Impact of Opioid Substitution Therapy on Antiretroviral Therapy Outcomes: A Systematic Review and Meta-Analysis

Low, Andrea; Mburu, Gitau; Welton, Nicky J; May, Margaret T; Davies, Charlotte; French, Clare E; Turner, Katherine Mary Elizabeth; Looker, Katharine J; Christensen, Hannah; McLean, Susie; Rhodes, Tim; Platt, Lucy; Hickman, Matthew; Guise, Andy; Vickerman, Peter

doi:10.1093/cid/ciw416

Cited by 187 publications

(134 citation statements)

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“…Methadone and buprenorphine are effective and essential medicines for the management of opioid dependence 7, 8. Opioid substitution treatment (OST) has positive benefits across multiple outcomes on mortality risk, transmission of HIV and hepatitis C virus (HCV), HIV treatment prognosis and drug‐related crime 1, 9, 10, 11, 12, 13, 14, 15, 16. OST is highly cost‐effective, whether delivered in the community or prison 17, 18, 19.…”

Section: Introductionmentioning

confidence: 99%

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

et al. 2018

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AimsTo estimate whether opioid substitution treatment (OST) with buprenorphine or methadone is associated with a greater reduction in the risk of all‐cause mortality (ACM) and opioid drug‐related poisoning (DRP) mortality.DesignCohort study with linkage between clinical records from Clinical Practice Research Datalink and mortality register.SettingUK primary care.ParticipantsA total of 11 033 opioid‐dependent patients who received OST from 1998 to 2014, followed‐up for 30 410 person‐years.MeasurementsExposure to methadone (17 373, 61%) OST episodes or buprenorphine (9173, 39%) OST episodes. ACM was available for all patients; information on cause of death and DRP was available for 5935 patients (54%) followed‐up for 16 363 person‐years. Poisson regression modelled mortality by treatment period with an interaction between OST type and treatment period (first 4 weeks on OST, rest of time off OST, first 4 weeks off OST, rest of time out of OST censored at 12 months) to test whether ACM or DRP differed between methadone and buprenorphine. Inverse probability weights were included to adjust for confounding and balance characteristics of patients prescribed methadone or buprenorphine.FindingsACM and DRP rates were 1.93 and 0.53 per 100 person‐years, respectively. DRP was elevated during the first 4 weeks of OST [incidence rate ratio (IRR) = 1.93 95% confidence interval (CI) = 0.97–3.82], the first 4 weeks off OST (IRR = 8.15, 95% CI = 5.45–12.19) and the rest of time out of OST (IRR = 2.13, 95% CI = 1.47–3.09) compared with mortality risk from 4 weeks to end of treatment. Patients on buprenorphine compared with methadone had lower ACM rates in each treatment period. After adjustment, there was evidence of a lower DRP risk for patients on buprenorphine compared with methadone at treatment initiation (IRR = 0.08, 95% CI = 0.01–0.48) and rest of time on treatment (IRR = 0.37, 95% CI = 0.17–0.79). Treatment duration (mean and median) was shorter on buprenorphine than methadone (173 and 40 versus 363 and 111, respectively). Model estimates suggest that there was a low probability that methadone or buprenorphine reduced the number of DRP in the population: 28 and 21%, respectively.ConclusionsIn UK general medical practice, opioid substitution treatment with buprenorphine is associated with a lower risk of all‐cause and drug‐related poisoning mortality than methadone. In the population, buprenorphine is unlikely to give greater overall protection because of the relatively shorter duration of treatment.

