Initiation of Low-threshold Buprenorphine in Nontreatment Seeking Patients With Opioid Use Disorder Engaged in Hepatitis C Treatment.
Initiation of Low-threshold Buprenorphine in Nontreatment Seeking Patients With Opioid Use Disorder Engaged in Hepatitis C Treatment.
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DOI：
10.1097/adm.0000000000000807
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发表时间：
2022-01-01
影响因子：
5.5
通讯作者：
Rosenthal ES
中科院分区：
文献类型：
--
作者：
Hill K;Nussdorf L;Mount JD;Silk R;Gross C;Sternberg D;Bijole P;Jones M;Kier R;Mccullough D;Mathur P;Kottilil S;Masur H;Kattakuzhy S;Rosenthal ES
ANCHOR项目在华盛顿特区的一个减少危害组织为丙型肝炎（HCV）治疗的注射吸毒者提供丁丙诺啡治疗。该分析描述了阿片类药物治疗连续一年的项目模型和结果。主要结局是丁丙诺啡的开始和护理的保留，在给定的时间点由有效的丁丙诺啡处方来定义。次要结局包括治疗中断、治疗未开始和终止的原因、丁丙诺啡和阿片类药物的使用以及艾滋病毒风险行为。通过尿液毒理学筛查测量丁丙诺啡和阿片类药物的使用情况，并通过有效的调查量化HIV风险行为。在基线时接受HCV治疗的67例患者中，96% （n=64）对丁丙诺啡感兴趣，73% （n=49）开始使用丁丙诺啡。在第1个月、第6个月和第12个月，留存率分别为82% （n=40）、65% （n=32）和59% （n=29）。12个月时的滞留与自我报告的常规医疗护理参与相关（p<0.01），但与性别、稳定的住房、过去的OAT或过去的用药过量无关。在留用患者中，阿片类药物尿液筛查在第1、6和12个月时呈阳性的分别为73% （n=29）、56% （n=18）和79% （n=23）。在治疗期间，艾滋病毒风险行为得分显著下降，主要是由于注射频率减少。在减少危害组织接受丙型肝炎治疗的患者显示出丁丙诺啡治疗的高起始率，与其他治疗环境相当。虽然大多数患者在治疗中继续使用阿片类药物，但注射药物的使用频率有所减少，这是与oud相关的风险的一个重要驱动因素。这些数据支持在HCV治疗的同时使用低阈值丁丙诺啡以降低OUD患者的发病率和死亡率。
The ANCHOR program offered buprenorphine treatment to people who inject drugs engaged in hepatitis C (HCV) treatment at a Washington, DC harm reduction organization. This analysis describes the program model and outcomes of the opioid care continuum at one year. Primary outcomes were initiation of buprenorphine and retention in care, defined by an active buprenorphine prescription at given time points. Secondary outcomes included treatment interruptions, reasons for treatment non-initiation and termination, buprenorphine and opiate use, and HIV risk behaviors. Buprenorphine and opiate use were measured by urine toxicology screens and HIV risk behavior was quantified using a validated survey. Of 67 patients receiving HCV treatment not on opioid agonist therapy (OAT) at baseline, 96% (n=64) were interested and 73% (n=49) initiated buprenorphine. Retention was 82% (n=40), 65% (n=32), and 59% (n=29) at months 1, 6, and 12, respectively. Retention at 12 months was associated with self-reported engagement in routine medical care (p<0.01), but was not associated with gender, stable housing, past OAT, or past overdose. Among retained patients, urine screens positive for opioids were 73% (n=29), 56% (n=18), and 79% (n=23) at months 1, 6, and 12. There was a significant mean decrease in HIV risk taking behavior scores over the treatment period, primarily driven by reduced injection frequency. Patients engaged in HCV treatment at a harm reduction organization showed a high rate of initiation of buprenorphine treatment, with retention comparable to other treatment settings. While most patients continued using opioids on treatment, there was a reduced frequency of injection drug use, a significant driver of OUD-related risk. These data support the use of low-threshold buprenorphine access alongside HCV treatment to reduce morbidity and mortality in people with OUD.