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What Predicts the Successful Completion of Addiction Treatment?
Bushauna A Freeman-Dr. Metzger
SUMR PROGRAM 2016Philadelphia, PAAugust 17, 2016
Overview• Background
• Addiction and Medication Assisted Treatment (MAT)
• Factors coinciding with the completion of MAT
• HIV Prevention Trials Network (HPTN): 058 Study
• Inclusion Criteria
• Demographic characteristics (Baseline)
• Results
• Conclusion
• Acknowledgments
Injection Drug Use and HIV Infection
• Globally, 36.7 million people living with HIV
• Approximately, 2.1 million people became newly infected with
HIV
• Around 13 million people inject drugs ; about 1.7 million of
them are living with HIV
• Injecting drug use accounts for approximately 10% of all new
HIV infections
Source: Joint United Nations Progamme on HIV/AIDS & W.H.O. (2015)
Heroin• Heroin is one of the most commonly
abused opioids
• Heroin usually appears as a white or brown powder that is used intravenously
• Studies estimate that approximately 23% of all individuals who use heroin become dependent on it
Source: National Institute on Drug Abuse
ADDICTION = CHRONIC MEDICAL CONDITION
1. Biological aspect
2. Behavioral aspect
• Opioid use disorder requires attention to both--medication assisted treatment (MAT)
Barriers to Effective Medication Assisted Treatment (MAT)
• Access is limited globally
• Cost (varies according to the type of MAT needed)
• Insurance coverage
• Stigma
• Entry and retention in MAT
JAIDS, 2015
USE OF (SUBOXONE) IN THE HPTN 058 STUDY
HPTN 058 Study Design
Opiate injectorsrecruited from
communities (4)and screened
Short-Term ArmSuboxone detox for 3 wks., Then at 6 months if needed;
plus 1 year counseling
Long-Term Arm
1 year of SuboxoneAdministration and
one year ofcounseling;Referral to
local resources
HIV testing and counseling
Every 6 months
Year 02
If not eligible, referredto local resources and terminated from study
HPTN 058: STUDY DESIGN
Enrollment SitesSites
Chiang Mai, Thailand
Urumuqi, Xinjiang
Heng County, Guangxi
Nanning, Guangxi
HPTN 058 Study
SUBOXONE
• Partial opiate agonist with longer half-life
• Dosage 3x per week is sufficient (standard)
• Reduced risk of overdose
• Less severe withdrawal as opposed to other MAT’s
HPTN 058 Study
Behavioral Drug and Risk Counseling (BDRC)(1 year period)
• Rooted in cognitive behavioral therapy (changing patterns of
thinking) – Dr. Aaron Beck, University of Pennsylvania
• Focus on short term behavioral goals (partaking in less risky
behaviors)
• Emphasis on drug use and related problems
• Relapse is anticipated and planned for
• 12 weekly individual sessions followed by nine monthly
sessions, every four weeks
HPTN 058 Study
Inclusion CriteriaLT-MAT
Age At least 18 yrs. of age - 41+ yrs.
Gender Male/Female
Marital Status Married, or living with partner;Single, Divorced, Widowed
Education Status None to 9+ yrs.
HPTN 058 Study
Baseline Drug Use Characteristics
Long Term- MedicationAssisted Treatment
LT-MAT
Percent meeting criteria for opiate dependence n=623 (100%)
Age of first injection (Mean) 26.1
Years of injection (Mean) 7.7
Opiate injection in prior 30 days (mean) 77.7
HPTN 058 Study
Common Factors that Inhibit Treatment Completion
• Age
• Gender
• Education
• Employment
• Poly Drug Use
• Sexual Risk Actions
What factors were actually associated with medication and counseling
completion?
