A Systematic Review and Meta-Analysis of Studies Evaluating the Effect of Medication Treatment for Opioid Use Disorder on Infectious Disease Outcomes

McNamara, Katelyn F; Biondi, Breanne E.; Hernández-Ramírez, Raúl Ulises; Taweh, Noor; Grimshaw, Alyssa; Springer, Sandra A.

doi:10.1093/ofid/ofab289

Cited by 36 publications

(13 citation statements)

References 37 publications

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“…Based on the findings, this analysis provides evidence that with the current incomplete, disparate, and non-integrated data systems across states, it is not feasible to construct all cascades, therefore, interfering with adequate public health policy planning. Given that MOUD is the most promising strategy for addressing all three conditions simultaneously [ 33 ], the inability to construct accurate OUD cascades in particular undermines effective implementation efforts to address this syndemic.…”

Section: Discussionmentioning

confidence: 99%

Strengthening systems of care for people with or at risk for HIV, HCV and opioid use disorder: a call for enhanced data collection

et al. 2022

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Background The syndemic between opioid use disorder (OUD), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) results in excessive burdens on the healthcare system. Integrating these siloed systems of care is critical to address all three conditions adequately. In this implementation project, we assessed the data capacity of the health system to measure a cascade of care (COC) across HIV, HCV and OUD services in five states to help guide public health planning. Materials and methods Data for this study were gathered from publicly available datasets and reports from government (SAMSHA, CMS, HRSA and CDC) sites. We created, where possible, COCs for HIV, HCV, and OUD spanning population estimate, diagnosis, treatment initiation, treatment retention, and patient outcomes for each of five states in the study. Results The process of data collection showed that baseline COCs examining the intersections of OUD, HIV, and HCV cannot be produced and that there are missing data in all states examined. Collection of specific data points is not consistent across all states. States are better at reporting HIV cascades due to federal requirements. Only gross estimates could be made for OUD cascades in all states because data are separated by payer source, leaving no central point of data collection from all sources. Data for HCV were not publicly available. Conclusion It is difficult to assess the strategies needed or the progress made towards increasing treatment access and decreasing the burden of disease without the ability to construct an accurate baseline. Using integrated COCs with relevant benchmarks can not only guide public health planning, but also provide meaningful targets for intervention. KEY MESSAGES While HIV COCs are available for most states at least annually, they are not disaggregated for populations with co-occurring OUD or HCV. Data to calculate HCV COC are not available and data to calculate OUD COC are partially available, but only for specific payers. States do not have systems in place to measure the scope of the syndemic or to identify targets for quality improvement activities.

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Section: Discussionmentioning

confidence: 99%

Strengthening systems of care for people with or at risk for HIV, HCV and opioid use disorder: a call for enhanced data collection

et al. 2022

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“…Second, we did not assess all possible comorbid affective and substance use disorders, in part due to time constraints to gather info on disorders with low base rates (e.g., schizophrenia, hallucinogen use disorder). Similarly, we did not assess addictions not commonly addressed at OTPs (e.g., tobacco use disorder, gambling disorder), nor did we assess comorbid health conditions, such as infectious diseases, that overlap with OUD ( 43 ), and represent other important avenues where integrated approaches improve treatment outcomes ( 44 ). Future studies should investigate a full spectrum of OUD-related comorbidities, which ostensibly would highlight an even higher comorbidity burden and need for integrated approaches than this analysis.…”

Section: Discussionmentioning

confidence: 99%

Comorbid Affective and Substance Use Disorders of Medicaid/Medicare Beneficiaries at an Opioid Treatment Program Serving Small Urban and Rural Communities

