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

Affiliations

¹ Division of Pediatric Global Health, Massachusetts General Hospital for Children, 55 Fruit Street, Boston, MA 02114, USA; Division of Pediatric Infectious Diseases, Massachusetts General Hospital for Children, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. Electronic address: lganapathi@mgh.harvard.edu.
² Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 733 N Broadway, Baltimore, MD 21205, USA.
³ Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, 21 Autumn Street, Boston, MA 02215, USA.
⁴ YR Gaitonde Centre for AIDS Research and Education, No. 34, East Street, Kilpauk Garden Colony, Chennai 600010, India.
⁵ Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA; The Fenway Institute, 1340 Boylston Street, Boston, MA 02215, USA.
⁶ Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
⁷ Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA.

PMID: 37031487
PMCID: PMC10416117
DOI: 10.1016/j.drugalcdep.2023.109839

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

Lakshmi Ganapathi et al. Drug Alcohol Depend. 2023.

. 2023 May 1:246:109839.

doi: 10.1016/j.drugalcdep.2023.109839. Epub 2023 Mar 20.

Affiliations

¹ Division of Pediatric Global Health, Massachusetts General Hospital for Children, 55 Fruit Street, Boston, MA 02114, USA; Division of Pediatric Infectious Diseases, Massachusetts General Hospital for Children, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. Electronic address: lganapathi@mgh.harvard.edu.
² Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 733 N Broadway, Baltimore, MD 21205, USA.
³ Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, 21 Autumn Street, Boston, MA 02215, USA.
⁴ YR Gaitonde Centre for AIDS Research and Education, No. 34, East Street, Kilpauk Garden Colony, Chennai 600010, India.
⁵ Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA; The Fenway Institute, 1340 Boylston Street, Boston, MA 02215, USA.
⁶ Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
⁷ Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA.

PMID: 37031487
PMCID: PMC10416117
DOI: 10.1016/j.drugalcdep.2023.109839

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.**
The Opioid Treatment Cascade for People who Inject Drugs receiving Buprenorphine at Integrated Care Centers in India.

**Figure 2.**
Buprenorphine dose characteristics among people who inject drugs initiating treatment at Integrated Care Centers.

**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

References

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

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

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