them regarding progress of the project;
  • Train local experts on the use of the NIATx implementation model;
  • Supervise the implementation of the NIATx model in all 3 countries;
  • Schedule and help organize national collaboratives and the regional, 3-country collaborative;
  • Provide continuing expertise to national and regional stakeholders to improve OAT scaleup;
  • Analyze OAT scale up, and the factors influencing it, from national and regional perspectives;
  • Publish all scientific findings from this project, making them available to all stakeholders, participants, government officials, and the public, so as to benefit future OAT scale-up.

The stakeholders and participants in each country will:

  • Provide initial authorization for the conduct of research in each country;
  • Work with the Yale team to conduct baseline and and all serial follow-up assessments;
  • Provide the Yale team with data pertaining to the scale up of OAT in their country for analysis;
  • Participate in the NIATx process by creating change teams, implementing rapid-change projects, and evaluating results from the PDSA cycle framework;
  • Participate in monthly NIATx calls at the Oblast level;
  • Participate in quarterly national NIATx collaboratives;
  • Participate in yearly regional, 3-country collaboratives.

Note: A complete explanation of all methods can be found on the NIATx website (www.niatx.net).

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