FYI. Of interest for those =
doing research with PWID and HIV. —  CF



Dear all,

This is a critically important longitudinal study th=
at confirms empirical observations over the past 25 years.  First is h=
igh coverage and retention in services and the second is the importance of =
 implementing low-threshold services (e.g.,
minimizing legal, regulatory and policy barriers that limit availability, =
accessibility, acceptability, and quality and utilization. =


Rich Needle


Low-threshold methadone maintenance =
reduces HIV risk for PWIDS:



Low-threshold me=
thadone maintenance reduces HIV risk for people who inject drugs

Keith Alcorn

Published: 12 August 2015

Receiving methadone maintenance therapy through prim=
ary care physicians or community pharmacies significantly reduced the risk =
of HIV infection for people who inject drugs in Vancouver, findings of a co=
hort study published this week in Lancet

Methadone maintenance therapy is a form of opioid su=
bstitution therapy. Its provision in drug treatment programmes has been sho=
wn to reduce the risk of HIV infection in people who inject drugs in severa=
l cities in the United States, but
access to methadone remains restricted both in the United States and in ma=
ny other countries.

One barrier to obtaining methadone lies in the restr=
ictions placed on access and prescribing. Services with a high threshold to=
access – such as only prescribing methadone within a drug detoxifica=
tion programme, with regular tests to check
on heroin use – limit access to methadone to those drug users who ar=
e able to undertake such a programme.

Harm reduction approaches to injecting drug use have=
emphasised the importance of lowering the threshold for access to methadon=
e, in order to enable drug users to avoid drug injecting. `Low-threshold` m=
ethadone provision can include prescribing
through primary care physicians (as in France and British Columbia), walk-=
in methadone clinics (as in Hong Kong) and mobile harm reduction services (=

In Canada methadone has been available for prescript=
ion since 1996. In the province of British Columbia primary care physicians=
prescribe methadone, which is dispensed as daily or weekly doses at commun=
ity pharmacies.

To assess the impact of low-threshold methadone pres=
cribing on the risk of HIV acquisition among people who inject drugs in the=
Vancouver area, researchers at the British Columbia Centre for Excellence =
in HIV/AIDS and the University of
British Columbia examined data from the Vancouver Injection Drug Users Stu=
dy. This cohort study recruited people who inject drugs in 1996 in the Grea=
ter Vancouver area.

The study assessed the risk of HIV infection accordi=
ng to methadone use in 1639 people who were HIV-negative at baseline and wh=
o returned for at least one follow-up visit at which they were tested for H=
IV. The study sample were older than
people who did not return for HIV testing, and less likely to have reporte=
d unprotected sex. Approximately two-thirds were men (67%). At baseline 20%=
of the study sample had received methadone in the previous six months. &nb=

Participants were followed for a median of 75.5 mont=
hs, during which time 138 acquired HIV infection, an incidence of 1.21 per =
100 person-years. After four years of follow up the cumulative incidence of=
HIV in those who had received methadone
at baseline was 2.3%, compared to 8.9% in those not receiving methadone. P=
eople receiving methadone at baseline were less likely to inject heroin dai=
ly, to borrow a used syringe or to engage in unprotected sex.

Methadone maintenance was associated with a 36% redu=
ced risk of acquiring HIV during the follow-up period after controlling for=
patterns of drug use including syringe borrowing and cocaine injecting, an=
d demographic or situational factors
including ethnicity, age, incarceration and sex work (adjusted relative ha=
zard 0.64, 95% confidence interval 0.41-0.98).

In an accompanying editorial comment, Zunyou Wu of t=
he Chinese Center for Disease Control and Prevention and Roget Detels of th=
e University of California Los Angeles School of Public Health note that &#=
8220;drug use is an illness for which methadone
is an essential medicine.” They noted the low coverage of methadone =
in the cohort, which was recruited on the street rather than in clinic sett=
ings, and the importance of more intensive efforts to reach people who inje=
ct drugs in order to limit HIV transmission.=


Ahamad K et al. Effect of low-threshold meth=
adone maintenance therapy for people who inject drugs on HIV incidence in V=
ancouver, BC, Canada: an observational cohort study.
 Lancet HIV, a=
dvance online publication, 7 August 2015.

Wu Z, Detels R. Methadone treatment in prima=
ry care.
 Lancet HIV, advance online publication, 7 August 2015.

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