Methadone Treatment for HIV Prevention--Feasibility, Retention, and Predictors of Attrition in Dar es Salaam, Tanzania: A Retrospective Cohort Study

Lambdin, Barrot H.; Masao, Frank; Chang, Olivia; Kaduri, Pamela; Mbwambo, Jessie; Magimba, Ayoub; Sabuni, Norman; Bruce, R. Douglas

doi:10.1093/cid/ciu382

Cited by 43 publications

(54 citation statements)

References 39 publications

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“…[18] In another study, an average of only 44% of buprenorphine clients spent at least 3 weeks in an Australian treatment facility. [19] The only other evaluation of an OST programme in Africa reported a retention rate of 57% over 2 years, [20] although it utilised methadone, which differs from buprenorphine with regard to retention. [17] The rate for the OST group in our study was therefore relatively high.…”

Section: Discussionmentioning

confidence: 99%

Report on the first government-funded opioid substitution programme for heroin users in the Western Cape Province, South Africa

Michie

Hoosain²,

Macharia

et al. 2017

S Afr Med J

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Background. Although pharmacological opioid substitution treatment (OST) is a well-established treatment modality for heroin addiction, it is a relatively recent introduction in low-and middle-income countries. Objective. To report on a pilot OST programme initiated in 2013 that was the only public-funded programme in South Africa (SA) at the time. Participants were offered standard care only (n=68) or, for the OST group (n=67), standard care plus Suboxone (Reckitt Benckiser), a synthetic partial opioid agonist, in a 12-week clinician-monitored programme. Methods. Clinical records of 135 participants in the rehabilitation programme at Sultan Bahu Rehabilitation Centre in Mitchell's Plain, Cape Town, SA, from 1 January to 31 December 2014 were reviewed. Data collected included demographics and duration in treatment (retention) as well as number of urine samples provided, positive tests or self-reported use events and dates of first positive/negative tests. Results. Significantly more participants in the OST group (65.7%) than controls (44.1%) completed the treatment (p=0.019). Among the non-completers, retention was higher in the OST group than in the standard care group (48.2 v. 30.1 days; p=0.001). The groups did not differ in respect of number of missed appointments and time to first positive test. However, the proportion of participants testing positive was higher in the OST group (80.6%) than in the standard care group (61.8%), although the former were tested nearly three times (18.3 v. 6.6 times) more. Consequently, the positive rate (proportion of positive tests) was substantially lower in the OST group (16.8%) than in the standard care group (23.3%).Conclusions. The results demonstrate modest success of this pilot OST programme in terms of completion and retention and should argue for a move to increase availability of and accessibility to OSTs for the management of opioid use disorder.

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Section: Discussionmentioning

confidence: 99%

Report on the first government-funded opioid substitution programme for heroin users in the Western Cape Province, South Africa

Michie

Hoosain²,

Macharia

et al. 2017

S Afr Med J

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“…Adequate medication dosing that exceeds 60 mg/day for methadone (National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction, 1998) and 8 mg/day for buprenorphine (WHO, 2009), has been found to be a strong predictor of retention by multiple studies (Anderson & Warren, 2004; Hillhouse, Canamar, & Ling, 2013; Lambdin et al, 2014; Villafranca, McKellar, Trafton, & Humphreys, 2006; Wei et al, 2013), including a meta-analysis of Chinese MAT program (Bao et al, 2009) and in a recent Cochrane Review (Mattick et al, 2014); however a recent meta-analysis of OAT studies in low- and middle-income countries (Feelemyer et al, 2013) failed to confirm this association. In this study, receiving low-dose OAT was significantly correlated with lower retention, whereas the effect of medium and high OAT doses did not differ significantly.…”

Section: Discussionmentioning

confidence: 99%

Retention in medication-assisted treatment programs in Ukraine—Identifying factors contributing to a continuing HIV epidemic

