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Addiction Science & Clinical Practice
Published in: Addiction Science & Clinical Practice 1/2018

Open Access 01-12-2018 | Research

Eligibility for heroin-assisted treatment (HAT) among people who inject opioids and are living with HIV in a Canadian setting

Authors: Jan Klimas, Huiru Dong, Nadia Fairbairn, Eugenia Socías, Rolando Barrios, Evan Wood, Thomas Kerr, Julio Montaner, M.-J. Milloy

Published in: Addiction Science & Clinical Practice | Issue 1/2018

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Abstract

Objectives

A growing body of evidence supports the effectiveness of injectable diacetylmorphine (i.e., heroin) for individuals with treatment-refractory opioid use disorder. Despite this evidence, and the increasing toll of opioid-associated morbidity and mortality, it remains controversial in some settings. To investigate the possible contribution of heroin-assisted treatment (HAT) to HIV treatment-related outcomes, we sought to estimate the proportion and characteristics of HIV-positive people who inject opioids that might be eligible for HAT in Vancouver, Canada.

Methods

We used data from a prospective cohort of people living with HIV who use illicit drugs in Vancouver, Canada. Using generalized estimating equations (GEE), we assessed the longitudinal relationships between eligibility for HAT, using criteria from previous clinical trials and guidelines, with behavioural, social, and clinical characteristics.

Results

Between 2005 and 2014, 478 participants were included in these analyses, contributing 1927 person-years of observation. Of those, 94 (19.7%) met eligibility for HAT at least once during the study period. In a multivariable GEE model, after adjusting for clinical characteristics, being eligible for HAT was positively associated with homelessness, female gender, high-intensity illicit drug use, drug dealing and higher CD4 count.

