Adherence to methadone maintenance treatment and antiretroviral therapy


Key take-home messages
  • HIV-positive intravenous drug users (IDUs) are at greater risk of non-adherence to highly active antiretroviral therapy (HAART) compared to the general HIV population.
  • Psychological problems, active drug use and incarceration are the main barriers to HAART adherence among HIV-positive IDUs.
  • When engaged in stable care with adequate support and experienced staff, IDUs can have HAART adherence and clinical outcomes comparable to non-IDU patients.
  • Reduction in substance use and enrollment in an opiate substitution treatment plan, such as methadone maintenance treatment, are associated with improved HAART adherence. Oral substitution treatment for IDUs reduces drug-related behaviours with a high risk of HIV transmission, but has less effect on sex-related risk behaviours.
  • Several factors/strategies have been shown to be effective in engaging and retaining people in opioid substitution treatment and in encouraging adherence to HAART:
    • Contingency management – a system of incentives and disincentives designed to make continued drug use less attractive and abstinence more attractive – is effective in reducing supplemental drug use in patients enrolled in methadone maintenance treatment.
    • Vouchers for free methadone maintenance treatment are more effective in linking active drug users to drug treatment than case management services.
    • Administration of higher doses during methadone treatment (60mg/day or more) is associated with increased adherence to drug treatment programs and effective treatment for opioid dependence.
    • Patients receiving methadone and HAART from their primary care provider may have increased adherence to both and feel a greater sense of trust and security.
    • DOT (Directly Observed Therapy)-HAART may be an effective adherence intervention when delivered to individuals at risk for non-adherence and focused on maximizing participant convenience and providing additional adherence support.
  • Future research needs to evaluate the effectiveness of delivering maintenance treatment focused on patient engagement with HAART in primary care settings.


The Ontario HIV Treatment Network: Rapid Response Service




  • Population(s)
    • People who use drugs
    • General HIV+ population
  • Engagement and Care Cascade
    • Retention in care
    • Treatment
  • Prevention
    • Drug use behaviours/harm reduction
  • Health Systems
    • Delivery arrangements


Abstract/Full paper

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