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

Christinah Mukandavire; Andrea Low; Gitau Mburu; Adam Trickey; Margaret T May; Charlotte F Davies; Clare E French; Katharine J Looker; Tim Rhodes; Lucy Platt; Andy Guise; Matthew Hickman; Peter Vickerman

doi:10.1097/QAD.0000000000001458

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

Christinah Mukandavire, Andrea Low, Gitau Mburu, Adam Trickey, Margaret T May, Charlotte F Davies, Clare E French, Katharine J Looker, Tim Rhodes, Lucy Platt, Andy Guise, Matthew Hickman, Peter Vickerman

Population Health Sciences

aSchool of Social and Community Medicine, University of Bristol, Bristol bInternational HIV/AIDS Alliance, Brighton cDivision of Health Research, Lancaster University, Lancaster, Lancashire dLondon School of Hygiene and Tropical Medicine, London, UK.

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

20 Citations (Scopus)

Abstract

OBJECTIVE: 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).

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 with if there was no ART - defined here as the prevention effectiveness of ART.

RESULTS: 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.

CONCLUSION: OST could improve the HIV prevention benefit of ART; supporting strategies that aim to concurrently scale-up OST with ART.

Original language	English
Pages (from-to)	1181-1190
Number of pages	10
Journal	AIDS (London, England)
Volume	31
Issue number	8
DOIs	https://doi.org/10.1097/QAD.0000000000001458
Publication status	Published - 15 May 2017

Keywords

Journal Article

UN SDGs

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

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10.1097/QAD.0000000000001458

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Mukandavire, C., Low, A., Mburu, G., Trickey, A., May, M. T., Davies, C. F., French, C. E., Looker, K. J., Rhodes, T., Platt, L., Guise, A., Hickman, M., & Vickerman, P. (2017). Impact of opioid substitution therapy on the HIV prevention benefit of antiretroviral therapy for people who inject drugs. AIDS (London, England), 31(8), 1181-1190. https://doi.org/10.1097/QAD.0000000000001458

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

abstract = "OBJECTIVE: 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).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 with if there was no ART - defined here as the prevention effectiveness of ART.RESULTS: 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.CONCLUSION: OST could improve the HIV prevention benefit of ART; supporting strategies that aim to concurrently scale-up OST with ART.",

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Mukandavire, C, Low, A, Mburu, G, Trickey, A, May, MT, Davies, CF, French, CE, Looker, KJ, Rhodes, T, Platt, L, Guise, A, Hickman, M & Vickerman, P 2017, 'Impact of opioid substitution therapy on the HIV prevention benefit of antiretroviral therapy for people who inject drugs', AIDS (London, England), vol. 31, no. 8, pp. 1181-1190. https://doi.org/10.1097/QAD.0000000000001458

TY - JOUR

T1 - Impact of opioid substitution therapy on the HIV prevention benefit of antiretroviral therapy for people who inject drugs

AU - Mukandavire, Christinah

AU - Low, Andrea

AU - Mburu, Gitau

AU - Trickey, Adam

AU - May, Margaret T

AU - Davies, Charlotte F

AU - French, Clare E

AU - Looker, Katharine J

AU - Rhodes, Tim

AU - Platt, Lucy

AU - Guise, Andy

AU - Hickman, Matthew

AU - Vickerman, Peter

PY - 2017/5/15

Y1 - 2017/5/15

N2 - OBJECTIVE: 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).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 with if there was no ART - defined here as the prevention effectiveness of ART.RESULTS: 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.CONCLUSION: OST could improve the HIV prevention benefit of ART; supporting strategies that aim to concurrently scale-up OST with ART.

AB - OBJECTIVE: 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).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 with if there was no ART - defined here as the prevention effectiveness of ART.RESULTS: 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.CONCLUSION: OST could improve the HIV prevention benefit of ART; supporting strategies that aim to concurrently scale-up OST with ART.

KW - Journal Article

U2 - 10.1097/QAD.0000000000001458

DO - 10.1097/QAD.0000000000001458

M3 - Article

C2 - 28323752

SN - 1473-5571

VL - 31

SP - 1181

EP - 1190

JO - AIDS (London, England)

JF - AIDS (London, England)

IS - 8

ER -

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

Abstract

Keywords

UN SDGs

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