Abstract
ObjectivesA growing body of evidence supports the effectiveness of injectable diacetylmorphine (i.e., heroin) for individuals with treatment-refractory opioid use disorder. Despite this evidence, and the increasing toll of opioid-associated morbidity and mortality, it remains controversial in some settings. To investigate the possible contribution of heroin-assisted treatment (HAT) to HIV treatment-related outcomes, we sought to estimate the proportion and characteristics of HIV-positive people who inject opioids that might be eligible for HAT in Vancouver, Canada.MethodsWe used data from a prospective cohort of people living with HIV who use illicit drugs in Vancouver, Canada. Using generalized estimating equations (GEE), we assessed the longitudinal relationships between eligibility for HAT, using criteria from previous clinical trials and guidelines, with behavioural, social, and clinical characteristics.ResultsBetween 2005 and 2014, 478 participants were included in these analyses, contributing 1927 person-years of observation. Of those, 94 (19.7%) met eligibility for HAT at least once during the study period. In a multivariable GEE model, after adjusting for clinical characteristics, being eligible for HAT was positively associated with homelessness, female gender, high-intensity illicit drug use, drug dealing and higher CD4 count.ConclusionsIn our study of HIV-positive people with a history of injection drug use, approximately 20% of participants were eligible for HAT at ≥ 1 follow-up period. Eligibility was linked to risk factors for sub-optimal HIV/AIDS treatment outcomes, such as homelessness and involvement in the local illicit drug trade, suggesting that scaling-up access to HAT might contribute to achieving optimal HIV treatment in this setting.
Highlights
A growing body of evidence, including findings from randomised controlled trials (RCT) in Europe and North America, and systematic reviews by the Cochrane Collaboration and others, supports the effectiveness of injectable diacetylmorphine for treatment-refractory opioid use disorder [1,2,3]
Between December 2005 and May 2014, 852 individuals were recruited into the cohort, of whom 478 (56.1%) participants satisfied all criteria, including age and injection drug use, and were included in the analysis
Most participants included in this analysis were Caucasian (273, 57.1%), males (321, 67.2%), with median age of 43.1 (IQR 36.7–47.9) years
Summary
A growing body of evidence, including findings from randomised controlled trials (RCT) in Europe and North America, and systematic reviews by the Cochrane Collaboration and others, supports the effectiveness of injectable diacetylmorphine (i.e., prescribed heroin) for treatment-refractory opioid use disorder [1,2,3]. Despite this support, heroin-assisted treatment (HAT) remains controversial and unavailable in most settings [4]. As a result of sub-optimal HIV treatment outcomes and barriers to accessing harm reduction supplies, such as sterile syringes, HIV outbreaks among PWID are common and ongoing in many settings [9, 10]
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