Amy J Kennedy1, Kathleen A McGinnis2, Jessica S Merlin1, E Jennifer Edelman3, Adam J Gordon4, P Todd Korthuis5, Melissa Skanderson2, Emily C Williams6, Jessica Wyse7, Benjamin Oldfield8, Kendall Bryant9, Amy Justice10, David A Fiellin3, Kevin L Kraemer11. 1. Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA. 2. VA Connecticut Healthcare System, West Haven, CT, USA. 3. Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA. 4. Program for Addiction Research, Clinical Care, Knowledge and Advocacy, Division of Epidemiology, Department of Internal Medicine, University of Utah; Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA. 5. Division of General Internal Medicine, Section of Addiction Medicine, Oregon Health and Sciences University, Portland, OR, USA. 6. Department of Health Services, University of Washington, VA Puget Sound Healthcare System, Seattle, WA, USA; Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development VA Puget Sound Healthcare System, Seattle, WA, USA. 7. VA Portland Healthcare System, Portland, OR, USA; School of Public Health, Oregon Health and Sciences University, Portland, OR, USA. 8. Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA. 9. National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA. 10. VA Connecticut Healthcare System, West Haven, CT, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA. 11. Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA; VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. Electronic address: kraemerkl@upmc.edu.
Abstract
BACKGROUND: Persons with HIV (PWH) and opioid use disorder (OUD) can have poor health outcomes. We assessed whether intensity of behavioral treatment for OUD (BOUD) with and without medication for OUD (MOUD) is associated with improved HIV clinical outcomes. METHODS: We used Veterans Aging Cohort Study (VACS) data from 2008 to 2017 to identify PWH and OUD with ≥1 BOUD episode. We assessed BOUD intensity and ≥6 months of MOUD (methadone or buprenorphine) receipt during the 12 months after BOUD initiation. Linear regression models assessed the association of BOUD intensity and MOUD receipt with pre-post changes in log viral load (VL), CD4 cell count, VACS Index 2.0, antiretroviral treatment (ART) initiation, and ART adherence. RESULTS: Among 2419 PWH who initiated BOUD, we identified five distinct BOUD intensity trajectories: single visit (39% of sample); low-intensity, not sustained (37%); high-intensity, not sustained (9%); low-intensity, sustained (11%); and high-intensity, sustained (5%). MOUD receipt was low (17%). Among 709 PWH not on ART at the start of BOUD, ART initiation increased with increased BOUD intensity (p < 0.01). Among 1401 PWH on ART at the start of BOUD, ART adherence improved more in higher-intensity BOUD groups (p < 0.01). VL, CD4 count and VACS Index 2.0 did not differ by BOUD or ≥6 months of MOUD treatment. CONCLUSION: Among PWH and OUD who initiated BOUD, higher intensity BOUD was associated with improved ART initiation and adherence, but neither BOUD alone nor BOUD plus ≥6 months MOUD was associated with improvements in VL, CD4 count or VACS Index 2.0. Published by Elsevier Inc.
BACKGROUND: Persons with HIV (PWH) and opioid use disorder (OUD) can have poor health outcomes. We assessed whether intensity of behavioral treatment for OUD (BOUD) with and without medication for OUD (MOUD) is associated with improved HIV clinical outcomes. METHODS: We used Veterans Aging Cohort Study (VACS) data from 2008 to 2017 to identify PWH and OUD with ≥1 BOUD episode. We assessed BOUD intensity and ≥6 months of MOUD (methadone or buprenorphine) receipt during the 12 months after BOUD initiation. Linear regression models assessed the association of BOUD intensity and MOUD receipt with pre-post changes in log viral load (VL), CD4 cell count, VACS Index 2.0, antiretroviral treatment (ART) initiation, and ART adherence. RESULTS: Among 2419 PWH who initiated BOUD, we identified five distinct BOUD intensity trajectories: single visit (39% of sample); low-intensity, not sustained (37%); high-intensity, not sustained (9%); low-intensity, sustained (11%); and high-intensity, sustained (5%). MOUD receipt was low (17%). Among 709 PWH not on ART at the start of BOUD, ART initiation increased with increased BOUD intensity (p < 0.01). Among 1401 PWH on ART at the start of BOUD, ART adherence improved more in higher-intensity BOUD groups (p < 0.01). VL, CD4 count and VACS Index 2.0 did not differ by BOUD or ≥6 months of MOUD treatment. CONCLUSION: Among PWH and OUD who initiated BOUD, higher intensity BOUD was associated with improved ART initiation and adherence, but neither BOUD alone nor BOUD plus ≥6 months MOUD was associated with improvements in VL, CD4 count or VACS Index 2.0. Published by Elsevier Inc.
Entities:
Keywords:
Behavioral treatment; HIV; Medication treatment; Opioid use disorder; Veterans
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