TY - JOUR
T1 - Predictors of timely opioid agonist treatment initiation among veterans with and without HIV
AU - Wyse, Jessica J.
AU - Robbins, Jonathan L.
AU - McGinnis, Kathleen A.
AU - Edelman, E. Jennifer
AU - Gordon, Adam J.
AU - Manhapra, Ajay
AU - Fiellin, David A.
AU - Moore, Brent A.
AU - Korthuis, P. Todd
AU - Gaither, Julie R.
AU - Gordon, Kirsha
AU - Skanderson, Melissa
AU - Barry, Declan T.
AU - Crystal, Stephen
AU - Justice, Amy
AU - Kraemer, Kevin L.
N1 - Publisher Copyright:
© 2019
PY - 2019/5/1
Y1 - 2019/5/1
N2 - Background: Opioid use disorder (OUD) is prevalent among people with HIV (PWH). Opioid agonist therapy (OAT) is the most effective treatment for OUD and is associated with improved health outcomes, but is often not initiated. To inform clinical practice, we identified factors predictive of OAT initiation among patients with and without HIV. Methods: We identified 19,698 new clinical encounters of OUD between 2000 and 2012 in the Veterans Aging Cohort Study (VACS), a national observational cohort of PWH and matched uninfected controls. Mixed effects models examined factors predictive of OAT initiation within 30-days of a new OUD clinical encounter. Results: 4.9% of both PWH and uninfected patients initiated OAT within 30 days of a new OUD clinical encounter. In adjusted models, participants with a psychiatric diagnosis (aOR = 0.54, 95% CI 0.47 – 0.62), PWH (aOR = 0.79, 95% CI 0.68–0.92), and rural residence (aOR = 0.56, 95% CI 0.39-0.78) had a lower likelihood of any OAT initiation, while African-American patients (aOR = 1.60, 95% CI 1.34–1.92), those with an alcohol related diagnosis (aOR = 1.76, 95% CI 1.48–2.08), diagnosis year 2005–2008 relative to 2000–2004 (aOR = 1.24, 95% CI 1.05–1.45), and patients with HCV (aOR = 1.50, 95% CI 1.27–1.77) had a greater likelihood of initiating any OAT within 30 days. Predictive factors were similar in the total sample and PWH only models. Conclusions: PWH were less likely to receive timely OAT initiation than demographically similar uninfected patients. Given the health benefits of such treatment, the low rate of OAT initiation warrants focused efforts in both PWH and uninfected populations.
AB - Background: Opioid use disorder (OUD) is prevalent among people with HIV (PWH). Opioid agonist therapy (OAT) is the most effective treatment for OUD and is associated with improved health outcomes, but is often not initiated. To inform clinical practice, we identified factors predictive of OAT initiation among patients with and without HIV. Methods: We identified 19,698 new clinical encounters of OUD between 2000 and 2012 in the Veterans Aging Cohort Study (VACS), a national observational cohort of PWH and matched uninfected controls. Mixed effects models examined factors predictive of OAT initiation within 30-days of a new OUD clinical encounter. Results: 4.9% of both PWH and uninfected patients initiated OAT within 30 days of a new OUD clinical encounter. In adjusted models, participants with a psychiatric diagnosis (aOR = 0.54, 95% CI 0.47 – 0.62), PWH (aOR = 0.79, 95% CI 0.68–0.92), and rural residence (aOR = 0.56, 95% CI 0.39-0.78) had a lower likelihood of any OAT initiation, while African-American patients (aOR = 1.60, 95% CI 1.34–1.92), those with an alcohol related diagnosis (aOR = 1.76, 95% CI 1.48–2.08), diagnosis year 2005–2008 relative to 2000–2004 (aOR = 1.24, 95% CI 1.05–1.45), and patients with HCV (aOR = 1.50, 95% CI 1.27–1.77) had a greater likelihood of initiating any OAT within 30 days. Predictive factors were similar in the total sample and PWH only models. Conclusions: PWH were less likely to receive timely OAT initiation than demographically similar uninfected patients. Given the health benefits of such treatment, the low rate of OAT initiation warrants focused efforts in both PWH and uninfected populations.
KW - Buprenorphine
KW - HIV
KW - Methadone
KW - Opioid agonist therapy
KW - Opioid use disorder
KW - Veterans affairs hospital
UR - http://www.scopus.com/inward/record.url?scp=85062837746&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85062837746&partnerID=8YFLogxK
U2 - 10.1016/j.drugalcdep.2019.01.038
DO - 10.1016/j.drugalcdep.2019.01.038
M3 - Article
C2 - 30878769
AN - SCOPUS:85062837746
SN - 0376-8716
VL - 198
SP - 70
EP - 75
JO - Drug and Alcohol Dependence
JF - Drug and Alcohol Dependence
ER -