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Section: Introductionmentioning

confidence: 99%

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

et al. 2018

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“…OAT is also highly effective in reducing HIV risk behaviors and transmission (Altice et al, 2006; Metzger et al, 1993), increasing access to antiretroviral treatment (ART) (Altice et al, 2011; Lucas et al, 2010; Uhlmann et al, 2010), and improving retention in HIV care and HIV treatment outcomes (Altice et al., 2011; Low et al, 2016; Palepu et al, 2006). …”

Section: Introductionmentioning

confidence: 99%

Retention in medication-assisted treatment programs in Ukraine—Identifying factors contributing to a continuing HIV epidemic

Dumchev

Dvoryak

Chernova

et al. 2017

International Journal of Drug Policy

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Background Opioid agonist treatments (OAT) are widely-used, evidence-based strategies for treating opioid dependence and reducing HIV transmission. The positive benefits of OAT are strongly correlated with time spent in treatment, making retention a key indicator for program quality. This study assessed patient retention and associated factors in Ukraine, where OAT was first introduced in 2004. Methods Data from clinical records of 2,916 patients enrolled in OAT at thirteen sites from 2005–2012 were entered into an electronic monitoring system. Survival analysis methods were used to determine the probability of retention and its correlates. Results Twelve-month retention was 65.8%, improving from 27.7% in 2005, to 70.9% in 2011. In multivariable analyses, the correlates of retention were receiving medium and high doses of medication (compared to low doses, dropout aHR=0.57 for both medium and high doses), having not been tested for HIV and tuberculosis (compared to being tested, dropout aHR=4.44 and 3.34, respectively), and among those who were tested – a negative TB test result (compared to receiving a positive test result, dropout aHR=0.67). Conclusion Retention in Ukrainian OAT programs, especially in recent years, is comparable to other countries. The results confirm the importance of adequate OAT dosing (≥ 60mg of methadone, ≥8mg of buprenorphine). Higher dosing, however, will require interventions that address negative attitudes toward OAT by patients and providers. Interruption of OAT, in the case developing tuberculosis, should incorporate continuity of OAT for TB patients through integrated care delivery systems.

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“…40 However, the integration of substance abuse treatment and HIV primary care can enhance the access to anti-retroviral treatment for people who use drugs, as well as, enhance the efficacy of anti-retroviral treatment for people who inject drugs. 41,42 Medication assisted treatment has been shown to increase recruitment in anti-retroviral treatment programs, increase treatment coverage, increase retention in care and adherence to anti-retroviral treatment regimens and increase viral suppression. 42 Together, medication assisted treatment and anti-retroviral treatment have been shown to reduce all cause mortality for people living with HIV who inject drugs.…”

Section: People Who Use Drugs Living With Hiv and Anti-retroviral Trmentioning

confidence: 99%

“…41,42 Medication assisted treatment has been shown to increase recruitment in anti-retroviral treatment programs, increase treatment coverage, increase retention in care and adherence to anti-retroviral treatment regimens and increase viral suppression. 42 Together, medication assisted treatment and anti-retroviral treatment have been shown to reduce all cause mortality for people living with HIV who inject drugs. 43 When integrated into incarceration settings, medicated assisted treatment and anti-retroviral treatment improves HIV treatment outcomes for those being released into the community, can provide a bridge to community-based services post release, and promote better clinical outcomes during the post release period.…”

Section: People Who Use Drugs Living With Hiv and Anti-retroviral Trmentioning

confidence: 99%

“…21, 60 Screening for and management of alcohol use disorders in HIV care or anti-retroviral clinics results in an increase medication adherence and retention in care and treatment, a reduction of HIV transmission and morbidity and mortality, as well as, enhanced quality of life. 22 Thus, incorporating screening for and management of substance use disorders in "Test and Start" programs that target people who use drugs would promote the attainment of good clinical outcomes.…”

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Test and Start for People Living With HIV and Who Use Drugs in Low and Middle Income Countries

Kresina¹,

Kaplowitz²,

Ahadpour³

et al. 2016

HIV/AIDS Res Treat Open J

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Impact of Opioid Substitution Therapy on Antiretroviral Therapy Outcomes: A Systematic Review and Meta-Analysis

Abstract: This meta-analysis provides strong evidence that opioid substitution therapy improves several key outcomes of the HIV care continuum among people who inject drugs, including recruitment onto antiretroviral therapy, retention in care, adherence, and viral suppression.

Cited by 187 publications

References 30 publications

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

Retention in medication-assisted treatment programs in Ukraine—Identifying factors contributing to a continuing HIV epidemic

Test and Start for People Living With HIV and Who Use Drugs in Low and Middle Income Countries

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