MD/MCR Program, School of Medicine, Oregon Health & Science University, Portland, OR, USA.
Department of Medicine, Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA.
Int J Drug Policy. 2022 Feb;100:103503. doi: 10.1016/j.drugpo.2021.103503. Epub 2021 Nov 9.
In Vietnam, access to medications for opioid use disorder (MOUD) for people living with HIV has rapidly expanded, but MOUD use over time remains low. We sought to assess factors associated with days of MOUD treatment exposure.
From 2015 to 2019, patients with OUD in six Northern Vietnamese HIV clinics were randomized to receive HIV clinic-based buprenorphine (BUP/NX) or referral for methadone maintenance therapy (MMT) and followed for 12 months. All MOUD doses were directly observed and abstracted from dosing logs. The primary outcome was days of MOUD treatment exposure (buprenorphine or methadone) received over 12 months. Negative binomial regression modelled associations with days of MOUD exposure.
Of 281 participants, 264 (94%) were eligible for analysis. Participants were primarily male (97%), unmarried (61%), employed (54%), and previously arrested (83%). Participants had a mean 187 (SD 150) days of MOUD exposure with 134 (51%) having at least 180 days, and 35 (13.2%) having at least 360 days of MOUD exposure. Age (IRR 1.26, 95% CI 1.02-1.55), income (IRR 0.96, 95% CI 0.93-1.001), and methadone (IRR 1.88, 95% CI 1.51-2.42) were associated with MOUD exposure in multivariate models. Multivariate models predicted 127 (95% CL 109-147) days of MOUD exposure for HIV clinic based-buprenorphine vs 243 (95% CL 205-288) for MMT.
MOUD treatment exposure was suboptimal among patients with HIV and OUD in Northern Vietnam and was influenced by several factors. Interventions to support populations at risk of lower MOUD exposure as well programs administering MOUD should be considered in countries seeking to expand access to MOUD.
在越南，为艾滋病毒感染者提供治疗阿片类药物使用障碍（MOUD）的药物已迅速普及，但随着时间的推移，MOUD 的使用仍然很低。我们试图评估与 MOUD 治疗暴露天数相关的因素。
2015 年至 2019 年，在越南北部的六家艾滋病毒诊所中，阿片类药物使用障碍患者被随机分配接受基于艾滋病毒诊所的丁丙诺啡（BUP/NX）或转介接受美沙酮维持治疗（MMT），并随访 12 个月。所有 MOUD 剂量均直接从剂量记录中观察和提取。主要结局是 12 个月内接受 MOUD 治疗（丁丙诺啡或美沙酮）的天数。负二项式回归分析与 MOUD 暴露天数的关联。
在 281 名参与者中，有 264 名（94%）符合分析条件。参与者主要为男性（97%）、未婚（61%）、有工作（54%）和曾被逮捕（83%）。参与者接受 MOUD 治疗的平均天数为 187（SD 150）天，其中 134 天（51%）至少 180 天，35 天（13.2%）至少 360 天。年龄（IRR 1.26，95%CI 1.02-1.55）、收入（IRR 0.96，95%CI 0.93-1.001）和美沙酮（IRR 1.88，95%CI 1.51-2.42）在多变量模型中与 MOUD 暴露相关。多变量模型预测，基于艾滋病毒诊所的丁丙诺啡治疗组的 MOUD 暴露天数为 127（95%CL 109-147），美沙酮治疗组的 MOUD 暴露天数为 243（95%CL 205-288）。
越南北部 HIV 合并 OUD 患者的 MOUD 治疗暴露情况不理想，受多种因素影响。在寻求扩大 MOUD 治疗机会的国家，应考虑为风险较低的 MOUD 暴露人群提供支持的干预措施以及管理 MOUD 的方案。
