Impact of Opioid Substitution Therapy on Antiretroviral Therapy Outcomes: a Systematic Review and Meta-Analysis.


Low, AJ; Mburu, G; Welton, NJ; May, MT; Davies, CF; French, C; Turner, KM; Looker, KJ; Christensen, H; McLean, S; Rhodes, T; Platt, L; Hickman, M; Guise, A; Vickerman, P; (2016) Impact of Opioid Substitution Therapy on Antiretroviral Therapy Outcomes: a Systematic Review and Meta-Analysis. Clinical infectious diseases. ISSN 1058-4838 DOI: https://doi.org/10.1093/cid/ciw416

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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.<br/> 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 I(2) statistic.<br/> 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).<br/> 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.<br/>

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Social and Environmental Health Research
PubMed ID: 27343545
Web of Science ID: 386044400019
URI: http://researchonline.lshtm.ac.uk/id/eprint/2572430

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