AgeMedication Completion Counseling Completion
0
10
20
30
40
50
60
70
80
18-28 29-34 35-40 41+ Total
AgeRangeIntervals
Incomplete
Completed
(p<.05)
0
10
20
30
40
50
60
70
80
18-28 29-34 35-40 41+ Total
AgeRangeIntervals
Incomplete
Completed
(p<.005)
Complete Adherence = attending 12 Weeks, 9 months counseling sessions; all medication visits
GenderMedication Completion Counseling Completion
Complete Adherence = attending 12 Weeks, 9 months counseling sessions; all medication visits
(p=NS)
0
10
20
30
40
50
60
70
Male Female Total
Gender
Incomplete
Completed
(p=NS)
0
10
20
30
40
50
60
70
Male Female Total
Gender
Incomplete
Completed
EmploymentMedication Completion Counseling Completion
0
10
20
30
40
50
60
70
No Job Regular Employment
Total
Employment Status
Incomplete
Completed
(p<.05)
Complete Adherence = attending 12 Weeks, 9 months counseling sessions; all medication visits
0
10
20
30
40
50
60
70
No Job Regular Employment
Total
Employment Status
Incomplete
Completed
(p=NS)
Education Status
Medication Completion Counseling Completion
(p<.005)
Complete Adherence = attending 12 Weeks, 9 months counseling sessions; all medication visits
0
10
20
30
40
50
60
70
80
NoEducation 1-8yrs. 9ormoreyrs. Total
YearsofSchooling
Incomplete
Completed
(p<.001)
0
10
20
30
40
50
60
70
80
NoEducation 1-8yrs. 9ormoreyrs. Total
YearsofSchooling
Incomplete
Completed
Poly Drug Use
Medication Completion Counseling Completion
0
10
20
30
40
50
60
70
OneDrug TwoormoreDrugs Total
#ofDrugsAbused
Incomplete
Completed
0
10
20
30
40
50
60
70
OneDrug TwoormoreDrugs Total
#ofDrugsAbused
Incomplete
Completed
(p=NS)(p=NS)
Complete Adherence = attending 12 Weeks, 9 months counseling sessions; all medication visits
Sexual Risk Actions
Medication Completion Counseling Completion
0
10
20
30
40
50
60
70
Yes No Total
Sexu
al P
ract
ices
in th
e pa
st m
onth
Vaginal/Anal Sex?
Incomplete
Completed
(p=NS)
0
10
20
30
40
50
60
70
Yes No Total
Sexu
al P
ract
ices
in th
e pa
st m
onth
Vaginal/Anal Sex?
Incomplete
Completed
(p=NS)
Complete Adherence = attending 12 Weeks, 9 months counseling sessions; all medication visits
Counseling Completion by Medication Completion
0
10
20
30
40
50
60
70
80
90
100
SomeSessions AllSessions Total
Med
icat
ion
Visit
s Rat
e
Completion of Counseling Treatment
Incomplete
Completed
(p<.001)
Reasons for Missed VisitsTOTAL
UNABLE TO SCHEDULE WINDOW
14.7% 52.7% 51.3% 43.2% 48.1%
UNABLE TO CONTACT
36.0% 11.8% 20.9% 21.4% 18.5%
PARTICIPANTINCACERATED
31.6% 25.8% 20.0% 0.3% 19.5%
PARTICIPANTDECEASED
0.0 0.2% 0.1% 0.0% 0.1%
86.2%
RESULTS SUMMARIZED
A l l F a c t o r s
§ Age
§ Gender
§ Education
§ Employment
§ Poly Drug Use
• Sexual Risk Actions
§ Completion of Counseling sessions by completion of Medication visits
S i g n i f i c a n t F a c t o r s§ Age
§ Education
§ Completion of Counseling sessions by completion of Medication visits
Conclusion• Age and education were significantly associated with medication
completion• Age, education and employment were significantly associated with
counseling completion• Counseling and medication completion were highly correlated• Data is consistent with the “maturing out hypothesis” which explains
that most drug users tend to reduce and eliminate drug use as they age
• The data indicated that the majority of participants who completed all counseling sessions, also completed their medication visits
- This finding proves to be the most significant and would indicate that the best incentive for completion of treatment would be to offer some form of medication in addition to counseling services
Lessons Learned• The ability to analyze and interpret data from a clinical trial
• The correlation between these significant factors and completion of treatment proves that there is in fact a connection, but these factors do not necessarily cause treatment outcomes
• The necessity for the expansion of Medication Assisted Treatment (MAT) within the U.S.
• Improved understanding and appreciation for the field of epidemiology
Acknowledgements
• David Metzger, Ph.D., Director
• Danielle Fiore, Data Analyst
• Tiffany Dominique, BA
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