Buprenorphine/naloxone treatment in primary care is associated with decreased human immunodeficiency virus risk behaviors

Abstract

Methadone treatment reduces HIV risk but the effects of primary care-based buprenorphine/naloxone on HIV risk are unknown. The purpose of the current study was to determine whether primary carebased buprenorphine/naloxone was associated with decreased HIV risk behavior. We conducted a longitudinal analysis of 166 opioid dependent persons (129 men and 37 women) receiving buprenorphine/naloxone treatment in a primary care clinic. We compared baseline, 12 and 24-week overall, drug-related and sex-related HIV risk behaviors using the AIDS/HIV Risk Inventory (ARI). Buprenorphine/naloxone treatment was associated with significant reductions in overall and drugrelated ARI scores from baseline to 12 and 24-weeks. Intravenous drug use in the past 3 months was endorsed by 37%, 12%, and 7%, of patients at baseline, 12 weeks and 24 weeks, respectively; p < 0.001. Sex while you or your partner were "high" was endorsed by 64%, 13%, and 15% of patients at baseline, 12 weeks and 24 weeks, respectively; p<0.001. Inconsistent condom use during sex with a steady partner was high at baseline and did not change over time. We conclude that primary carebased buprenorphine/naloxone treatment is associated with decreased drug-related HIV risk but additional efforts may be needed to address sex-related HIV risk when present. (ClinicalTrials.gov number, NCT00023283).

Factors associated with Medicaid patients' access to buprenorphine treatment

“…This condition may predispose patients to enroll in OAT, but this finding may also reflect increased screening rates at the time of admission as recommended by treatment guidelines (Center for Substance Abuse Treatment, 2004Treatment, , 2005. Patients with HIV were less likely to be receiving agonist treatment, which is concerning because agonist treatment is associated with improved adherence to antiretroviral medication regimens (Altice et al, 2006;Roux et al, 2008) and is effective in decreasing HIV risk behaviors and transmission (Metzger et al, 1993;Sullivan, Metzger, Fudala, & Fiellin, 2005;Sullivan et al, 2008).…”

The effectiveness of harm reduction in preventing HIV among injecting drug users

“…[25][26][27] The evidence is much stronger for methadone than for buprenorphine treatment. 27,28 Methadone substantially reduces drug injecting and thereby the sharing of injecting equipment. 26,29 Seroprevalence studies suggest that reductions in injecting risk behaviour can result in reductions in HIV infection but relatively few (expensive and difficult) seroincidence studies have been published.…”

Integrating Buprenorphine Treatment into Office-based Practice: a Qualitative Study

“…Relapse with pharmacologic withdrawal and naltrexone has been noted to be exceedingly high, while opioid agonist treatment has demonstrated efficacy in decreasing drug use and HIV transmission [6][7][8] . Treatment with opioid agonists that bind to opioid receptors and therefore decrease opioid craving has been endorsed by a National Institutes of Health consensus panel as the recommended treatment for opioid-dependent patients 9 .…”