Conclusions

In our study of HIV-positive people with a history of injection drug use, approximately 20% of participants were eligible for HAT at ≥ 1 follow-up period. Eligibility was linked to risk factors for sub-optimal HIV/AIDS treatment outcomes, such as homelessness and involvement in the local illicit drug trade, suggesting that scaling-up access to HAT might contribute to achieving optimal HIV treatment in this setting.
Literature
1.
Nosyk B, Guh DP, Bansback NJ, Oviedo-Joekes E, Brissette S, Marsh DC, Meikleham E, Schechter MT, Anis AH. Cost-effectiveness of diacetylmorphine versus methadone for chronic opioid dependence refractory to treatment. Can Med Assoc J. 2012;184:E317–28.CrossRef
2.
Oviedo-Joekes E, Marchand K, Lock K, MacDonald S, Guh D, Schechter MT. The SALOME study: recruitment experiences in a clinical trial offering injectable diacetylmorphine and hydromorphone for opioid dependency. Subst Abuse Treat Prev Policy. 2015;10:3.CrossRefPubMedPubMedCentral
3.
Ferri M, Davoli M, Perucci CA. Heroin maintenance for chronic heroin-dependent individuals. Cochrane Database Syst Rev. 2011;8:CD003410.
4.
Strang J, Groshkova T, Uchtenhagen A, van den Brink W, Haasen C, Schechter MT, Lintzeris N, Bell J, Pirona A, Oviedo-Joekes E, et al. Heroin on trial: systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction. Br J Psychiatry. 2015;207:5–14.CrossRefPubMed
5.
6.
Milloy M-J, Montaner J, Wood E. Barriers to HIV treatment among people who use injection drugs: implications for ‘treatment as prevention’. Curr Opin HIV AIDS. 2012;7:332–8.CrossRefPubMed
7.
Meyer JP, Althoff AL, Altice FL. Optimizing care for HIV-infected people who use drugs: evidence-based approaches to overcoming healthcare disparities. Clin Infect Dis. 2013;57(9):1309–17.CrossRefPubMedPubMedCentral
8.
Montaner JS, Hogg R, Wood E, Kerr T, Tyndall M, Levy AR, Harrigan PR. The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic. Lancet. 2006;368:531–6.CrossRefPubMed
9.
Mesquita F, Jacka D, Ricard D, Shaw G, Tieru H, Yifei H, Poundstone K, Salva M, Fujita M, Singh N. Accelerating harm reduction interventions to confront the HIV epidemic in the Western Pacific and Asia: the role of WHO (WPRO). Harm Reduct J. 2008;5:1.CrossRef
10.
Ratliff EA, McCurdy SA, Mbwambo JK, Lambdin BH, Voets A, Pont S, Maruyama H, Kilonzo GP. An overview of HIV prevention interventions for people who inject drugs in Tanzania. Adv Prev Med. 2013;2013:183187.CrossRefPubMedPubMedCentral
11.
Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014;2:CD002207.
12.
Amato L, Davoli M, Perucci CA, Ferri M, Faggiano F, Mattick RP. An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research. J Subst Abuse Treat. 2005;28:321–9.CrossRefPubMed
13.
Altice FL, Kamarulzaman A, Soriano VV, Schechter M, Friedland GH. Treatment of medical, psychiatric, and substance-use comorbidities in people infected with HIV who use drugs. Lancet. 2010;376:367–87.CrossRefPubMedPubMedCentral
14.
Oviedo-Joekes E, Nosyk B, Brissette S, Chettiar J, Schneeberger P, Marsh DC, Krausz M, Anis A, Schechter MT. The North American Opiate Medication Initiative (NAOMI): profile of participants in North America’s first trial of heroin-assisted treatment. J Urban Health. 2008;85:812–25.CrossRefPubMedPubMedCentral
15.
Strathdee SA, Palepu A, Cornelisse PG, Yip B, O’Shaughnessy MV, Montaner JS, Schechter MT, Hogg RS. Barriers to use of free antiretroviral therapy in injection drug users. JAMA. 1998;280:547–9.CrossRefPubMed
16.
Wood E, Hogg RS, Bonner S, Kerr T, Li K, Palepu A, Guillemi S, Schechter MT, Montaner JS. Staging for antiretroviral therapy among HIV-infected drug users. JAMA. 2004;292:1175–7.CrossRefPubMed
17.
Kerr T, Small W, Johnston C, Li K, Montaner JS, Wood E. Characteristics of injection drug users who participate in drug dealing: implications for drug policy. J Psychoact Drugs. 2008;40:147–52.CrossRef
18.
Hogg RS, Heath KV, Yip B, Craib KJ, O’Shaughnessy MV, Schechter MT, Montaner JS. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA. 1998;279:450–4.CrossRefPubMed
19.
Lucas GM. Substance abuse, adherence with antiretroviral therapy, and clinical outcomes among HIV-infected individuals. Life Sci. 2011;88:948–52.CrossRefPubMed
20.
