Impact of Opioid Substitution Therapy on the HIV Prevention Benefit of Antiretroviral Therapy for People Who Inject Drugs

May 2017 - Combination Prevention

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Mukandavire, C., Low, A., Mburu, G., et al. AIDS (March 2017), e-publication ahead of print, doi:10.1097/QAD.0000000000001458.

The authors of this article used modeling to determine whether introducing opioid substitution therapy (OST) could improve the coverage of antiretroviral therapy (ART) across a population of people who inject drugs (PWID) for different baseline ART coverage levels. Using data from a previous meta-analysis, they examined the effect of OST on ART at different levels of ART coverage, along with changes in levels of viral suppression, to project the relative reduction in yearly HIV transmission risk achieved by ART (with or without OST). They then compared these findings to models in which no ART was present (defined as the prevention effectiveness of ART). They found that OST could significantly increase the benefit of ART for HIV prevention among PWID, depending on the baseline ART coverage level (by 44% for low coverage, 31% for moderate coverage, and 20% for high coverage), compared to PWID not on OST. Their findings also indicated that introducing OST would improve the population-level prevention effectiveness of ART across all PWID, compared to OST not being introduced. They concluded that introducing OST could markedly improve the HIV prevention benefit of ART, but cautioned that this improvement would require removing policy barriers, such as stigma and the criminalization of drug use.

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