Impact of opioid substitution therapy on the HIV prevention benefit of antiretroviral therapy for people who inject drugs

Mukandavire, Christinah and Low, Andrea J. and Mburu, Gitau and Trickey, Adam and May, Margaret T. and Davies, Charlotte F. and French, Clare E. and Looker, Katharine J. and Rhodes, Tim and Platt, Lucy and Guise, Andy and Hickman, Matthew and Vickerman, Peter (2017) Impact of opioid substitution therapy on the HIV prevention benefit of antiretroviral therapy for people who inject drugs. AIDS, 31 (8). pp. 1181-1190. ISSN 0269-9370

[img]
Preview
PDF (OST_ART_modelling paper submitted)
OST_ART_modelling_paper_submitted_.pdf - Accepted Version
Available under License Creative Commons Attribution-NonCommercial.

Download (1MB)

Abstract

Objective: A recent meta-analysis suggested that opioid substitution therapy (OST) increased uptake of anti-retroviral treatment (ART) and HIV viral suppression. We modelled whether OST could improve the HIV prevention benefit achieved by ART amongst people who inject drugs (PWID). Methods: We modelled how introducing OST could improve the coverage of ART across a PWID population for different baseline ART coverage levels. Using existing data on how yearly HIV-transmission risk is related to HIV plasma viral load, changes in the level of viral suppression across the population were used to project the relative reduction in yearly HIV-transmission risk achieved by ART, with or without OST, compared to if there was no ART - defined here as the prevention effectiveness of ART. Results: Due to OST use increasing the chance of being on ART and achieving viral suppression if on ART, the prevention effectiveness of ART for PWID on OST (compared to PWID not on OST) increases by 44%, 31% or 20% for a low (20%), moderate (40%) or high (60%) baseline ART coverage, respectively. Improvements in the population-level prevention effectiveness of ART are also achieved across all PWID, compared to if OST was not introduced. For instance, if OST is introduced at 40% coverage, the population-level prevention effectiveness of ART could increase by 27%, 20% or 13% for a low (20%), moderate (40%) or high (60%) baseline ART coverage, respectively. Conclusions: OST could markedly improve the HIV prevention benefit of ART; supporting strategies that aim to concurrently scale-up OST with ART.

Item Type:
Journal Article
Journal or Publication Title:
AIDS
Additional Information:
This is a preprint, or manuscript version and that the article has been accepted for publication in AIDS
Uncontrolled Keywords:
/dk/atira/pure/subjectarea/asjc/2400/2403
Subjects:
ID Code:
85665
Deposited By:
Deposited On:
30 Mar 2017 09:12
Refereed?:
Yes
Published?:
Published
Last Modified:
08 Aug 2020 05:49