Spire B, Lucas GM, Carrieri MP. Adherence to HIV treatment among IDUs and the role of opioid substitution treatment (OST). Int J Drug Policy. 2007;18:262–70.CrossRefPubMed
21.
Erickson A, Becker M, Shaw S, Kasper K, Keynan Y. Substance use and its impact on care outcomes among HIV-infected individuals in Manitoba. AIDS Care. 2015;27:1168–73.CrossRefPubMed
22.
Lee WK, Milloy MJ, Walsh J, Nguyen P, Wood E, Kerr T. Psychosocial factors in adherence to antiretroviral therapy among HIV-positive people who use drugs. Health Psychol. 2016;35:290–7.CrossRefPubMed
23.
Pan W. Akaike’s information criterion in generalized estimating equations. Biometrics. 2001;57:120–5.CrossRefPubMed
24.
Wood E, Hogg RS, Lima VD, Kerr T, Yip B, Marshall BD, Montaner JS. Highly active antiretroviral therapy and survival in HIV-infected injection drug users. JAMA. 2008;300:550–4.CrossRefPubMed
25.
Nolan S, Dias Lima V, Fairbairn N, Kerr T, Montaner J, Grebely J, Wood E. The impact of methadone maintenance therapy on hepatitis C incidence among illicit drug users. Addiction. 2014;109:2053–9.CrossRefPubMedPubMedCentral
26.
Ahamad K, Hayashi K, Nguyen P, Dobrer S, Kerr T, Schutz CG, Montaner JS, Wood E. Effect of low-threshold methadone maintenance therapy for people who inject drugs on HIV incidence in Vancouver, BC, Canada: an observational cohort study. Lancet HIV. 2015;2:e445–50.CrossRefPubMedPubMedCentral
27.
Woo A. B.C. mulls framework for expanded heroin-assisted treatment. In: The Globe and Mail. Vancouver; 2017.
28.
Cheng T, Wood E, Nguyen P, Kerr T, DeBeck K. Increases and decreases in drug use attributed to housing status among street-involved youth in a Canadian setting. Harm Reduct J. 2014;11:12.CrossRefPubMedPubMedCentral
29.
Zivanovic R, Milloy MJ, Hayashi K, Dong H, Sutherland C, Kerr T, Wood E. Impact of unstable housing on all-cause mortality among persons who inject drugs. BMC Public Health. 2015;15:106.CrossRefPubMedPubMedCentral
30.
Iversen J, Page K, Madden A, Maher L. HIV, HCV, and health-related harms among women who inject drugs: implications for prevention and treatment. J Acquir Immune Defic Syndr. 2015;69(Suppl 2):S176–81.CrossRefPubMedPubMedCentral
31.
Puskas CM, Kaida A, Miller CL, Zhang W, Yip B, Pick N, Montaner JS, Hogg RS. The adherence gap: a longitudinal examination of men’s and women’s antiretroviral therapy adherence in British Columbia, 2000–2014. AIDS. 2017;31:827–33.CrossRefPubMed
32.
Metsch LR, Feaster DJ, Gooden L, Matheson T, Mandler RN, Haynes L, Tross S, Kyle T, Gallup D, Kosinski AS, et al. Implementing rapid HIV testing with or without risk-reduction counseling in drug treatment centers: results of a randomized trial. Am J Public Health. 2012;102:1160–7.CrossRefPubMedPubMedCentral
33.
Woody GE, Bruce D, Korthuis PT, Chhatre S, Poole S, Hillhouse M, Jacobs P, Sorensen J, Saxon AJ, Metzger D, Ling W. HIV risk reduction with buprenorphine-naloxone or methadone: findings from a randomized trial. J Acquir Immune Defic Syndr. 2014;66:288–93.CrossRefPubMedPubMedCentral
34.
Caputo F, Addolorato G, Domenicali M, Mosti A, Viaggi M, Trevisani F, Gasbarrini G, Bernardi M, Stefanini GF, Treatment TSFA. Short-term methadone administration reduces alcohol consumption in non-alcoholic heroin addicts. Alcohol Alcohol. 2002;37:164–8.CrossRefPubMed
35.
Sordo L, Barrio G, Bravo MJ, Indave BI, Degenhardt L, Wiessing L, Ferri M, Pastor-Barriuso R. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ. 2017;357:j1550.CrossRefPubMedPubMedCentral
36.
Nosyk B, Marsh DC, Sun H, Schechter MT, Anis AH. Trends in methadone maintenance treatment participation, retention, and compliance to dosing guidelines in British Columbia, Canada: 1996–2006. J Subst Abuse Treat. 2010;39:22–31.CrossRefPubMed
Metadata
Title
Eligibility for heroin-assisted treatment (HAT) among people who inject opioids and are living with HIV in a Canadian setting
Authors
Jan Klimas
Huiru Dong
Nadia Fairbairn
Eugenia Socías
Rolando Barrios
Evan Wood
Thomas Kerr
Julio Montaner
M.-J. Milloy
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Addiction Science & Clinical Practice / Issue 1/2018
Electronic ISSN: 1940-0640
DOI
https://doi.org/10.1186/s13722-017-0104-y

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