Trajectories of medication for opioid use disorder and their impact on HIV testing among people who inject drugs in India: A longitudinal assessment of clinic-based data.

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2024-11-27 DOI:10.1111/add.16713

Allison M McFall, Lakshmi Ganapathi, Mihili P Gunaratne, Aylur K Srikrishnan, Conjeevaram K Vasudevan, Santhanam Anand, Sunil S Solomon, Shruti H Mehta, Gregory M Lucas

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引用次数: 0

Abstract

Aims: The aim of this study was to identify longitudinal trajectories of medication for opioid use disorder (MOUD) use throughout 1 year following MOUD initiation and to examine the association of trajectory membership with HIV testing among people who inject drugs in India.

Design, setting and participants: The study comprised group-based trajectory modeling using longitudinal clinic-based MOUD use data, set in seven Indian cities with integrated care centers (ICC) delivering MOUD, predominantly buprenorphine, in 2018-2019. A total of 1562 people who inject drugs who initiated MOUD for the first time at an ICC between 1 January 2018 and 31 December 2018 were included in this study. Median age was 26 years, 98% were male and 22% were living with HIV.

Measurements: Daily directly observed MOUD visits were biometrically verified and entered into an electronic database. A dichotomous variable for MOUD use each day throughout 1 year following initiation was created for the trajectory models. Client socio-demographics, HIV status and testing at the ICC and dose were extracted from the clinical database.

Findings: We found five MOUD trajectory groups: (1) early dropout (41%), (2) late dropout (18%), (3) delayed dropout (10%), (4) intermittent use (12%) and (5) persistent use (19%). Differences between the dropout groups were characterized by the rate of decline in MOUD use over time. The late dropout group had an 18% higher rate of HIV testing [adjusted rate ratio (aRR) = 1.18, 95% confidence interval (CI) = 1.10-1.27] and those with persistent MOUD use had a 91% higher rate of testing (aRR = 1.91, 95% CI = 1.77-2.05) compared with the early dropout group.

Conclusions: Nearly 70% of clients initiating medication for opioid use disorder (MOUD) at integrated care centers (ICCs) in India stop MOUD use within 1 year, with trajectories characterized by the rate of decline in engagement. Clients with better MOUD adherence appear to return more frequently for HIV testing at the ICCs, underscoring the value of integrated care models.

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印度注射吸毒者阿片类药物使用障碍的用药轨迹及其对艾滋病毒检测的影响：对诊所数据的纵向评估。

目的：本研究旨在确定阿片类药物使用障碍（MOUD）用药后一年内的纵向使用轨迹，并研究印度注射吸毒者中轨迹成员与艾滋病毒检测之间的关联：该研究包括基于群体的轨迹建模，使用基于纵向诊所的 MOUD 使用数据，该数据设定在 2018-2019 年印度七个城市的综合护理中心 (ICC)，这些中心提供 MOUD，主要是丁丙诺啡。本研究共纳入了 1562 名注射吸毒者，他们于 2018 年 1 月 1 日至 2018 年 12 月 31 日期间首次在 ICC 开始使用 MOUD。中位年龄为 26 岁，98% 为男性，22% 为 HIV 感染者：对每日直接观察的 MOUD 访问进行生物特征验证并输入电子数据库。为轨迹模型创建了一个二分变量，即在开始使用后的 1 年内每天使用 MOUD 的情况。从临床数据库中提取了客户的社会人口统计数据、HIV 感染状况以及在 ICC 进行的检测和剂量：我们发现了五组 MOUD 使用轨迹：(1) 早期辍学（41%），(2) 晚期辍学（18%），(3) 延迟辍学（10%），(4) 间歇使用（12%）和 (5) 持续使用（19%）。辍学组之间的差异主要体现在随着时间推移使用 MOUD 的下降率上。与早期辍学组相比，晚期辍学组的艾滋病检测率高出18%[调整率比（aRR）=1.18，95%置信区间（CI）=1.10-1.27]，而持续使用MOUD者的检测率高出91%（aRR=1.91，95%CI=1.77-2.05）：结论：在印度的综合治疗中心（ICCs），近70%开始接受阿片类药物使用障碍（MOUD）药物治疗的患者在1年内停止使用MOUD，其轨迹以参与率下降为特征。阿片类药物使用失调症治疗依从性较好的患者似乎会更频繁地回到综合治疗中心接受艾滋病毒检测，这凸显了综合治疗模式的价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.