Impact of intensity of behavioral treatment, with or without medication treatment, for opioid use disorder on HIV outcomes in persons with HIV

Amy J. Kennedy, Kathleen A. McGinnis, Jessica S. Merlin, E. Jennifer Edelman, Adam J. Gordon, P. Todd Korthuis, Melissa Skanderson, Emily C. Williams, Jessica Wyse, Benjamin Oldfield, Kendall Bryant, Amy Justice, David A. Fiellin, Kevin L. Kraemer

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Persons with HIV (PWH) and opioid use disorder (OUD) can have poor health outcomes. We assessed whether intensity of behavioral treatment for OUD (BOUD) with and without medication for OUD (MOUD) is associated with improved HIV clinical outcomes. Methods: We used Veterans Aging Cohort Study (VACS) data from 2008 to 2017 to identify PWH and OUD with ≥1 BOUD episode. We assessed BOUD intensity and ≥6 months of MOUD (methadone or buprenorphine) receipt during the 12 months after BOUD initiation. Linear regression models assessed the association of BOUD intensity and MOUD receipt with pre-post changes in log viral load (VL), CD4 cell count, VACS Index 2.0, antiretroviral treatment (ART) initiation, and ART adherence. Results: Among 2419 PWH who initiated BOUD, we identified five distinct BOUD intensity trajectories: single visit (39% of sample); low-intensity, not sustained (37%); high-intensity, not sustained (9%); low-intensity, sustained (11%); and high-intensity, sustained (5%). MOUD receipt was low (17%). Among 709 PWH not on ART at the start of BOUD, ART initiation increased with increased BOUD intensity (p < 0.01). Among 1401 PWH on ART at the start of BOUD, ART adherence improved more in higher-intensity BOUD groups (p < 0.01). VL, CD4 count and VACS Index 2.0 did not differ by BOUD or ≥6 months of MOUD treatment. Conclusion: Among PWH and OUD who initiated BOUD, higher intensity BOUD was associated with improved ART initiation and adherence, but neither BOUD alone nor BOUD plus ≥6 months MOUD was associated with improvements in VL, CD4 count or VACS Index 2.0.

Original languageEnglish (US)
Article number108509
JournalJournal of Substance Abuse Treatment
Volume132
DOIs
StatePublished - Jan 2022

Keywords

  • Behavioral treatment
  • HIV
  • Medication treatment
  • Opioid use disorder
  • Veterans

ASJC Scopus subject areas

  • Phychiatric Mental Health
  • Medicine (miscellaneous)
  • Clinical Psychology
  • Psychiatry and Mental health

Fingerprint

Dive into the research topics of 'Impact of intensity of behavioral treatment, with or without medication treatment, for opioid use disorder on HIV outcomes in persons with HIV'. Together they form a unique fingerprint.

Cite this