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

Andrea J Low; Gitau Mburu; Nicky J Welton; Margaret T May; Charlotte F Davies; Clare French; Katy M Turner; Katharine J Looker; Hannah Christensen; Susie McLean; Tim Rhodes; Lucy Platt; Matthew Hickman; Andrew Guise; Peter Vickerman

doi:10.1093/cid/ciw416

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

Andrea J Low, Gitau Mburu, Nicky J Welton, Margaret T May, Charlotte F Davies, Clare French, Katy M Turner, Katharine J Looker, Hannah Christensen, Susie McLean, Tim Rhodes, Lucy Platt, Matthew Hickman, Andrew Guise, Peter Vickerman

Population Health Sciences

University of Bristol
d Program Impact Unit , International HIV/AIDS Alliance , Brighton , UK.
Department Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom & Department Health Sciences, University of Leicester, Leicester, United Kingdom.

Research output: Contribution to journal › Article › peer-review

175 Citations (Scopus)

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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.

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.

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.

Original language	English
Pages (from-to)	1094-1104
Number of pages	11
Journal	Clinical Infectious Diseases
Volume	63
Issue number	8
DOIs	https://doi.org/10.1093/cid/ciw416
Publication status	Published - 15 Oct 2016

Keywords

Journal Article

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Low, A. J., Mburu, G., Welton, N. J., May, M. T., Davies, C. F., French, C., Turner, K. M., Looker, K. J., 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, 63(8), 1094-1104. https://doi.org/10.1093/cid/ciw416

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title = "Impact of Opioid Substitution Therapy on Antiretroviral Therapy Outcomes: A Systematic Review and Meta-Analysis",

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 I(2) 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.",

keywords = "Journal Article",

author = "Low, {Andrea J} and Gitau Mburu and Welton, {Nicky J} and May, {Margaret T} and Davies, {Charlotte F} and Clare French and Turner, {Katy M} and Looker, {Katharine J} and Hannah Christensen and Susie McLean and Tim Rhodes and Lucy Platt and Matthew Hickman and Andrew Guise and Peter Vickerman",

note = "{\textcopyright} The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.",

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doi = "10.1093/cid/ciw416",

language = "English",

volume = "63",

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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, vol. 63, no. 8, pp. 1094-1104. https://doi.org/10.1093/cid/ciw416

TY - JOUR

T1 - Impact of Opioid Substitution Therapy on Antiretroviral Therapy Outcomes

T2 - A Systematic Review and Meta-Analysis

AU - Low, Andrea J

AU - Mburu, Gitau

AU - Welton, Nicky J

AU - May, Margaret T

AU - Davies, Charlotte F

AU - French, Clare

AU - Turner, Katy M

AU - Looker, Katharine J

AU - Christensen, Hannah

AU - McLean, Susie

AU - Rhodes, Tim

AU - Platt, Lucy

AU - Hickman, Matthew

AU - Guise, Andrew

AU - Vickerman, Peter

PY - 2016/10/15

Y1 - 2016/10/15

N2 - 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 I(2) 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.

AB - 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 I(2) 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.

KW - Journal Article

U2 - 10.1093/cid/ciw416

DO - 10.1093/cid/ciw416

M3 - Article

C2 - 27343545

SN - 1058-4838

VL - 63

SP - 1094

EP - 1104

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 8

ER -

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

Abstract

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