Low Opioid Agonist Treatment Engagement Among Veterans With and Without HIV With New Diagnosis of OUD

Opioid agonist treatment (OAT) is associated with improved clinical outcomes among people living with HIV (PLWH) with opioid use disorder (OUD). Early access to treatment is vital to reducing harm associated with OUD. In a national sample of veterans with and without HIV, researchers examined the prevalence of and factors associated with OAT initiation and the impact of HIV status to inform future policy and practice interventions to promote OAT. The primary analysis was to investigate predictors of OAT initiation. The authors identified 19,698 new clinical encounters resulting in a diagnosis of OUD in the Veterans Aging Cohort Study between 2000–2012, and examined factors associated with OAT initiation within 30 days of an OUD diagnosis.

• Only 5% of patients (with and without HIV) with a new diagnosis of OUD initiated OAT within 30 days.
• Patients with a psychiatric diagnosis (adjusted odds ratio [aOR], 0.54), HIV (aOR, 0.79), and rural residence (aOR, 0.56) had a lower likelihood of OAT initiation within 30 days.
• African-American patients (aOR, 1.60), those with an alcohol-related diagnosis (aOR, 1.76), a diagnosis year 2005–2008 relative to 2000–2004 (aOR, 1.24), and patients with HCV (aOR, 1.50) had a greater likelihood of initiating OAT within 30 days.
• Predictive factors were similar in total sample and PLWH only.

Comments: Although this study was conducted using data from 2000–2012 and therefore doesn’t reflect the recent opioid epidemic and current OAT access levels, especially buprenorphine, the findings confirm other studies suggesting that people with HIV and OUD are less likely to initiate timely OAT. Models of care need to be developed to improve OAT access among all patients, and quality measures for OUD care need to be standardized.

Jeanette M. Tetrault, MD

Reference: Wyse JJ, Robbins JL, McGinnis KA, et al. Predictors of timely opioid agonist treatment initiation among veterans with and without HIV. Drug Alcohol Depend. 2019;198:70–75.