Bazazi, Alexander R. and Culbert, Gabriel J. and Wegman, Martin P. and Heimer, Robert and Kamarulzaman, Adeeba and Altice, Frederick L. (2022) 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. BMC Infectious Diseases, 22 (1). ISSN 1471-2334, DOI https://doi.org/10.1186/s12879-022-07804-6.
Full text not available from this repository.Abstract
Introduction 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. Methods 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. Results 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(+) T-lymphocyte count (HR 0.8 per 100-cell/mL increase, 95% CI 0.7-1.0). Conclusions 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. Trial registration: NCT02396979. Retrospectively registered 24/03/2015
| Item Type: | Article |
|---|---|
| Funders: | United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute on Drug Abuse (NIDA) (Grant No: R01DA025943, R01DA041271, F30DA039716, K24DA017072 & K23DA041988), United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute of Mental Health (NIMH) (Grant No: F30MH105153, R25MH060482 & P30MH062294), nited States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute of General Medical Sciences (NIGMS) (Grant No: T32GM07205), University of Malaya-Ministry of Higher Education (Grant No: UM.C/625/1/HIR/MOHE/MED01) |
| Uncontrolled Keywords: | Methadone; HIV; Opioid use disorder; Prison; Mortality |
| Subjects: | R Medicine > R Medicine (General) |
| Divisions: | Faculty of Medicine Centre of Excellence for Research in AIDS (CERiA) |
| Depositing User: | Ms. Juhaida Abd Rahim |
| Date Deposited: | 14 Nov 2023 04:35 |
| Last Modified: | 14 Nov 2023 04:35 |
| URI: | http://eprints.um.edu.my/id/eprint/40717 |
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