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
- People who use drugs
- General HIV+ population
- Engagement and Care Cascade
- Retention in care
- Drug use behaviours/harm reduction
- Health Systems
- Delivery arrangements