652 - Exploring the Perspectives of Opioid Use Disorder, Medications for Opioid Use Disorder, and HIV Care amongst Caregivers of Adolescents and Young Adults with Opioid Use Disorder in India

Publication Number: 3632.652

Sonia Taneja, Boston Medical Center, Boston, MA, United States; Lalsangliana Pachuau, YRG CARE, BOSTON, MA, United States; Lalremkima Hrahsel, YRG care, Aizawl, Mizoram, India; Hmingsangy Tlau Bual Chuan, YRG Care, Boston, MA, United States; Aishwarya Thakur, Children’s National Medical Center, Washington, DC, United States; Helen Lalremruati. Renthlei, YRGCARE, Aizawl, Mizoram, India; Yasmine Patel, Emory University, Colts Neck, NJ, United States; Anisha Mohan, Massachusetts General Hospital, Issaquah, WA, United States; Mohammad Aquil, integral university lucknow India, Aizawl, Mizoram, India; Ramya Ramadas, University of California, San Francisco, School of Medicine, Oakland, CA, United States; Areej Hassan, Boston Children's Hospital, Boston, MA, United States; Lakshmi Ganapathi, MassGeneral Hospital for Children, Boston, MA, United States

Background: Supporting adolescents and young adults (AYA) with opioid use disorder (OUD) requires developmentally-appropriate evidence-based interventions, including medications for opioid use disorder (MOUD), HIV prevention services, and caregiver engagement. However, little is known about caregiver perspectives, particularly in low- and middle-income countries (LMICs) where differing family expectations, structural barriers to OUD treatment, and scarce family-centered services may uniquely shape caregiver experiences.

Objective: To explore caregiver perspectives on opioid use disorder (OUD), medications for opioid use disorder (MOUD), and awareness of HIV prevention among AYA with OUD in India.

Design/Methods: We purposively sampled 18 caregivers of AYA aged 18 – 25 with OUD. Participants were recruited from five government-funded clinics for people with OUD in Mizoram, India. Semi-structured qualitative interviews were conducted in English or Mizo with trained facilitators. Two coders analyzed data utilizing inductive thematic analysis.

Results: Caregivers had a mean age of 42.4 (range 21 – 64); 17 caregivers were female, while 1 was male. Eleven were mothers of AYA with OUD, 3 were wives, 1 sister, 1 grandmother, and 1 father. Ten were employed outside the home. Six key themes emerged, several of which were aligned with similar studies in the US: (1) Perspectives of OUD were shaped by changes observed in their youth including theft and disengagement from family life (2) Caregivers of AYA actively engaged in MOUD tended to view OUD as a treatable medical condition, though many continued to attribute it to weak motivation; (3) Most caregivers sought multiple treatment options prior to initiating MOUD including rehabilitation centers sans evidence based treatments, sedative medications, and religious intervention (4) Awareness of injection-related HIV risk was high and caregivers engaged in harm reduction practices for their AYA (5) While caregivers recognized MOUD as effective, many advocated rapid tapering due to concerns about dependency, pervasive stigma, and logistical barriers to adherence; and (6) Caregivers experienced loss of trust, family communication breakdown, and caregiver burden due to AYA OUD with limited access to psychosocial supports.

Conclusion(s): In high-volume community-based settings, interventions prioritizing caregiver involvement is crucial. Shaping caregiver perspectives on OUD and MOUD, as well as addressing caregiver support needs through intervention holds potential to improve OUD treatment engagement and outcomes for adolescents and young adults.