Association between opioid agonist therapy use and HIV testing uptake among people who have recently injected drugs: a systematic review and meta‐analysis

Abstract Background and aim Globally, 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. Methods We 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. Results Of 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. Conclusions Opioid 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.

[1]  P. Read,et al.  Association between opioid agonist therapy and testing, treatment uptake, and treatment outcomes for hepatitis C infection among people who inject drugs: A systematic review and meta-analysis. , 2020, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[2]  Graeme Henderson,et al.  Global patterns of opioid use and dependence: harms to populations, interventions, and future action , 2019, The Lancet.

[3]  J. Leung,et al.  A Global Meta-analysis of the Prevalence of HIV, Hepatitis C Virus, and Hepatitis B Virus Among People Who Inject Drugs-Do Gender-Based Differences Vary by Country-Level Indicators? , 2019, The Journal of infectious diseases.

[4]  Josephine G. Walker,et al.  The contribution of injection drug use to hepatitis C virus transmission globally, regionally, and at country level: a modelling study. , 2019, The lancet. Gastroenterology & hepatology.

[5]  J. E. Dorn,et al.  The 2019 , 2019, International Journal of Cultural Property.

[6]  S. Hutchinson,et al.  Re-emergence of HIV related to injecting drug use despite a comprehensive harm reduction environment: a cross-sectional analysis. , 2019, The lancet. HIV.

[7]  Josephine G. Walker,et al.  Incarceration history and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis , 2018, The Lancet. Infectious diseases.

[8]  F. Altice,et al.  Opioid Agonist Treatment and Improved Outcomes at Each Stage of the HIV Treatment Cascade in People Who Inject Drugs in Ukraine , 2018, Journal of acquired immune deficiency syndromes.

[9]  Y. Sazonova,et al.  Trends in HIV prevalence among people injecting drugs, men having sex with men, and female sex workers in Ukraine , 2018, International journal of STD & AIDS.

[10]  J. Havens,et al.  Implementing Treatment of Opioid-Use Disorder in Rural Settings: a Focus on HIV and Hepatitis C Prevention and Treatment , 2018, Current HIV/AIDS Reports.

[11]  M. Maglione,et al.  Effects of Medication-Assisted Treatment (MAT) for Opioid Use Disorder on Functional Outcomes: A Systematic Review. , 2020, Rand health quarterly.

[12]  F. Crawford,et al.  HIV Testing and awareness of HIV status among people who inject drugs in greater Kuala Lumpur, Malaysia. , 2018, AIDS care.

[13]  H. Hagan,et al.  Needle and syringe programmes and opioid substitution therapy for preventing HCV transmission among people who inject drugs: findings from a Cochrane Review and meta‐analysis , 2017, Addiction.

[14]  J. Leung,et al.  Global, regional, and country-level coverage of interventions to prevent and manage HIV and hepatitis C among people who inject drugs: a systematic review , 2017, The Lancet. Global health.

[15]  J. Leung,et al.  Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review , 2017, The Lancet. Global health.

[16]  F. Altice,et al.  Retention in medication-assisted treatment programs in Ukraine-Identifying factors contributing to a continuing HIV epidemic. , 2017, The International journal on drug policy.

[17]  L. Barajas-Nava Oral Substitution Treatment of Injecting Opioid Users for Prevention of HIV Infection , 2017, The Journal of the Association of Nurses in AIDS Care : JANAC.

[18]  L. Degenhardt,et al.  Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies , 2017, British Medical Journal.

[19]  T. Vos,et al.  Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013. , 2016, The Lancet. Infectious diseases.

[20]  F. Altice,et al.  Determinants of willingness to enroll in opioid agonist treatment among opioid dependent people who inject drugs in Ukraine. , 2016, Drug and alcohol dependence.

[21]  Jelle J Goeman,et al.  Plea for routinely presenting prediction intervals in meta-analysis , 2016, BMJ Open.

[22]  K. Looker,et al.  Impact of Opioid Substitution Therapy on Antiretroviral Therapy Outcomes: A Systematic Review and Meta-Analysis , 2016, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[23]  M. Čivljak,et al.  HIV and hepatitis C prevalence, and related risk behaviours among people who inject drugs in three cities in Croatia: Findings from respondent-driven sampling surveys. , 2016, The International journal on drug policy.

[24]  Oliver Laeyendecker,et al.  Community viral load, antiretroviral therapy coverage, and HIV incidence in India: a cross-sectional, comparative study. , 2016, The lancet. HIV.

[25]  S. Torres-Rueda,et al.  Illicit drug use in sexual settings (‘chemsex’) and HIV/STI transmission risk behaviour among gay men in South London: findings from a qualitative study , 2015, Sexually Transmitted Infections.

[26]  L. Marsch,et al.  Opioid Use Trajectories, Injection Drug Use, and Hepatitis C Virus Risk Among Young Adult Immigrants from the Former Soviet Union Living in New York City , 2015, Journal of addictive diseases.

[27]  E. Poveda,et al.  The START Trial: Definitive Evidence to Treat All HIV-Positive Persons Regardless of CD4 Counts. , 2015, AIDS reviews.

[28]  C. Celum,et al.  Biomedical HIV Prevention Including Pre-exposure Prophylaxis and Opiate Agonist Therapy for Women Who Inject Drugs: State of Research and Future Directions , 2015, Journal of acquired immune deficiency syndromes.

[29]  J. Parry,et al.  Sex work amongst people who inject drugs in England, Wales and Northern Ireland: findings from a National Survey of Health Harms and Behaviours. , 2015, The International journal on drug policy.

[30]  A. Nardone,et al.  WHO ‘Treatment as Prevention’ guidelines are unlikely to decrease HIV transmission in the UK unless undiagnosed HIV infections are reduced , 2014, AIDS.

[31]  P. Vickerman,et al.  Combination Interventions to Prevent HCV Transmission Among People Who Inject Drugs: Modeling the Impact of Antiviral Treatment, Needle and Syringe Programs, and Opiate Substitution Therapy , 2013, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[32]  Chyvette T. Williams,et al.  Racial Disparities in HIV Prevalence and Risk Behaviors Among Injection Drug Users and Members of Their Risk Networks , 2013, Journal of acquired immune deficiency syndromes.

[33]  P. Vickerman,et al.  Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis , 2012, BMJ : British Medical Journal.

[34]  Sarah J. Erickson,et al.  Implementing rapid HIV testing with or without risk-reduction counseling in drug treatment centers: results of a randomized trial. , 2012, American journal of public health.

[35]  J. Bryant,et al.  Syringe Coverage in an Australian Setting: Does a High Level of Syringe Coverage Moderate Syringe Sharing Behaviour? , 2012, AIDS and Behavior.

[36]  J. Sterne,et al.  The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials , 2011, BMJ : British Medical Journal.

[37]  T. Rhodes,et al.  Prevention of HIV infection for people who inject drugs: why individual, structural, and combination approaches are needed , 2010, The Lancet.

[38]  Matthew Hickman,et al.  HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage , 2010, The Lancet.

[39]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement , 2009, BMJ.

[40]  Evan Wood,et al.  Longitudinal community plasma HIV-1 RNA concentrations and incidence of HIV-1 among injecting drug users: prospective cohort study , 2009, BMJ : British Medical Journal.

[41]  J. Parry,et al.  Improvingblood‐borne viral diagnosis; clinical audit of the uptake of dried blood spot testing offered by a substance misuse service , 2009, Journal of viral hepatitis.

[42]  David J Spiegelhalter,et al.  A re-evaluation of random-effects meta-analysis , 2009, Journal of the Royal Statistical Society. Series A,.