Impact of opioid substitution therapy on antiretroviral therapy outcomes : a systematic review and meta-analysis

Low, Andrea J. and Mburu, Gitau and May, Margaret T. and Davies, Charlotte F. and French, Clare and Turner, Katy M. and Looker, Katharine J. and Christensen, Hannah and McLean, Susie and Rhodes, Tim and Platt, Lucy and Hickman, Matthew and Guise, Andy and Vickerman, Peter (2016) Impact of opioid substitution therapy on antiretroviral therapy outcomes : a systematic review and meta-analysis. Clinical Infectious Diseases, 63 (8). pp. 1094-1104. ISSN 1058-4838

[thumbnail of Impact of Opioid Substitution Therapy on Antiretroviral Therapy Outcomes: A Systematic Review and Meta-Analysis]
Preview
PDF (Impact of Opioid Substitution Therapy on Antiretroviral Therapy Outcomes: A Systematic Review and Meta-Analysis)
Impact_of_Opioid_Substitution_Therapy_on_Antiretroviral_Therapy_Outcomes_A_Systematic_Review_and_Meta_Analysis.pdf - Published Version
Available under License Creative Commons Attribution-NonCommercial-NoDerivs.

Download (576kB)

Abstract

BACKGROUND: Human immunodeficiency virus (HIV)-infected people who inject drugs (PWID) frequently encounter barriers accessing and remaining on antiretroviral therapy (ART). Some studies have suggested that opioid substitution therapy (OST) could facilitate PWID's engagement with HIV services. We conducted a systematic review and meta-analysis to evaluate the impact of concurrent OST use on ART-related outcomes among HIV-infected PWID. METHODS: We searched Medline, PsycInfo, Embase, Global Health, Cochrane, Web of Science, and Social Policy and Practice databases for studies between 1996 to November 2014 documenting the impact of OST, compared to no OST, on ART outcomes. Outcomes considered were coverage and recruitment onto ART, adherence, viral suppression, attrition from ART, and mortality. Meta-analyses were conducted using random-effects modeling, and heterogeneity assessed using Cochran Q test and I2 statistic. RESULTS: We identified 4685 articles, and 32 studies conducted in North America, Europe, Indonesia, and China were included. OST was associated with a 69% increase in recruitment onto ART (hazard ratio [HR], 1.69; 95% confidence interval [CI], 1.32-2.15), a 54% increase in ART coverage (odds ratio [OR], 1.54; 95% CI, 1.17-2.03), a 2-fold increase in adherence (OR, 2.14; 95% CI, 1.41-3.26), and a 23% decrease in the odds of attrition (OR, 0.77; 95% CI, .63-.95). OST was associated with a 45% increase in odds of viral suppression (OR, 1.45; 95% CI, 1.21-1.73), but there was limited evidence from 6 studies for OST decreasing mortality for PWID on ART (HR, 0.91; 95% CI, .65-1.25). CONCLUSIONS: These findings support the use of OST, and its integration with HIV services, to improve the HIV treatment and care continuum among HIV-infected PWID.

Item Type:
Journal Article
Journal or Publication Title:
Clinical Infectious Diseases
Uncontrolled Keywords:
/dk/atira/pure/subjectarea/asjc/2700/2725
Subjects:
?? hiv people who inject drugsmedication-assisted therapy for opioid dependence (mat)antiretroviral treatment (art)systematic reviewmeta-analysisinfectious diseasesmicrobiology (medical) ??
ID Code:
80442
Deposited By:
Deposited On:
18 Jul 2016 14:28
Refereed?:
Yes
Published?:
Published
Last Modified:
18 Dec 2023 01:39