Eligibility for heroin-assisted treatment (HAT) among people who inject opioids and are living with HIV in a Canadian setting

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Title: Eligibility for heroin-assisted treatment (HAT) among people who inject opioids and are living with HIV in a Canadian setting
Authors: Klimas, Jan
Dong, Huiru
Fairbairn, Nadia
Socías, Eugenia
et al.
Permanent link: http://hdl.handle.net/10197/9861
Date: 7-Feb-2018
Online since: 2019-04-09T10:16:05Z
Abstract: Objectives: A growing body of evidence supports the effectiveness of injectable diacetylmorphine (i.e., heroin) for individuals with treatment-refractory opioid use disorder. Despite this evidence, and the increasing toll of opioid-associated morbidity and mortality, it remains controversial in some settings. To investigate the possible contribution of heroin-assisted treatment (HAT) to HIV treatment-related outcomes, we sought to estimate the proportion and characteristics of HIV-positive people who inject opioids that might be eligible for HAT in Vancouver, Canada. Methods: We used data from a prospective cohort of people living with HIV who use illicit drugs in Vancouver, Canada. Using generalized estimating equations (GEE), we assessed the longitudinal relationships between eligibility for HAT, using criteria from previous clinical trials and guidelines, with behavioural, social, and clinical characteristics. Results: Between 2005 and 2014, 478 participants were included in these analyses, contributing 1927 person-years of observation. Of those, 94 (19.7%) met eligibility for HAT at least once during the study period. In a multivariable GEE model, after adjusting for clinical characteristics, being eligible for HAT was positively associated with homelessness, female gender, high-intensity illicit drug use, drug dealing and higher CD4 count. Conclusions: In our study of HIV-positive people with a history of injection drug use, approximately 20% of participants were eligible for HAT at ≥ 1 follow-up period. Eligibility was linked to risk factors for sub-optimal HIV/AIDS treatment outcomes, such as homelessness and involvement in the local illicit drug trade, suggesting that scaling-up access to HAT might contribute to achieving optimal HIV treatment in this setting.
Funding Details: European Commission Horizon 2020
Irish Research Council
Type of material: Journal Article
Publisher: BMC
Journal: Addiction Science & Clinical Practice
Volume: 13
Issue: 3
Start page: 1
End page: 8
Copyright (published version): 2018 the Authors
Keywords: Substance-related disordersHeroinHIV/AIDSIllicit drug useOpioid agoinist treatment
DOI: 10.1186/s13722-017-0104-y
Other versions: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5812056/
Language: en
Status of Item: Peer reviewed
Appears in Collections:Medicine Research Collection

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