Prescribing methadone in prison predicts linkage to HIV care after release from prison: A randomized and patient preference trial

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy Pub Date : 2025-02-08 DOI:10.1016/j.drugpo.2025.104733

Allison M. Mobley , Martin P. Wegman , Alexander R. Bazazi , Sheela V. Shenoi , Daniel J. Bromberg , Ahsan Ahmad , Adeeba Kamarulzaman , Frederick L. Altice

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引用次数: 0

Abstract

Purpose

The transition from prison is hazardous, especially for people with HIV and opioid use disorder. To determine the impact of methadone on linkage to HIV care in people with HIV and opioid use disorder, we prospectively compared those allocated to pre-release methadone or not.

Methods

A prospective, open-label trial of 310 people with HIV and opioid use disorder at Malaysia's largest prison were allocated to pre-release methadone up to 24 weeks before release or not by randomization (n = 64) or preference (n = 246); 296 were included in the final analytical sample. Directed acyclic graphing was used to theorize the relationship between pre-release methadone and post-release linkage to HIV care and identify confounding variables. An inverse probability weighted Cox proportional hazards model estimated the impact of pre-release methadone on linkage to HIV care through 360 days after release.

Results

Overall, 218 (73.6 %) of 296 study participants initiated methadone before release. Receiving pre-release methadone significantly predicted linkage to HIV care at all time points through 360 days (aHR = 1.87; 95 % CI 1.15–2.85) after release. The corresponding numbers needed to treat with pre-release methadone for one increased linkage to HIV care at 30 and 360 days were 14 (95 % CI 9.2–62.4) and 5 (95 % CI 3.4–22.0), respectively.

Conclusions

While treatment with methadone should be available to everyone with opioid use disorder, it should especially be included as part of an HIV treatment-as-prevention strategy for people in prisons, especially by the time of release. It can optimize HIV treatment outcomes by jumpstarting the HIV treatment cascade.

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在监狱中开美沙酮处方与出狱后艾滋病毒护理相关：一项随机和患者偏好试验

目的从监狱过渡是危险的，特别是对艾滋病毒和阿片类药物使用障碍的人。为了确定美沙酮对艾滋病病毒感染者和阿片类药物使用障碍患者艾滋病护理联系的影响，我们前瞻性地比较了分配美沙酮预释放组和未分配美沙酮预释放组。方法在马来西亚最大的监狱进行了一项前瞻性、开放标签试验，在释放前24周，通过随机分配（n = 64）或优先分配（n = 246），将310名艾滋病毒和阿片类药物使用障碍患者分配给预释放美沙酮；其中296个被纳入最终分析样品。定向无环图被用于理论化美沙酮释放前和释放后与HIV护理的联系，并识别混杂变量。反概率加权Cox比例风险模型估计释放前美沙酮对释放后360天内HIV护理联系的影响。结果296名研究参与者中，218人（73.6%）在美沙酮释放前开始使用美沙酮。在360天的所有时间点，接受释放前美沙酮治疗与HIV护理显著相关(aHR = 1.87；95% CI 1.15-2.85)。在30天和360天，使用美沙酮治疗与HIV护理增加联系所需的相应数量分别为14 （95% CI 9.2-62.4）和5 （95% CI 3.4-22.0）。结论：虽然每个阿片类药物使用障碍患者都应获得美沙酮治疗，但尤其应将其作为监狱服刑人员的艾滋病毒治疗预防战略的一部分，特别是在释放时。它可以通过启动艾滋病毒治疗级联来优化艾滋病毒治疗结果。

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来源期刊

International Journal of Drug Policy SUBSTANCE ABUSE-

CiteScore

7.80

自引率

11.40%

发文量

307

审稿时长

62 days

期刊介绍： The International Journal of Drug Policy provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. It seeks to publish material on the social, political, legal, and health contexts of psychoactive substance use, both licit and illicit. The journal is particularly concerned to explore the effects of drug policy and practice on drug-using behaviour and its health and social consequences. It is the policy of the journal to represent a wide range of material on drug-related matters from around the world.