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. 2023 May 1:246:109839.
doi: 10.1016/j.drugalcdep.2023.109839. Epub 2023 Mar 20.

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

Lakshmi Ganapathi  1 , Allison M McFall  2 , Kimberly F Greco  3 , Aylur K Srikrishnan  4 , Muniratnam Suresh Kumar  4 , Kenneth H Mayer  5 , Conall O'Cleirigh  6 , Shruti H Mehta  2 , Gregory M Lucas  7 , Sunil S Solomon  7
Affiliations

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

Lakshmi Ganapathi et al. Drug Alcohol Depend. .

Abstract

Background: India is facing overlapping opioid injection and HIV epidemics among people who inject drugs (PWID) in several cities. Integrated Care Centers (ICCs) provide single-venue HIV and substance use services to PWID. We evaluated PWID engagement in daily observed buprenorphine treatment at 7 ICCs to inform interventions.

Methods: We analyzed 1-year follow-up data for PWID initiating buprenorphine between 1 January - 31 December 2018, evaluating receipt frequency, treatment interruptions (no buprenorphine receipt for 60 consecutive days with subsequent re-engagement), and drop-out (no buprenorphine receipt for 60 consecutive days without re-engagement). Using descriptive statistics, we explored differences between ICCs in the opioid-endemic Northeast region and ICCs in the emerging opioid epidemic North/Central region. We used a multivariable logistic regression model to determine predictors of treatment drop-out by 6 months.

Results: 1312 PWID initiated buprenorphine (76% North/Central ICCs vs. 24% Northeast ICCs). 31% of PWID in North/Central, and 25% in Northeast ICCs experienced ≥ 1 treatment interruption in 1 year. Over 6 months, 48% of PWID in North/Central vs. 60% in Northeast ICCs received buprenorphine ≤ 2 times/week (p < 0.0001). A third of PWID in North/Central vs. half in Northeast ICCs experienced treatment drop-out by 6 months (p < 0.001). In the multivariable model, living in Northeast cities was associated with increased odds of drop-out while counseling receipt was associated with decreased odds.

Conclusions: Retention among PWID initiating buprenorphine at ICCs was comparable to global reports. However, regional heterogeneity in retention, and low daily buprenorphine receipt suggest patient-centered interventions adapted to regional contexts are urgently needed.

Keywords: Buprenorphine; India; Opioid use; People who inject drugs; Retention; Treatment.

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Conflict of interest statement

Conflicts of interest The authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
The Opioid Treatment Cascade for People who Inject Drugs receiving Buprenorphine at Integrated Care Centers in India.
Figure 2.
Figure 2.
Buprenorphine dose characteristics among people who inject drugs initiating treatment at Integrated Care Centers.
Figure 3.
Figure 3.
Kaplan Meir survival probabilities among PWID initiating buprenorphine at Integrated Care Centers (Panel A), by region (Panel B), and counseling frequency (Panel C).
See this image and copyright information in PMC

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