Dumchev

Dvoryak

Chernova

et al. 2017

International Journal of Drug Policy

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Background Opioid agonist treatments (OAT) are widely-used, evidence-based strategies for treating opioid dependence and reducing HIV transmission. The positive benefits of OAT are strongly correlated with time spent in treatment, making retention a key indicator for program quality. This study assessed patient retention and associated factors in Ukraine, where OAT was first introduced in 2004. Methods Data from clinical records of 2,916 patients enrolled in OAT at thirteen sites from 2005–2012 were entered into an electronic monitoring system. Survival analysis methods were used to determine the probability of retention and its correlates. Results Twelve-month retention was 65.8%, improving from 27.7% in 2005, to 70.9% in 2011. In multivariable analyses, the correlates of retention were receiving medium and high doses of medication (compared to low doses, dropout aHR=0.57 for both medium and high doses), having not been tested for HIV and tuberculosis (compared to being tested, dropout aHR=4.44 and 3.34, respectively), and among those who were tested – a negative TB test result (compared to receiving a positive test result, dropout aHR=0.67). Conclusion Retention in Ukrainian OAT programs, especially in recent years, is comparable to other countries. The results confirm the importance of adequate OAT dosing (≥ 60mg of methadone, ≥8mg of buprenorphine). Higher dosing, however, will require interventions that address negative attitudes toward OAT by patients and providers. Interruption of OAT, in the case developing tuberculosis, should incorporate continuity of OAT for TB patients through integrated care delivery systems.

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“…Detailed procedures have been explained elsewhere. 15 Briefly, enrollment into OTP required referral from a community-based organization. In preparation for OTP initiation, individuals were also required to attend a series of educational sessions on HIV, sexually transmitted infections, medication adherence, and supportive services provided by community based organizations.…”

Section: Methodsmentioning

confidence: 99%

“…13,14 The first publicly-funded opioid treatment program (OTP), using methadone, on the mainland of sub-Saharan Africa was launched in February 2011, offering daily directly observed methadone services at Muhimbili National Hospital (MNH) in Dar es Salaam. 15 The estimated prevalence of HIV at 39% 16 and tuberculosis (TB) at 4% 17 among PWID enrolling into the MNH OTP clinic is over 7 times and 20 times, 18,19 respectively, the prevalence in the general population, and is an important challenge for the national HIV/TB response.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and predictors of HCV among a cohort of opioid treatment patients in Dar es Salaam, Tanzania

Lambdin

Lorvick

Mbwambo

et al. 2017

International Journal of Drug Policy

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Background. The government of Tanzania launched an opioid treatment program (OTP), using methadone, in Dar es Salaam in February of 2011. Hepatitis C virus (HCV) is a leading cause of morbidity and mortality globally, especially among people who inject drugs (PWID). We conducted a cross-sectional study among PWID engaged in OTP in Dar es Salaam to describe the prevalence and predictors of HCV antibody serostatus. Methods. Routine programmatic data on patients enrolled in Muhimbili National Hospital’s OTP clinic from February 2011 to January 2013 were utilized. Multivariable Poisson regression was used to examine factors associated with HCV antibody serostatus. Results. A total of 630 PWID enrolled into the OTP clinic during the study period, seven percent of which were women. The overall seroprevalence of HCV antibody was 57% (95% Confidence interval: 53%-61%). In adjusted analysis, methadone patients who used heroin for 5-10 years (adjusted prevalence ratio; aPR=1.41; 95% CI: 1.10-1.81) and >10 years (aPR=1.48; 95% CI: 1.17-1.88) were more likely to be HCV antibody positive, compared to patients who used heroin for < 5 years. Patients who reported sharing needles or other equipment at their last injection (aPR=1.20; 95% CI: 1.01-1.41; p=0.022), being arrested (aPR=1.20; 95% CI: 1.04-1.40; p=0.012) and who were HIV-positive (aPR=1.84; 95% CI: 1.56-2.16; p<0.001) were also more likely to be HCV antibody positive than their counterparts. Conclusion. Our observed HCV antibody prevalence among PWID engaged in OTP is higher than previously reported estimates in Dar es Salaam. Predictors of HCV antibody serostatus in this sample were similar to those found among PWID in many other settings. Integrating HCV care and treatment into OTP clinics should be considered, leveraging lessons learned from the integration of HIV services into OTP. Global efforts to develop HCV care and treatment programs in low and middle-income countries are critical, especially among PWID who have a high burden of HCV.

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Methadone Treatment for HIV Prevention--Feasibility, Retention, and Predictors of Attrition in Dar es Salaam, Tanzania: A Retrospective Cohort Study

Cited by 43 publications

References 39 publications

Report on the first government-funded opioid substitution programme for heroin users in the Western Cape Province, South Africa

Report on the first government-funded opioid substitution programme for heroin users in the Western Cape Province, South Africa

Retention in medication-assisted treatment programs in Ukraine—Identifying factors contributing to a continuing HIV epidemic

Prevalence and predictors of HCV among a cohort of opioid treatment patients in Dar es Salaam, Tanzania

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