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

A recent meta-analysis suggested that opioid substitution therapy (OST) increased uptake of antiretroviral treatment (ART) and HIV viral suppression. We modelled whether OST could improve the HIV prevention benefit achieved by ART among people who inject drugs (PWID). We modelled how introducing OST...

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Bibliographic Details
Published in:AIDS (London) Vol. 31; no. 8; p. 1181
Main Authors: Mukandavire, Christinah, Low, Andrea, Mburu, Gitau, Trickey, Adam, May, Margaret T, Davies, Charlotte F, French, Clare E, Looker, Katharine J, Rhodes, Tim, Platt, Lucy, Guise, Andy, Hickman, Matthew, Vickerman, Peter
Format: Journal Article
Language:English
Published: England 15.05.2017
Subjects:
Anti-Retroviral Agents - administration & dosage
Chemoprevention - methods
Chemoprevention - statistics & numerical data
Disease Transmission, Infectious - prevention & control
Drug Utilization
HIV Infections - drug therapy
HIV Infections - prevention & control
HIV Infections - transmission
Humans
Models, Statistical
Opiate Substitution Treatment
Substance Abuse, Intravenous - complications
Substance Abuse, Intravenous - drug therapy
Treatment Outcome
ISSN:1473-5571, 1473-5571
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Summary:A recent meta-analysis suggested that opioid substitution therapy (OST) increased uptake of antiretroviral treatment (ART) and HIV viral suppression. We modelled whether OST could improve the HIV prevention benefit achieved by ART among people who inject drugs (PWID). 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 with if there was no ART - defined here as the prevention effectiveness of ART. Owing 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 with 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 with 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. OST could improve the HIV prevention benefit of ART; supporting strategies that aim to concurrently scale-up OST with ART.
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ISSN:1473-5571
1473-5571
DOI:10.1097/QAD.0000000000001458