HIV Pre-exposure Prophylaxis and Buprenorphine at a Drug Detoxification Center During the Opioid Epidemic: Opportunities and Challenges

Assoumou, Sabrina A; Paniagua, Samantha M.; Sáenz-González, Pilar; Wang, Jianbo; Beckwith, Curt G.; White, Laura F.; Taylor, Jessica; Coogan, Kristen; Samet, Jeffrey H.; Linas, Benjamin P.

doi:10.1007/s10461-021-03220-0

Cited by 12 publications

(8 citation statements)

References 34 publications

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“…15,21,22 Our findings of an association between receipt of MOUD and receipt of PrEP are consistent with previous research revealing that integrating both HIV PrEP and MOUD into care could be an acceptable and beneficial policy, especially in locations where PWID already access services (eg, drug detoxification centers). 23 Finally, the very low PrEP prescribing rates in our cohort demand interventions to address other well-described PrEP barriers, including the financial burden of medication. 24 Even very low copays have been shown to discourage use of MOUD, 25 and existing programs, such as the Health Resources and Services Administration's Ryan White HIV/AIDS Program, have had great success in mitigating copay burden for HIV retroviral treatment.…”

Section: Discussionmentioning

confidence: 94%

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Prevalence of HIV Preexposure Prophylaxis Prescribing Among Persons With Commercial Insurance and Likely Injection Drug Use

et al. 2022

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Key Points Question What is the prevalence of HIV preexposure prophylaxis (PrEP) among commercially insured persons with opioid and/or stimulant use disorder by injection drug use (IDU) status? Findings In this cross-sectional study of 547 709 commercially insured persons with opioid and/or stimulant use disorder, including 110 592 persons with evidence of IDU, 0.09% of the population overall and 0.15% of those with evidence of IDU received a PrEP prescription. Meaning In this study, HIV PrEP delivery for persons with substance use disorder, including those who inject drugs, remained low.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Prevalence of HIV Preexposure Prophylaxis Prescribing Among Persons With Commercial Insurance and Likely Injection Drug Use

et al. 2022

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“…Although oral PrEP is approved for reducing HIV transmission via injection drug use, TAF/FTC and injectable cabotegravir have not yet been evaluated for injection drug use–related risk among persons who inject drugs . However, persons who use drugs may acquire HIV via condomless sexual intercourse; therefore, if they are at sexual risk of HIV acquisition, they should be offered PrEP (evidence rating: AIa) …”

Section: Substance Use In Persons At Risk For and With Hivmentioning

confidence: 99%

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Gandhi

Bedimo

Hoy

et al. 2023

JAMA

260

148

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ImportanceRecent advances in treatment and prevention of HIV warrant updated recommendations to guide optimal practice.ObjectiveBased on a critical evaluation of new data, to provide clinicians with recommendations on use of antiretroviral drugs for the treatment and prevention of HIV, laboratory monitoring, care of people aging with HIV, substance use disorder and HIV, and new challenges in people with HIV, including COVID-19 and monkeypox virus infection.Evidence ReviewA panel of volunteer expert physician scientists were appointed to update the 2020 consensus recommendations. Relevant evidence in the literature (PubMed and Embase searches, which initially yielded 7891 unique citations, of which 834 were considered relevant) and studies presented at peer-reviewed scientific conferences between January 2020 and October 2022 were considered.FindingsInitiation of antiretroviral therapy (ART) is recommended as soon as possible after diagnosis of HIV. Barriers to care should be addressed, including ensuring access to ART and adherence support. Integrase strand transfer inhibitor–containing regimens remain the mainstay of initial therapy. For people who have achieved viral suppression with a daily oral regimen, long-acting injectable therapy with cabotegravir plus rilpivirine given as infrequently as every 2 months is now an option. Weight gain and metabolic complications have been linked to certain antiretroviral medications; novel strategies to ameliorate these complications are needed. Management of comorbidities throughout the life span is increasingly important, because people with HIV are living longer and confronting the health challenges of aging. In addition, management of substance use disorder in people with HIV requires an evidence-based, integrated approach. Options for preexposure prophylaxis include oral medications (tenofovir disoproxil fumarate or tenofovir alafenamide plus emtricitabine) and, for the first time, a long-acting injectable agent, cabotegravir. Recent global health emergencies, like the SARS-CoV-2 pandemic and monkeypox virus outbreak, continue to have a major effect on people with HIV and the delivery of services. To address these and other challenges, an equity-based approach is essential.Conclusions and RelevanceAdvances in treatment and prevention of HIV continue to improve outcomes, but challenges and opportunities remain.

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“…Buprenorphine can be prescribed in primary care, is dispensed at community pharmacies, and has robust evidence to treat OUD and reduce overdose and all-cause mortality. [4][5][6][7][8][9] The strong evidence that buprenorphine saves lives has led to recent national increases in buprenorphine treatment fueled primarily by nonspecialists, 10 yet substantial gaps in prescribing clinician capacity still exist. 11 To prescribe buprenorphine for OUD, physicians were required to be board certified in addiction psychiatry or addiction medicine or take 8 hours of training certified by Substance Abuse and Mental Health Services Administration (SAMHSA), and nurse practitioners and physician assistants were required to take 24 hours of training certified by SAMHSA.…”

Section: Introductionmentioning

confidence: 99%

Prescribe to Save Lives: Improving Buprenorphine Prescribing Among HIV Clinicians

Jawa

Walley

Wilson

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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HIV Pre-exposure Prophylaxis and Buprenorphine at a Drug Detoxification Center During the Opioid Epidemic: Opportunities and Challenges

Cited by 12 publications

References 34 publications

Prevalence of HIV Preexposure Prophylaxis Prescribing Among Persons With Commercial Insurance and Likely Injection Drug Use

Prevalence of HIV Preexposure Prophylaxis Prescribing Among Persons With Commercial Insurance and Likely Injection Drug Use

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Prescribe to Save Lives: Improving Buprenorphine Prescribing Among HIV Clinicians

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