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Assessing the Temporality Between Transitions onto Opioid Agonist Therapy and Engagement with Antiretroviral Therapy in a Cohort of HIV-Positive People Who Use Opioids Daily

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Abstract

A robust evidence-base describes the beneficial association between opioid agonist therapy (OAT) and HIV-related outcomes among people living with HIV and opioid use disorder. While some evidence suggests the stabilizing effect of OAT on antiretroviral therapy (ART) treatment engagement, less is understood about the potential for an inverse relationship. We sought to examine the relationship between transitions in ART engagement and transitions onto OAT. We used data from a prospective cohort of people living with HIV who use drugs in Vancouver, Canada—a setting with no-cost access to ART and low or no-cost access to OAT among low-income residents. Restricting the sample to those who reported daily or greater opioid use, we used generalized linear mixed-effects models to estimate the relationships between our primary outcome of transitions onto OAT (methadone or buprenorphine/naloxone) and transitions (1) onto ART and (2) into ART adherence. Subsequent analyses assessed the temporal sequencing of transitions. Between 2005 and 2017, among 433 participants, 48.3% reported transitioning onto OAT at least once. In concurrent analyses, transitions onto ART were positively and significantly associated with transitions onto OAT. Temporal sequencing revealed that transitions into OAT were also positively and significantly associated with subsequent transitions onto ART. OAT’s potential to facilitate the uptake of ART points to the continued need to scale-up low-threshold, client-centered substance use services integrated alongside HIV care.

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Availability of Data and Materials

Public sharing of data for this study is not permitted under the parameters of the research ethics approval, given potentially identifying and sensitive health and legal information. Requests for anonymized data can be made to the University of British Columbia/Providence Health Care Research Ethics Board by researchers who meet specific criteria set in the ethics approval. For further inquiries, please contact the research administration office of the British Columbia Centre on Substance Use: inquiries@bccsu.ubc.ca.

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Acknowledgements

We would like to thank the study participants for their contributions to the research, as well as past and current researchers and staff, especially Dr. Ekaterina Novosa, Christy Zonneveld, Steve Kain and Ana Prado for their research and administrative assistance. We gratefully acknowledge the British Columbia Centre for Excellence in HIV/AIDS’ contribution of data from the Drug Treatment Programme.

Funding

This study was supported by the US National Institutes of Health (NIH; R01DA021525). Sanjana Mitra is supported by a Frederick Banting and Charles Best CIHR Doctoral Award. Lindsey Richardson and M-J Milloy are supported by New Investigator Awards from the Canadian Institutes of Health Research and Scholar Awards from the Michael Smith Foundation for Health Research (CIHR; MSH 217672, MSH 360816). Lindsey Richardson’s research is additionally supported by a CIHR Foundation Grant (FDN-154320) and the Canada Research Chairs program through a Tier II Canada Research Chair in Social Inclusion and Health Equity. M-J Milloy is additionally supported in part by NIH (U01DA021525). Seonaid Nolan is supported by a Health Professional Award from the Michael Smith Foundation for Health Research and the University of British Columbia’s Steven Diamond Professorship in Addiction Care Innovation. No funding sources were involved in the study design, data collection, analysis, or interpretation.

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Authors and Affiliations

  1. Interdisciplinary Graduate Studies Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC, V6T 1Z4, Canada

    Sanjana Mitra

  2. British Columbia Centre on Substance Use, University of British Columbia, 400-1045 Howe, Vancouver, BC, V6Z 2A9, Canada

    Sanjana Mitra, Cameron Grant, Seonaid Nolan, M.-J. Milloy & Lindsey Richardson

  3. Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada

    Seonaid Nolan & M.-J. Milloy

  4. Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia

    Nur Afiqah Mohd Salleh

  5. Centre of Excellence for Research in AIDS, University of Malaya, 50603, Kuala Lumpur, Malaysia

    Nur Afiqah Mohd Salleh

  6. Department of Sociology, University of British Columbia, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada

    Lindsey Richardson

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  1. Sanjana Mitra
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  2. Cameron Grant
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Contributions

SM: Conceptualization, Methodology, Writing—Original Draft, Cameron Grant: Formal Analysis, Data curation, Writing—Review & Editing, Seonaid Nolan: Conceptualization, Writing—Review & Editing, Nur Afiqah Mohd Salleh: Writing—Review & Editing, M-J Milloy: Investigation, Writing—Review & Editing, Funding acquisition, Lindsey Richardson: Investigation, Supervision, Conceptualization, Methodology, Writing—Review & Editing, Funding acquisition.

Corresponding author

Correspondence to Lindsey Richardson.

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Conflict of Interest

M-J Milloy’s institution (the University of British Columbia) has received an unstructured gift from NG Biomed Ltd., a private firm seeking a government license to produce medical cannabis, to support him. M-JM is also 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. He has no personal financial relationships (e.g., employment, stock ownership, consulting, etc.) with the cannabis industry.

Ethical Approval

This study was approved by the Providence Health Care/University of British Columbia Research Ethics Boards.

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All cohort participants provided written informed consent.

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Mitra, S., Grant, C., Nolan, S. et al. Assessing the Temporality Between Transitions onto Opioid Agonist Therapy and Engagement with Antiretroviral Therapy in a Cohort of HIV-Positive People Who Use Opioids Daily. AIDS Behav 26, 1933–1942 (2022). https://doi.org/10.1007/s10461-021-03543-y

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