HIV clinic-based buprenorphine plus naloxone versus referral for methadone maintenance therapy for treatment of opioid use disorder in HIV clinics in Vietnam (BRAVO): an open-label, randomised, non-inferiority trial

Korthuis, P. Todd; King, Caroline; Cook, Ryan; Khuyen, Tong Thi; Kunkel, Lynn E.; Bart, Gavin; Nguyen, Thuan; Thúy, Đinh Thanh; Bielavitz, Sarann; Nguyen, Diep Bich; Tâm, Nguyễn Thị; Giang, Lê Minh

doi:10.1016/s2352-3018(20)30302-7

Cited by 17 publications

(15 citation statements)

References 29 publications

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“…The included studies were published between 1976 and 2021, and the size of the study ranged from 19 to 1,269 participants. These trials were conducted in the United States (N = 37) [ 38 , 39 , 42 , 48 , 50 – 54 , 58 , 60 – 65 , 68 , 69 , 71 , 78 – 80 , 82 , 83 , 85 , 89 , 90 , 92 , 97 , 99 , 101 – 103 , 107 – 109 , 114 ], Europe including Russia (N = 24) [ 40 , 43 , 47 , 49 , 56 , 57 , 66 , 67 , 72 – 77 , 84 , 88 , 95 , 96 , 98 , 104 , 106 , 110 , 111 , 113 ], Asia including the Middle East and the Caucasus (N = 14) [ 44 – 46 , 59 , 70 , 81 , 87 ...…”

Section: Resultsmentioning

confidence: 99%

“…All of the included studies focused on patients with OUD, with 13 studies focusing specifically on patients with heroin-related disorders [ 37 , 41 , 44 , 50 , 55 , 65 – 67 , 69 , 77 , 91 , 103 , 114 ]. Two studies recruited patients with co-occurring opioid use disorder and chronic non-cancer pain [ 89 , 90 ], while 61 studies excluded patients with psychiatric disorders or concurrent dependence on alcohol, sedative, or hypnotic medications [ 37 , 39 , 40 , 42 , 43 , 48 – 50 , 52 , 54 – 57 , 59 , 60 , 62 – 68 , 70 , 74 – 80 , 82 – 88 , 90 – 93 , 95 – 113 , 115 ].…”

Section: Resultsmentioning

confidence: 99%

“…Overall, the risk of bias was judged ‘Low’ for 38 studies [ 39 , 40 , 50 , 53 – 57 , 60 , 63 – 67 , 70 , 73 – 80 , 82 , 83 , 85 – 87 , 89 , 90 , 97 , 100 – 102 , 109 – 112 ], ‘Some Concerns’ for 37 studies [ 37 , 38 , 41 – 43 , 45 – 49 , 51 , 52 , 58 , 59 , 62 , 68 , 71 , 72 , 81 , 84 , 88 , 91 – 96 , 98 , 99 , 104 – 108 , 113 , 115 ], and ‘High’ for 4 studies [ 44 , 69 , 103 , 114 ] ( Table 2 ; see S6 Table for a more detailed assessment of risk of bias). For randomization and allocation concealment, 49 tria...…”

Section: Resultsmentioning

confidence: 99%

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Relative effectiveness of medications for opioid-related disorders: A systematic review and network meta-analysis of randomized controlled trials

et al. 2022

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Introduction Several pharmacotherapeutic interventions are available for maintenance treatment for opioid-related disorders. However, previous meta-analyses have been limited to pairwise comparisons of these interventions, and their efficacy relative to all others remains unclear. Our objective was to unify findings from different healthcare practices and generate evidence to strengthen clinical treatment protocols for the most widely prescribed medications for opioid-use disorders. Methods We searched Medline, EMBASE, PsycINFO, CENTRAL, and ClinicalTrials.gov for all relevant randomized controlled trials (RCT) from database inception to February 12, 2022. Primary outcome was treatment retention, and secondary outcome was opioid use measured by urinalysis. We calculated risk ratios (RR) and 95% credible interval (CrI) using Bayesian network meta-analysis (NMA) for available evidence. We assessed the credibility of the NMA using the Confidence in Network Meta-Analysis tool. Results Seventy-nine RCTs met the inclusion criteria. Due to heterogeneity in measuring opioid use and reporting format between studies, we conducted NMA only for treatment retention. Methadone was the highest ranked intervention (Surface Under the Cumulative Ranking [SUCRA] = 0.901) in the network with control being the lowest (SUCRA = 0.000). Methadone was superior to buprenorphine for treatment retention (RR = 1.22; 95% CrI = 1.06–1.40) and buprenorphine superior to naltrexone (RR = 1.39; 95% CrI = 1.10–1.80). However, due to a limited number of high-quality trials, confidence in the network estimates of other treatment pairs involving naltrexone and slow-release oral morphine (SROM) remains low. Conclusion All treatments had higher retention than the non-pharmacotherapeutic control group. However, additional high-quality RCTs are needed to estimate more accurately the extent of efficacy of naltrexone and SROM relative to other medications. For pharmacotherapies with established efficacy profiles, assessment of their long-term comparative effectiveness may be warranted. Trial Registration This systematic review has been registered with PROSPERO (https://www.crd.york.ac.uk/prospero) (identifier CRD42021256212).