et al. 2022

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ObjectivesIdentify rates and correlates of comorbid affective and substance use disorders among an understudied population, Medicaid/Medicare beneficiaries receiving care at an opioid treatment program serving patients from small urban and rural areas. Examine whether past-year non-medical opioid use status differentiates comorbidity status.MethodsA cross-sectional, venue-based design was used to recruit a convenience sample of patients treated with methadone for opioid use disorder. Measures were assessed across three domains: (1) demographic characteristics, (2) opioid use characteristics, and (3) comorbid disorders. Brief validated screeners categorized probable comorbid disorders. Bivariate analyses examined correlates of comorbid disorders and determined variable selection for multivariable analyses.ResultsIn this sample (N = 210; mean age = 38.5 years; female = 62.2%; Non-Hispanic White race/ethnicity = 86.1%), comorbid disorders were common. Rates were as follows: current anxiety (48.1%), depression (41.1%), and PTSD (33.7%), and past-year stimulant (27.6%), marijuana (19.0%), alcohol (14.9%), and sedative (7.6%). In bivariate analyses, past-year non-medical opioid use and a greater accumulation of opioid use consequences were associated with most disorders. When including demographic and opioid use characteristics in multivariable analyses, past-year non-medical opioid use was associated with anxiety, PTSD, stimulant use disorder, and sedative use disorder.ConclusionsFew studies have investigated comorbid disorders among this understudied population. This analysis highlights a high burden, especially for affective disorders. Our findings demonstrate that routine, ongoing assessment of non-medical opioid use may be a promising and feasible strategy to detect patients needing integrated care. Future research should investigate whether changes to assessment protocols at opioid treatment programs in small urban and rural settings facilitate care coordination.

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“… For persons with alcohol use disorder (AUD), medications (extended-release naltrexone, oral naltrexone) reduce alcohol use, thereby reducing HIV risk (eTable 6 in the Supplement). For those with HIV, medication treatment of OUD and AUD improves ART adherence and viral suppression and thus is recommended with ART (eFigure in the Supplement) (evidence rating: AIa) . Clinically significant drug-drug interactions between ART or hepatitis C virus direct-acting antiviral medications and medications used to treat SUDs are infrequent; neither ART nor medication treatments for SUDs should be withheld (evidence rating: AIII).…”

Section: Substance Use In Persons At Risk For and With Hivmentioning

confidence: 99%

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Gandhi

Bedimo

Hoy

et al. 2023

JAMA

309

148

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ImportanceRecent advances in treatment and prevention of HIV warrant updated recommendations to guide optimal practice.ObjectiveBased on a critical evaluation of new data, to provide clinicians with recommendations on use of antiretroviral drugs for the treatment and prevention of HIV, laboratory monitoring, care of people aging with HIV, substance use disorder and HIV, and new challenges in people with HIV, including COVID-19 and monkeypox virus infection.Evidence ReviewA panel of volunteer expert physician scientists were appointed to update the 2020 consensus recommendations. Relevant evidence in the literature (PubMed and Embase searches, which initially yielded 7891 unique citations, of which 834 were considered relevant) and studies presented at peer-reviewed scientific conferences between January 2020 and October 2022 were considered.FindingsInitiation of antiretroviral therapy (ART) is recommended as soon as possible after diagnosis of HIV. Barriers to care should be addressed, including ensuring access to ART and adherence support. Integrase strand transfer inhibitor–containing regimens remain the mainstay of initial therapy. For people who have achieved viral suppression with a daily oral regimen, long-acting injectable therapy with cabotegravir plus rilpivirine given as infrequently as every 2 months is now an option. Weight gain and metabolic complications have been linked to certain antiretroviral medications; novel strategies to ameliorate these complications are needed. Management of comorbidities throughout the life span is increasingly important, because people with HIV are living longer and confronting the health challenges of aging. In addition, management of substance use disorder in people with HIV requires an evidence-based, integrated approach. Options for preexposure prophylaxis include oral medications (tenofovir disoproxil fumarate or tenofovir alafenamide plus emtricitabine) and, for the first time, a long-acting injectable agent, cabotegravir. Recent global health emergencies, like the SARS-CoV-2 pandemic and monkeypox virus outbreak, continue to have a major effect on people with HIV and the delivery of services. To address these and other challenges, an equity-based approach is essential.Conclusions and RelevanceAdvances in treatment and prevention of HIV continue to improve outcomes, but challenges and opportunities remain.

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A Systematic Review and Meta-Analysis of Studies Evaluating the Effect of Medication Treatment for Opioid Use Disorder on Infectious Disease Outcomes

Cited by 36 publications

References 37 publications

Strengthening systems of care for people with or at risk for HIV, HCV and opioid use disorder: a call for enhanced data collection

Strengthening systems of care for people with or at risk for HIV, HCV and opioid use disorder: a call for enhanced data collection

Comorbid Affective and Substance Use Disorders of Medicaid/Medicare Beneficiaries at an Opioid Treatment Program Serving Small Urban and Rural Communities

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

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