McFall Allison M, Ganapathi Lakshmi, Gunaratne Mihili P, Srikrishnan Aylur K, Vasudevan Conjeevaram K, Anand Santhanam, Solomon Sunil S, Mehta Shruti H, Lucas Gregory M
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Division of Pediatric Global Health, Massachusetts General Hospital, Boston, MA, USA.
Addiction. 2025 Apr;120(4):745-755. doi: 10.1111/add.16713. Epub 2024 Nov 27.
The aim of this study was to identify longitudinal trajectories of medication for opioid use disorder (MOUD) use throughout 1 year following MOUD initiation and to examine the association of trajectory membership with HIV testing among people who inject drugs in India.
DESIGN, SETTING AND PARTICIPANTS: The study comprised group-based trajectory modeling using longitudinal clinic-based MOUD use data, set in seven Indian cities with integrated care centers (ICC) delivering MOUD, predominantly buprenorphine, in 2018-2019. A total of 1562 people who inject drugs who initiated MOUD for the first time at an ICC between 1 January 2018 and 31 December 2018 were included in this study. Median age was 26 years, 98% were male and 22% were living with HIV.
Daily directly observed MOUD visits were biometrically verified and entered into an electronic database. A dichotomous variable for MOUD use each day throughout 1 year following initiation was created for the trajectory models. Client socio-demographics, HIV status and testing at the ICC and dose were extracted from the clinical database.
We found five MOUD trajectory groups: (1) early dropout (41%), (2) late dropout (18%), (3) delayed dropout (10%), (4) intermittent use (12%) and (5) persistent use (19%). Differences between the dropout groups were characterized by the rate of decline in MOUD use over time. The late dropout group had an 18% higher rate of HIV testing [adjusted rate ratio (aRR) = 1.18, 95% confidence interval (CI) = 1.10-1.27] and those with persistent MOUD use had a 91% higher rate of testing (aRR = 1.91, 95% CI = 1.77-2.05) compared with the early dropout group.
Nearly 70% of clients initiating medication for opioid use disorder (MOUD) at integrated care centers (ICCs) in India stop MOUD use within 1 year, with trajectories characterized by the rate of decline in engagement. Clients with better MOUD adherence appear to return more frequently for HIV testing at the ICCs, underscoring the value of integrated care models.
本研究的目的是确定阿片类药物使用障碍药物治疗（MOUD）开始后1年内的用药纵向轨迹，并研究轨迹类别与印度注射吸毒者艾滋病毒检测之间的关联。
设计、地点和参与者：该研究采用基于群组的轨迹模型，使用基于诊所的MOUD纵向用药数据，数据来自2018 - 2019年在印度七个设有提供MOUD（主要是丁丙诺啡）综合护理中心（ICC）的城市。本研究纳入了2018年1月1日至2018年12月31日期间在ICC首次开始接受MOUD治疗的1562名注射吸毒者。中位年龄为26岁，98%为男性，22%感染艾滋病毒。
每日直接观察到的MOUD就诊情况通过生物识别进行核实并录入电子数据库。为轨迹模型创建了一个关于开始治疗后1年内每日MOUD使用情况的二分变量。从临床数据库中提取客户的社会人口统计学特征、艾滋病毒感染状况、在ICC的检测情况以及用药剂量。
我们发现了五个MOUD轨迹组：（1）早期停药组（41%），（2）晚期停药组（18%），（3）延迟停药组（10%），（4）间歇使用组（12%）和（5）持续使用组（19%）。停药组之间的差异表现为MOUD使用随时间下降的速率。与早期停药组相比，晚期停药组的艾滋病毒检测率高18%[调整率比（aRR）= 1.18，95%置信区间（CI）= 1.10 - 1.27]，持续使用MOUD的患者检测率高91%（aRR = 1.91，95% CI = 1.77 - 2.05）。
在印度综合护理中心（ICC）开始接受阿片类药物使用障碍药物治疗（MOUD）的患者中，近70%在1年内停止使用MOUD，其轨迹特征为参与度下降的速率。MOUD依从性较好的患者似乎更频繁地返回ICC进行艾滋病毒检测，这突出了综合护理模式的价值。
