Impact of prerelease methadone on mortality among people with HIV and opioid use disorder after prison release: results from a randomized and participant choice open-label trial in Malaysia.
HIV
Methadone
Mortality
Opioid use disorder
Prison
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
11 Nov 2022
11 Nov 2022
Historique:
received:
05
11
2021
accepted:
06
06
2022
entrez:
11
11
2022
pubmed:
12
11
2022
medline:
16
11
2022
Statut:
epublish
Résumé
Mortality is elevated after prison release and may be higher in people with HIV and opioid use disorder (OUD). Maintenance with opioid agonist therapy (OAT) like methadone or buprenorphine reduces mortality in people with OUD and may confer benefits to people with OUD and HIV leaving prison. Survival benefits of OAT, however, have not been evaluated prospectively in people with OUD and HIV leaving prison. This study prospectively evaluated mortality after prison release and whether methadone initiated before release increased survival after release in a sample of men with HIV and OUD (n = 291). We linked national death records to data from a controlled trial of prerelease methadone initiation conducted from 2010 to 2014 with men with HIV and OUD imprisoned in Malaysia. Vital statistics were collected through 2015. Allocation to prerelease methadone was by randomization (n = 64) and participant choice (n = 246). Cox proportional hazards models were used to estimate treatment effects of prerelease methadone on postrelease survival. Overall, 62 deaths occurred over 872.5 person-years (PY) of postrelease follow-up, a crude mortality rate of 71.1 deaths per 1000 PY (95% confidence interval [CI] 54.5-89.4). Most deaths were of infectious etiology, mostly related to HIV. In a modified intention-to-treat analysis, the impact of prerelease methadone on postrelease mortality was consistent with a null effect in unadjusted (hazard ratio [HR] 1.3, 95% CI 0.6-3.1) and covariate-adjusted (HR 1.2, 95% CI 0.5-2.8) models. Predictors of mortality were educational level (HR 1.4, 95% CI 1.0-1.8), pre-incarceration alcohol use (HR 2.0, 95% CI 1.1-3.9), and lower CD4 Postrelease mortality in this sample of men with HIV and OUD was extraordinarily high, and most deaths were likely of infectious etiology. No effect of prerelease methadone on postrelease mortality was observed, which may be due to study limitations or an epidemiological context in which inadequately treated HIV, and not inadequately treated OUD, is the main cause of death after prison release. NCT02396979. Retrospectively registered 24/03/2015.
Identifiants
pubmed: 36368939
doi: 10.1186/s12879-022-07804-6
pii: 10.1186/s12879-022-07804-6
pmc: PMC9652918
doi:
Substances chimiques
Analgesics, Opioid
0
Methadone
UC6VBE7V1Z
Banques de données
ClinicalTrials.gov
['NCT02396979']
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
837Subventions
Organisme : NIDA NIH HHS
ID : K23DA041988
Pays : United States
Organisme : NIMH NIH HHS
ID : R25MH060482
Pays : United States
Organisme : NIMH NIH HHS
ID : F30MH105153
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Organisme : NIDA NIH HHS
ID : F30 DA039716
Pays : United States
Organisme : Universiti Malaya
ID : High Impact Research Grant UM.C/625/1/HIR/MOHE/MED01
Organisme : NIGMS NIH HHS
ID : T32GM07205
Pays : United States
Organisme : NIDA NIH HHS
ID : F30DA039716
Pays : United States
Organisme : NIMH NIH HHS
ID : R25 MH060482
Pays : United States
Organisme : NIDA NIH HHS
ID : R01DA025943
Pays : United States
Informations de copyright
© 2022. The Author(s).
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