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Relative effectiveness of medications for opioid-related disorders: A systematic review and network meta-analysis of randomized controlled trials

et al. 2022

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“…A recent report assessing associations between participant characteristics and critical steps in the HIV care continuum of the BRAVO (Buprenorphine to Improve HIV Care Engagement and Outcomes) study suggested the need for an intervention such as integrating opioid use disorder treatment in HIV treatment settings, and at the same time highlighted the essential of family and social relationships in HIV viral suppression (King et al, 2020). Korthuis et al (2021) pointed out improved HIV viral suppression in participants at HIV clinics that integrated either buprenorphine plus naloxone or methadone maintenance therapy, and that the retention in either antiretroviral treatment or opioid use disorder medications of participants could influent the appearance of serious adverse events and deaths.…”

Section: Drug Intervention and Opportunities For Evidencebased Treatments For Drug Addiction In Vietnammentioning

confidence: 99%

Facing drug addiction: Vietnam’s struggle with opioids

Hieu

Gray

Tuan

et al. 2021

Drug Science, Policy and Law

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Drug addiction is a historical issue in Vietnam. Although Vietnam has a long history as a producer of opium poppies and crossroads for the illicit drug trade, it is now has some of the most stringent drug laws in the world. Vietnam has shown some success in reducing the production, trade, and transportation of narcotics. There has also been a shift in the attitudes of lawmakers and government authorities toward viewing drug abuse as a health problem rather than a social vice. Educating and encouraging citizens to collaboratively reduce drug use has also proven effective. However, despite these changes, the number of people who use drugs has increased in recent years. The US, too, has also experienced an increase in illicit opioid use. The Trump administration declared opioid addiction a public health emergency and has established goals to address the crisis. The results of these efforts have also been uneven. This article reviews Vietnam’s efforts to tackle its opioid epidemic, with the goal of identifying areas where Vietnam’s approach to opioid addiction may be improved. A brief overview of efforts by the U.S. government, an important foreign partner for Vietnam in the control of illicit opioids, serves to demonstrate the difficulty of treating opioid use in different political systems.

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“…Studies in high-income countries have shown engagement in methadone treatment may reduce drug use, improve ART adherence and increase viral suppression (Palepu et al, 2006), and in the United States (US), viral suppression was associated with methadone use (Stein et al, 2000). Similar studies done in Vietnam examined buprenorphine plus naloxone and referral for methadone maintenance therapy and showed reduced heroin use, increased receipt of ART and HIV viral suppression with these interventions (Korthuis et al, 2021), while a study in Taiwan showed high retention among PWID on methadone (Chao et al, 2020). Integrated methadone and HIV care programs can provide promising infrastructure for promoting ART uptake and adherence by reducing transportation costs associated with traveling to multiple clinic sites, establishing trust with healthcare providers who are trained on the specific needs of PWID, and offering non-judgmental, safe-spaces for PWID (Berg, Litwin, Li, Heo, & Arnsten, 2011;Tran, 2012).…”

Section: Introductionmentioning

confidence: 99%

Participation in methadone programs improves antiretroviral uptake and HIV viral suppression among people who inject drugs in Kenya

Mbogo¹,

Sambai²,

Monroe‐Wise³

et al. 2022

Journal of Substance Abuse Treatment

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Background: HIV prevalence among people who inject drugs (PWID) in Kenya is estimated to be 18% compared to 4.5% in the general population. Studies from high-income countries have demonstrated that methadone use is associated with increased uptake of antiretroviral therapy (ART) and higher rates of viral suppression among PWID with HIV. However, it is unclear whether methadone use has the same effect among African PWID living with HIV. Methods: We performed a cross-sectional study to evaluate associations between methadone program participation and ART uptake and viral suppression (HIV RNA viral load <1000 copies/ml) among PWID with HIV in Kenya. Participants were recruited from needle and syringe programs and methadone clinics, interviewed on site, and samples were obtained and assayed for HIV viral loads. Univariate and multiple logistic regression were used to determine associations. Results: Among 679 participants, median age was 37 years, 48% were female, and 24% were in a methadone program. We observed higher proportions of ART use (96% vs. 87%, p = 0.001) and HIV viral suppression (78% vs. 65%, p = 0.012) among PWID on methadone compared to those not on methadone treatment. PWID who were not participating in a methadone program were 3-fold more likely to be off ART and approximately twice as likely to be viremic compared to those in methadone programs (adjusted odds ratio [aOR] = 3.35, 95% confidence interval [CI]: 1.35-8.35 and aOR = 1.90, 95% CI: 1.03-3.52, respectively). Conclusions: In this study, Kenyan PWID living with HIV participating in a methadone treatment program were more likely to be on ART and to have achieved viral suppression. Scale-up of methadone programs may have a positive impact on HIV epidemic control for this key population.

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HIV clinic-based buprenorphine plus naloxone versus referral for methadone maintenance therapy for treatment of opioid use disorder in HIV clinics in Vietnam (BRAVO): an open-label, randomised, non-inferiority trial

Cited by 17 publications

References 29 publications

Relative effectiveness of medications for opioid-related disorders: A systematic review and network meta-analysis of randomized controlled trials

Relative effectiveness of medications for opioid-related disorders: A systematic review and network meta-analysis of randomized controlled trials

Facing drug addiction: Vietnam’s struggle with opioids

Participation in methadone programs improves antiretroviral uptake and HIV viral suppression among people who inject drugs in Kenya

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