Abstract
Objectives: We sought to examine the association between dispensation of methadone maintenance therapy (MMT) and antiretroviral therapy (ART) at the same facility, across multiple low-barrier dispensing outlets, and achieving optimal adherence to ART among people who use illicit drugs (PWUD). Methods: We used data from the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS) study, a long-running study of a community-recruited cohort of HIV-positive PWUD, linked to comprehensive HIV clinical records in Vancouver, Canada, a setting of no-cost, universal access to HIV care. The longitudinal relationship between MMT-ART dispensation at the same facility and the odds of ≥ 95% ART adherence was analysed using multivariable generalized linear mixed-effects modelling. We conducted a further analysis using a marginal structural mode with inverse probability of treatment weights as a sensitivity analysis. Results: This study included data on 1690 interviews of 345 ART- and MMT-exposed participants carried out between June 2012 and December 2017. In the final multivariable model, MMT-ART dispensation, compared with nondispensation at the same facility, was associated with greater odds of achieving ≥ 95% adherence [adjusted odds ratio (AOR) 1.56; 95% confidence interval (CI) 1.26–1.96]. A marginal structural model estimated a 1.48 (95% CI 1.15–1.80) greater odds of ≥ 95% adherence among participants who reported MMT-ART dispensation at the same facility compared with those who did not. Conclusions: The odds of achieving optimal adherence to ART were 56% higher during periods in which MMT and ART medications were dispensed at the same facility, in a low-barrier setting. Our findings highlight the need to consider a simpler integrated approach with medication dispensation at the same facility in low-threshold settings.
| Original language | English |
|---|---|
| Pages (from-to) | 606-614 |
| Number of pages | 9 |
| Journal | HIV Medicine |
| Volume | 20 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - Oct 1 2019 |
| Externally published | Yes |
Bibliographical note
Funding Information:The authors thank the study participants for their contributions to the research, as well as current and past researchers and staff. We would like to thank Ekaterina Nosova, Gaganpreet Kaur, Jennifer Matthews, Steve Kain, Ana Prado and Paul Sereda for their research and administrative assistance. NAMS's postgraduate studies at UBC are sponsored by the University of Malaya and the Malaysian Ministry of Higher Education. NF is supported by a Michael Smith Foundation for Health Research (MSFHR)/St Paul's Foundation Scholar Award. SN is supported by an MSFHR Health Professional Investigator award. LR and M-JM are supported by MSFHR Scholar awards and Canadian Institutes of Health Research (CIHR) New Investigator awards (MSH 217672). RB reports personal fees from Gilead Sciences and Merck, outside the submitted work. LR is additionally supported by a CIHR Foundation Award (FDN-154320). M-JM is additionally supported by the National Institutes of Health (U01-DA0251525). His institution has received an unstructured gift from NG Biomed Ltd, a private firm seeking a government licence to produce medical cannabis, to support him. M-JM is the Canopy Growth professor of cannabis science at the University of British Columbia, a position established by arms’ length gifts from Canopy Growth, a licensed producer of cannabis, and the Government of British Columbia's Ministry of Mental Health and Addictions. Conflicts of interest: All authors declare no conflicts of interest.
Publisher Copyright:
© 2019 British HIV Association
ASJC Scopus Subject Areas
- Health Policy
- Infectious Diseases
- Pharmacology (medical)
