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Drug Alcohol Depend. 2019 May 1;198:70-75. doi: 10.1016/j.drugalcdep.2019.01.038. Epub 2019 Mar 9.

Predictors of timely opioid agonist treatment initiation among veterans with and without HIV.

Author information

1
VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR, 97239, USA; School of Public Health, Oregon Health & Science University-Portland State University. Electronic address: Jessica.wyse@va.gov.
2
Division of General Internal Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
3
VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA.
4
Department of Internal Medicine, Yale School of Medicine, 330 Cedar St, Boardman 110, New Haven, CT, 06520, USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 60 College St, New Haven, CT, 06510, USA.
5
University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA; VA Salt Lake City Health Care System, 500 Foothill Dr., Salt Lake City, UT, 84148, USA.
6
Advanced PACT Pain Clinic, Hampton VA Medical Center, 100 Emancipation Dr., Hampton, VA, 23667, USA; Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT, 06511, USA.
7
VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT, 06511, USA.
8
Section of Addiction Medicine, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
9
VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA; Department of Pediatrics, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA.
10
VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA; Department of Internal Medicine, Yale School of Medicine, 330 Cedar St, Boardman 110, New Haven, CT, 06520, USA.
11
Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT, 06511, USA; APT Foundation, Pain Treatment Services, 1 Long Wharf Dr., New Haven, CT, 06511, USA.
12
Center for Health Services Research, Institute for Health, Rutgers University, 112 Paterson St, New Brunswick, NJ, 08901, USA.
13
VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA; Department of Internal Medicine, Yale School of Medicine, 330 Cedar St, Boardman 110, New Haven, CT, 06520, USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 60 College St, New Haven, CT, 06510, USA.
14
Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Suite 933W, Pittsburgh, PA, 15213, USA; VA Pittsburgh Healthcare System, 4100 Allequippa St, Pittsburgh, PA, 15213, USA.

Abstract

BACKGROUND:

Opioid use disorder (OUD) is prevalent among people with HIV (PWH). Opioid agonist therapy (OAT) is the most effective treatment for OUD and is associated with improved health outcomes, but is often not initiated. To inform clinical practice, we identified factors predictive of OAT initiation among patients with and without HIV.

METHODS:

We identified 19,698 new clinical encounters of OUD between 2000 and 2012 in the Veterans Aging Cohort Study (VACS), a national observational cohort of PWH and matched uninfected controls. Mixed effects models examined factors predictive of OAT initiation within 30-days of a new OUD clinical encounter.

RESULTS:

4.9% of both PWH and uninfected patients initiated OAT within 30 days of a new OUD clinical encounter. In adjusted models, participants with a psychiatric diagnosis (aOR = 0.54, 95% CI 0.47 - 0.62), PWH (aOR = 0.79, 95% CI 0.68-0.92), and rural residence (aOR = 0.56, 95% CI 0.39-0.78) had a lower likelihood of any OAT initiation, while African-American patients (aOR = 1.60, 95% CI 1.34-1.92), those with an alcohol related diagnosis (aOR = 1.76, 95% CI 1.48-2.08), diagnosis year 2005-2008 relative to 2000-2004 (aOR = 1.24, 95% CI 1.05-1.45), and patients with HCV (aOR = 1.50, 95% CI 1.27-1.77) had a greater likelihood of initiating any OAT within 30 days. Predictive factors were similar in the total sample and PWH only models.

CONCLUSIONS:

PWH were less likely to receive timely OAT initiation than demographically similar uninfected patients. Given the health benefits of such treatment, the low rate of OAT initiation warrants focused efforts in both PWH and uninfected populations.

KEYWORDS:

Buprenorphine; HIV; Methadone; Opioid agonist therapy; Opioid use disorder; Veterans affairs hospital

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