title: Impact of Opioid Substitution Therapy on Antiretroviral Therapy Outcomes: A Systematic Review and Meta-Analysis.
abstract: Human immunodeficiency virus (HIV)-infected people who inject drugs (PWID) frequently encounter barriers accessing and remaining on antiretroviral therapy (ART). Some studies have suggested that opioid substitution therapy (OST) could facilitate PWID's engagement with HIV services. We conducted a systematic review and meta-analysis to evaluate the impact of concurrent OST use on ART-related outcomes among HIV-infected PWID.
  
  
  
  We searched Medline, PsycInfo, Embase, Global Health, Cochrane, Web of Science, and Social Policy and Practice databases for studies between 1996 to November 2014 documenting the impact of OST, compared to no OST, on ART outcomes. Outcomes considered were coverage and recruitment onto ART, adherence, viral suppression, attrition from ART, and mortality. Meta-analyses were conducted using random-effects modeling, and heterogeneity assessed using Cochran Q test and I(2) statistic.
  
  
  
  We identified 4685 articles, and 32 studies conducted in North America, Europe, Indonesia, and China were included. OST was associated with a 69% increase in recruitment onto ART (hazard ratio [HR], 1.69; 95% confidence interval [CI], 1.32-2.15), a 54% increase in ART coverage (odds ratio [OR], 1.54; 95% CI, 1.17-2.03), a 2-fold increase in adherence (OR, 2.14; 95% CI, 1.41-3.26), and a 23% decrease in the odds of attrition (OR, 0.77; 95% CI, .63-.95). OST was associated with a 45% increase in odds of viral suppression (OR, 1.45; 95% CI, 1.21-1.73), but there was limited evidence from 6 studies for OST decreasing mortality for PWID on ART (HR, 0.91; 95% CI, .65-1.25).
  
  
  
  These findings support the use of OST, and its integration with HIV services, to improve the HIV treatment and care continuum among HIV-infected PWID.
authors.affiliation: School of Social and Community Medicine, University of Bristol, United Kingdom.|ICAP, Columbia University, New York, New York.
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Low
authors.affiliation: International HIV/AIDS Alliance, Brighton.|Division of Health Research, Lancaster University.
authors.forename: Gitau
authors.initials: G
authors.lastname: Mburu
authors.affiliation: School of Social and Community Medicine, University of Bristol, United Kingdom.
authors.forename: Nicky J
authors.initials: NJ
authors.lastname: Welton
authors.affiliation: School of Social and Community Medicine, University of Bristol, United Kingdom.
authors.forename: Margaret T
authors.initials: MT
authors.lastname: May
authors.affiliation: School of Social and Community Medicine, University of Bristol, United Kingdom.
authors.forename: Charlotte F
authors.initials: CF
authors.lastname: Davies
authors.affiliation: School of Social and Community Medicine, University of Bristol, United Kingdom.
authors.forename: Clare
authors.initials: C
authors.lastname: French
authors.affiliation: School of Clinical Veterinary Sciences, University of Bristol.
authors.forename: Katy M
authors.initials: KM
authors.lastname: Turner
authors.affiliation: School of Clinical Veterinary Sciences, University of Bristol.
authors.forename: Katharine J
authors.initials: KJ
authors.lastname: Looker
authors.affiliation: School of Social and Community Medicine, University of Bristol, United Kingdom.
authors.forename: Hannah
authors.initials: H
authors.lastname: Christensen
authors.affiliation: International HIV/AIDS Alliance, Brighton.
authors.forename: Susie
authors.initials: S
authors.lastname: McLean
authors.affiliation: London School of Hygiene and Tropical Medicine, United Kingdom.
authors.forename: Tim
authors.initials: T
authors.lastname: Rhodes
authors.affiliation: London School of Hygiene and Tropical Medicine, United Kingdom.
authors.forename: Lucy
authors.initials: L
authors.lastname: Platt
authors.affiliation: School of Social and Community Medicine, University of Bristol, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hickman
authors.affiliation: University of California, San Diego.
authors.forename: Andy
authors.initials: A
authors.lastname: Guise
authors.affiliation: School of Social and Community Medicine, University of Bristol, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Vickerman
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D002047:Buprenorphine / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D006801:Humans; D055118:Medication Adherence; D008691:Methadone / Q000627:therapeutic use; D016017:Odds Ratio; D058850:Opiate Substitution Treatment; D017594:Publication Bias; D019966:Substance-Related Disorders / Q000150:complications* / Q000188:drug therapy; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents; D002047:Buprenorphine; D008691:Methadone
keywords: HIV; antiretroviral treatment (ART); medication-assisted therapy for opioid dependence (MAT); people who inject drugs (PWID); systematic review