TY - JOUR

T1 - Impact of opioid substitution therapy on the HIV prevention benefit of antiretroviral therapy for people who inject drugs

AU - Mukandavire, Christinah

AU - Low, Andrea J.

AU - Mburu, Gitau

AU - Trickey, Adam

AU - May, Margaret T.

AU - Davies, Charlotte F.

AU - French, Clare E.

AU - Looker, Katharine J.

AU - Rhodes, Tim

AU - Platt, Lucy

AU - Guise, Andy

AU - Hickman, Matthew

AU - Vickerman, Peter

N1 - This is a preprint, or manuscript version and that the article has been accepted for publication in AIDS

PY - 2017/5/15

Y1 - 2017/5/15

N2 - Objective: A recent meta-analysis suggested that opioid substitution therapy (OST) increased uptake of anti-retroviral treatment (ART) and HIV viral suppression. We modelled whether OST could improve the HIV prevention benefit achieved by ART amongst people who inject drugs (PWID).Methods: We modelled how introducing OST could improve the coverage of ART across a PWID population for different baseline ART coverage levels. Using existing data on how yearly HIV-transmission risk is related to HIV plasma viral load, changes in the level of viral suppression across the population were used to project the relative reduction in yearly HIV-transmission risk achieved by ART, with or without OST, compared to if there was no ART - defined here as the prevention effectiveness of ART.Results: Due to OST use increasing the chance of being on ART and achieving viral suppression if on ART, the prevention effectiveness of ART for PWID on OST (compared to PWID not on OST) increases by 44%, 31% or 20% for a low (20%), moderate (40%) or high (60%) baseline ART coverage, respectively. Improvements in the population-level prevention effectiveness of ART are also achieved across all PWID, compared to if OST was not introduced. For instance, if OST is introduced at 40% coverage, the population-level prevention effectiveness of ART could increase by 27%, 20% or 13% for a low (20%), moderate (40%) or high (60%) baseline ART coverage, respectively.Conclusions: OST could markedly improve the HIV prevention benefit of ART; supporting strategies that aim to concurrently scale-up OST with ART.

AB - Objective: A recent meta-analysis suggested that opioid substitution therapy (OST) increased uptake of anti-retroviral treatment (ART) and HIV viral suppression. We modelled whether OST could improve the HIV prevention benefit achieved by ART amongst people who inject drugs (PWID).Methods: We modelled how introducing OST could improve the coverage of ART across a PWID population for different baseline ART coverage levels. Using existing data on how yearly HIV-transmission risk is related to HIV plasma viral load, changes in the level of viral suppression across the population were used to project the relative reduction in yearly HIV-transmission risk achieved by ART, with or without OST, compared to if there was no ART - defined here as the prevention effectiveness of ART.Results: Due to OST use increasing the chance of being on ART and achieving viral suppression if on ART, the prevention effectiveness of ART for PWID on OST (compared to PWID not on OST) increases by 44%, 31% or 20% for a low (20%), moderate (40%) or high (60%) baseline ART coverage, respectively. Improvements in the population-level prevention effectiveness of ART are also achieved across all PWID, compared to if OST was not introduced. For instance, if OST is introduced at 40% coverage, the population-level prevention effectiveness of ART could increase by 27%, 20% or 13% for a low (20%), moderate (40%) or high (60%) baseline ART coverage, respectively.Conclusions: OST could markedly improve the HIV prevention benefit of ART; supporting strategies that aim to concurrently scale-up OST with ART.

KW - antiretroviral therapy

KW - HIV

KW - injecting drug use

KW - opiate substitution therapy

KW - treatment as prevention

KW - viral suppression

U2 - 10.1097/QAD.0000000000001458

DO - 10.1097/QAD.0000000000001458

M3 - Journal article

VL - 31

SP - 1181

EP - 1190

JO - AIDS

JF - AIDS

SN - 0269-9370

IS - 8

ER -