Abstract

Background and aimGlobally, nearly one in five people who inject drugs (PWID) are living with HIV, and the rate of new HIV infections in PWID is increasing in some settings. Early diagnosis is crucial for effective HIV control. We reviewed the evidence on the association between opioid agonist therapy (OAT) and HIV testing uptake among PWID.MethodsWe conducted a systematic review searching MEDLINE, Scopus, Web of Science, Cochrane Central Register of Controlled Trials and PsycINFO for studies published from January 2000 to March 2019. Reference lists and conference proceedings were hand‐searched. Observational and intervention studies were eligible for inclusion. Risk of bias was assessed using the Risk of Bias in Non‐Randomised Studies of Interventions (ROBINS‐I) tool. Meta‐analyses were conducted using random‐effects models.ResultsOf 13 373 records identified, 11 studies from Australia, Europe, Malaysia and the United States were included. All studies had at least a serious risk of bias, largely due to confounding and selection bias, making it difficult to draw causal conclusions from the evidence. Ten studies provided data on the association between current OAT use and recent HIV testing. Six showed a positive association, while four provided little evidence of an association: pooled odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.28–2.27. Looking at having ever been on OAT and having ever been HIV tested, seven studies showed a positive association and three showed either weak or no evidence of an association: pooled OR = 3.82, 95% CI = 2.96–4.95.ConclusionsOpioid agonist therapy may increase uptake of HIV testing among people who inject drugs, providing further evidence that opioid agonist therapy improves the HIV treatment care cascade.

Highlights

  • There are an estimated 15.6 million people aged 15–64 years who inject drugs (PWID) [1]

  • Data on opioid agonist therapy (OAT) use and HIV testing was extracted for inclusion in our meta-analysis from routinely collected cross-sectional survey data [26,32,33,34]

  • A total of 53 012 individuals were included in our analysis, the majority (73%) of whom are male

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Summary

Introduction

There are an estimated 15.6 million people aged 15–64 years who inject drugs (PWID) [1]. In contrast to an overall 25% decline in global HIV incidence between 2010 and 2017, the incidence among PWID is increasing in some regions [4]. To reverse this trend, there is a need to improve engagement in every aspect of the HIV cascade of care [4]. Nearly one in five people who inject drugs (PWID) are living with HIV, and the rate of new HIV infections in PWID is increasing in some settings. We reviewed the evidence on the association between opioid agonist therapy (OAT) and HIV testing uptake among PWID

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