Review: Opioid substitution therapy access with HIV care improves antiretroviral treatment outcomes for people who inject drugs

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From starting treatment, to sticking with it, to suppressing virus, from the United States to Ukraine, services that support dual needs of people who inject drugs and live with HIV pay off, a look at 32 studies spanning two decades finds

A systematic analysis of studies examining the impacts on antiretroviral treatment goals of access to opioid substitution therapy in HIV care settings for people who inject drugs, found improved outcomes on treatment initiation, retention, and effectiveness, an article in Clinical Infectious Diseases released this week says.

The one exception to a pattern of benefits accruing from medication-assisted therapy for opioid dependence included in treatment for people who inject drugs and are living with HIV, demonstrated across the studies was a reduction in mortality, with only one study examining and confirming a reduction in HIV-related mortality, and others not finding a link between the services and drops in all cause mortality.

The authors of the study combed through 3558 studies, to find 32 that met the criteria of describing impacts of opioid substitution therapy on HIV program objectives that included antiretroviral treatment recruitment, adherence, and viral suppression among people who inject drugs. Examining studies of services to more than 36,000 people in 9 countries between 1996 and 2014, they found access to the therapy increased rates of antiretroviral treatment coverage among people who inject drugs by 54 percent, increased treatment enrollment by 87 percent, doubled rates of adherence to treatment, and increased rates of viral suppression by 45 percent.

Higher rates of antiretroviral treatment coverage linked to opioid substitution therapy access were seen in North America and Europe, where rates of antiretroviral treatment coverage are higher in any case. Otherwise, the analysis found geographic region made little difference. The authors note that with the exception of China and Indonesia, all studies took place in high-income countries and say this highlights the need to examine the impacts of opioid substitution therapy on HIV programming for people who inject drugs in low- and middle-income countries. They also note that while HIV infections attributed to injecting drug use accounts for about 30 percent of HIV incidence outside of sub-Saharan Africa, injecting drug use has increased in high HIV-prevalence countries that include Kenya and Tanzania.

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