Effect of integrating HIV and addiction care for non-engaging HIV-infected opiate-dependent patients

Kinahan, J C; Surah, S; Keating, Shay; Bergin, Colm; Mulcahy, Fiona; Lyons, F; Keenan, Eamon

doi:10.1007/s11845-015-1319-0

Cited by 7 publications

(8 citation statements)

References 20 publications

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“…Integration of HIV and methadone treatment services has been shown to improve immunologic function in people who use drugs (Kinahan et al, 2015). The high failure rate to initiate ART among people who inject drugs in resource-limited settings represents a lost opportunity to reduce morbidity, mortality and the spread of infection.…”

Section: Discussionmentioning

confidence: 99%

“Can’t you initiate me here?”: Challenges to timely initiation on antiretroviral therapy among methadone clients in Dar es Salaam, Tanzania

Saleem

Mushi

Hassan

et al. 2016

International Journal of Drug Policy

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Background Despite dramatic improvement in antiretroviral therapy (ART) access globally, people living with HIV who inject drugs continue to face barriers that limit their access to treatment. This paper explores barriers and facilitators to ART initiation among clients attending a methadone clinic in Dar es Salaam, Tanzania. Methods We interviewed 12 providers and 20 clients living with HIV at the Muhimbili National Hospital methadone clinic between January and February 2015. We purposively sampled clients based on sex and ART status and providers based on job function. To analyze interview transcripts, we adopted a content analysis approach. Results Participants identified several factors that hindered timely ART initiation for clients at the methadone clinic. These included delays in CD4 testing and receiving CD4 test results; off-site HIV clinics; stigma operating at the individual, social and institutional levels; insufficient knowledge of the benefits of early ART initiation among clients; treatment breakdown at the clinic level possibly due to limited staff; and initiating ART only once one feels physically ill. Participants perceived social support as a buffer against stigma and facilitator of HIV treatment. Some clients also reported that persistent monitoring and follow-up on their HIV care and treatment by methadone clinic providers led them to initiate ART. Conclusion Health system factors, stigma and limited social support pose challenges for methadone clients living with HIV to initiate ART. Our findings suggest that on-site point-of-care CD4 testing, a peer support system, and trained HIV treatment specialists who are able to counsel HIV-positive clients and initiate them on ART at the methadone clinic could help reduce barriers to timely ART initiation for methadone clients.

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Section: Discussionmentioning

confidence: 99%

“Can’t you initiate me here?”: Challenges to timely initiation on antiretroviral therapy among methadone clients in Dar es Salaam, Tanzania

Saleem

Mushi

Hassan

et al. 2016

International Journal of Drug Policy

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“…While most studies took place in North America (n=15 in the United States and n=1 in Canada), four took place in Europe [53,54,60,68] and three took place in Asia [52,59,74]. Half of studies had a follow-up period of 12 months or longer ( Table 1).…”

Section: Description Of Studiesmentioning

confidence: 99%

“…In two randomized trials, HIV testing and counseling alone in opioid treatment settings led to increased HIV testing performed and feedback of results [55,75], but the addition of sexual risk-reduction counseling did not lead to significant changes in sexual risk behaviors [69]. ART management in opioid treatment settings involved the prescription of ART in methadone clinics [68] or directly-administered ART (DAART) [53,56,60,[64][65][66]70]. DAART in residential opioid treatment settings [53] and methadone clinics was safe and feasible [56,60,[64][65][66]70], but a randomized trial demonstrated that DAART compared with self-administered ART in methadone clinics did not lead to significant differences in clinical outcomes [63].…”

Section: Interventions In Opioid Treatment Settingsmentioning

confidence: 99%

Integration of care for HIV and opioid use disorder

Oldfield

Muñoz²,

McGovern

et al. 2019

Aids

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Objective: We sought to identify optimal strategies for integrating HIV-and opioid use disorder-(OUD) screening and treatment in diverse settings. Design: Systematic review. Methods: We searched Ovid MEDLINE, PubMed, Embase, and PsycINFO and pre-identified websites. Studies were included if they were published in English on or after 2002 through May 2017, and evaluated interventions that integrated, at an organizational level, screening and/or treatment for HIV and OUD in any care setting in any country. Results: Twenty-nine articles met criteria for inclusion, including 23 unique studies: six took place in HIV care settings, 12 in opioid treatment settings, and five elsewhere. Eight involved screening strategies, 22 involved treatment strategies, and seven involved strategies that encompassed screening and treatment. Randomized controlled studies demonstrated low to moderate risk of bias and observational studies demonstrated fair to good quality. Studies in HIV care settings (n=6) identified HIV-and OUD-related clinical benefits with the use of buprenorphine/naloxone for OUD. No studies in HIV care settings focused on screening for OUD. Studies in opioid treatment settings (n=12) identified improving HIV screening uptake and clinical

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“…This serves as a basis for future model development to answer the WHO call to reach key populations with integrated HIV services using a combination approach that includes harm reduction services [1,2]. Other clinics have successfully integrated HIV care and opioid treatment programs, but this is the first time, to our knowledge, that it is being reported in sub-Saharan Africa [21,39,40]. IMAT adds to the body of literature showing that integration of HIV care for PWUD is an effective approach to ensuring their timely and appropriate care and treatment [41,42,43].…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Integrated Methadone and Anti-Retroviral Therapy Strategy in Tanzania Using the RE-AIM Framework

Hassan

Cooke

Saleem

et al. 2019

IJERPH

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There are an estimated 50,000 people who inject drugs in Tanzania, with an HIV prevalence in this population of 42%. The Integrated Methadone and Anti-Retroviral Therapy (IMAT) strategy was developed to integrate HIV services into an opioid treatment program (OTP) in sub-Saharan Africa and increase anti-retroviral therapy (ART) initiation rates. In this paper, we evaluate the IMAT strategy using an implementation science framework to inform future care integration efforts in the region. IMAT centralized HIV services into an OTP clinic in Dar Es Salaam, Tanzania: HIV diagnosis, ART initiation, monitoring and follow up. A mixed-methods, concurrent design, was used for evaluation: quantitative programmatic data and semi-structured interviews with providers and clients addressed 4 out of 5 components of the RE-AIM framework: reach, effectiveness, adoption, implementation. Results showed high reach: 98% of HIV-positive clients received HIV services; effectiveness: 90-day ART initiation rate doubled, from 41% pre-IMAT to 87% post-IMAT (p < 0.001); proportion of HIV-positive eligible clients on ART increased from 71% pre-IMAT to 98% post-IMAT (p < 0.001). There was high adoption and implementation protocol fidelity. Qualitative results informed barriers and facilitators of RE-AIM components. In conclusion, we successfully integrated HIV care into an OTP clinic in sub-Saharan Africa with increased rates of ART initiation. The IMAT strategy represents an effective care integration model to improve HIV care delivery for OTP clients.

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Effect of integrating HIV and addiction care for non-engaging HIV-infected opiate-dependent patients

Abstract: Integration of HIV and addiction care optimises the physical health of non-engaging HIV-positive opiate-dependent patients with no substantial effect on their methadone maintenance programme.

Cited by 7 publications

References 20 publications

“Can’t you initiate me here?”: Challenges to timely initiation on antiretroviral therapy among methadone clients in Dar es Salaam, Tanzania

“Can’t you initiate me here?”: Challenges to timely initiation on antiretroviral therapy among methadone clients in Dar es Salaam, Tanzania

Integration of care for HIV and opioid use disorder

Evaluating the Integrated Methadone and Anti-Retroviral Therapy Strategy in Tanzania Using the RE-AIM Framework

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