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HIV Med. 2019 Jul 29. doi: 10.1111/hiv.12777. [Epub ahead of print]

Dispensation of antiretroviral therapy and methadone maintenance therapy at the same facility in a low-barrier setting linked to optimal adherence to HIV treatment.

Author information

1
Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada.
2
BC Centre on Substance Use, Vancouver, BC, Canada.
3
Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
4
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
5
BC Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada.
6
Vancouver Coastal Health, Vancouver, BC, Canada.
7
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
8
Department of Sociology, University of British Columbia, Vancouver, BC, Canada.

Abstract

OBJECTIVES:

We sought to examine the association between dispensation of methadone maintenance therapy (MMT) and antiretroviral therapy (ART) at the same facility, across multiple low-barrier dispensing outlets, and achieving optimal adherence to ART among people who use illicit drugs (PWUD).

METHODS:

We used data from the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS) study, a long-running study of a community-recruited cohort of HIV-positive PWUD, linked to comprehensive HIV clinical records in Vancouver, Canada, a setting of no-cost, universal access to HIV care. The longitudinal relationship between MMT-ART dispensation at the same facility and the odds of ≥ 95% ART adherence was analysed using multivariable generalized linear mixed-effects modelling. We conducted a further analysis using a marginal structural mode with inverse probability of treatment weights as a sensitivity analysis.

RESULTS:

This study included data on 1690 interviews of 345 ART- and MMT-exposed participants carried out between June 2012 and December 2017. In the final multivariable model, MMT-ART dispensation, compared with nondispensation at the same facility, was associated with greater odds of achieving ≥ 95% adherence [adjusted odds ratio (AOR) 1.56; 95% confidence interval (CI) 1.26-1.96]. A marginal structural model estimated a 1.48 (95% CI 1.15-1.80) greater odds of ≥ 95% adherence among participants who reported MMT-ART dispensation at the same facility compared with those who did not.

CONCLUSIONS:

The odds of achieving optimal adherence to ART were 56% higher during periods in which MMT and ART medications were dispensed at the same facility, in a low-barrier setting. Our findings highlight the need to consider a simpler integrated approach with medication dispensation at the same facility in low-threshold settings.

KEYWORDS:

HIV ; antiretroviral therapy, highly active; medication adherence; methadone; people who use illicit drugs

PMID:
31359615
DOI:
10.1111/hiv.12777

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