Integration of methadone maintenance treatment and HIV care for injecting drug users: a cohort study in Bandung, Indonesia.
OBJECTIVE
to know the effectiveness of antiretroviral treatment (ART) among methadone clients and patients who started ART outside the methadone program during the same period.


METHODS
uptake of HIV testing and treatment were evaluated in a cohort of IDUs starting MMT. Effectiveness of anti-retroviral treatment (ART) was compared with matched 175 HIV-patients with a history of IDU outside MMT.


RESULTS
overall, 223 patients were enrolled in MMT between May 2006 and January 2009, of whom 44% were tested for HIV, with an HIV prevalence of 73%. Screening of MMT clients was responsible for diagnosing HIV and starting ART in 31.9%, respectively 45.7%. Two year retention (100% vs 97.1%; p=0.23) and survival (93.9% vs 92.3%; p=0.76) during ART were not significantly different for 35 patients who combined ART with methadone, and the control group (n=175). Virological failure was found in one patient (3.7%) in MMT compared to 10.5% of the control group.


CONCLUSIONS
providing HIV testing and treatment is a feasible and effective way to increase detection and treatment of HIV among clients enrolled in MMT. HIV- treatment integrated with methadone maintenance can be very effective. These results support wider application of integrated HIV care and opioid substitution.
Achmad
Yanni Melliandari
YM
Health Research Unit, Faculty of Medicine, Padjadjaran University/Hasan Sadikin Hospital. Jl. Pasirkaliki no. 190, Bandung 40151, Indonesia. melliandari@yahoo.com
Istiqomah
Arifah Nur
AN
Iskandar
Shelly
S
Wisaksana
Rudi
R
van Crevel
Reinout
R
Hidayat
Teddy
T
D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006556:Heroin Dependence / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment; D015819:Substance Abuse, Intravenous / Q000534:rehabilitation*
D008691:Methadone