Buprenorphine treatment receipt characteristics and retention among people who inject drugs at Integrated Care Centers in India

Abstract

Background: India is facing an alarming rise in the injection of opioids leading to burgeoning HIV epidemics among people who inject drugs (PWID) in several cities. Integrated Care Centers (ICCs) provide free single-venue HIV services and substance use treatment to PWID and have been established across 8 Indian cities. We evaluated engagement of PWID in buprenorphine treatment at ICCs to inform interventions. Methods: We retrospectively analyzed 1-year follow-up data for PWID initiating buprenorphine between 1 January and 31 December 2018 across 7 ICCs. We used descriptive statistics to evaluate buprenorphine uptake, receipt frequency, treatment interruptions (no buprenorphine receipt for 60 consecutive days but with subsequent re-engagement in treatment), and treatment drop-out (no buprenorphine receipt for 60 consecutive days without subsequent re-engagement), and explore differences between historical opioid epidemic regions (i.e., Northeast cities (NEC)) and emerging opioid epidemic regions (i.e., North/Central/Northwest cities (NCC)). We used a multivariable logistic regression model to determine predictors of treatment drop-out by 6 months. Results: 1312 PWID initiated buprenorphine (76% NCC vs. 24% NEC). 31% of PWID in NCC, and 25% in NEC experienced >=1 treatment interruption. About a third (34%) of PWID in NCC vs. half (50%) in NEC dropped-out by 6 months (p<0.0001). Over 6 months, 48% of PWID in NCC vs. 60% in NEC received buprenorphine <=2 times/week on average (p<0.0001). In multivariable models, living in NEC was associated with increased odds of treatment drop-out while receipt of counseling was associated with decreased odds of treatment drop-out. Conclusions: PWID at ICCs, particularly those in NEC have low buprenorphine receipt and retention. Patient-centered interventions adapted to regional contexts are urgently needed to ameliorate these gaps.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study was supported by the National Institute on Drug Abuse of the National Institutes of Health (R01DA032059, R01DA041034, DP2DA040244 and K24DA035684). The study was also supported by the Harvard University Center for AIDS Research (CFAR), an NIH funded program (P30AI060354), The Johns Hopkins University CFAR (P30AI094189), The Elton John AIDS Foundation, and the Thrasher Research Fund. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

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I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Institutional Review Boards of The Johns Hopkins University School of Medicine and Boston Childrens Hospital and the Y.R. Gaitonde Centre for AIDS Research and Education gave ethical approval for this work.

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Data Availability

All data produced in the present study are available upon reasonable request to the authors.

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