What Predicts the Successful Completion of Addiction Treatment?

Transcription

1 What Predicts the Successful Completion of Addiction Treatment? Bushauna A Freeman -Dr. Metzger SUMR PROGRAM 2016 Philadelphia, PA August 17, 2016

2 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

3 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)

4 Heroin Heroin is one of the most commonly abused opioids Heroin usually appears as a white or brown powder that is used intravenously Source: National Institute on Drug Abuse Studies estimate that approximately 23% of all individuals who use heroin become dependent on it

5 ADDICTION = CHRONIC MEDICAL CONDITION 1. Biological aspect 2. Behavioral aspect Opioid use disorder requires attention to both--medication assisted treatment (MAT)

6 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

7 USE OF (SUBOXONE) IN THE HPTN 058 STUDY JAIDS, 2015

8 HPTN 058 Study Design HPTN 058: STUDY DESIGN Opiate injectors recruited from communities (4) and screened If not eligible, referred to local resources and terminated from study Short-Term Arm Suboxone detox for 3 wks., Then at 6 months if needed; plus 1 year counseling Long-Term Arm 1 year of Suboxone Administration and one year of counseling; Referral to local resources HIV testing and counseling Every 6 months Year 02

9 HPTN 058 Study Enrollment Sites Sites Chiang Mai, Thailand Urumuqi, Xinjiang Heng County, Guangxi Nanning, Guangxi

10 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

11 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

12 HPTN 058 Study Inclusion Criteria LT-MAT Age At least 18 yrs. of age yrs. Gender Male/Female Marital Status Married, or living with partner; Single, Divorced, Widowed Education Status None to 9+ yrs.

13 HPTN 058 Study Baseline Drug Use Characteristics Long Term- Medication Assisted 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

14 Common Factors that Inhibit Treatment Completion Age Gender Education Employment Poly Drug Use Sexual Risk Actions

15 What factors were actually associated with medication and counseling completion?

16 Age Medication Completion (p<.005) Counseling Completion (p<.05) Incomplete Completed Incomplete Completed Total Total Age Range Intervals Age Range Intervals Complete Adherence = attending 12 Weeks, 9 months counseling sessions; all medication visits

17 Gender Medication Completion (p=ns) Counseling Completion (p=ns) Incomplete Completed Incomplete Completed Male Female Total 0 Male Female Total Gender Gender Complete Adherence = attending 12 Weeks, 9 months counseling sessions; all medication visits

18 Employment 70 Medication Completion 70 Counseling Completion 60 (p=ns) 60 (p<.05) Incomplete Completed Incomplete Completed No Job Regular Employment Total 0 No Job Regular Employment Total Employment Status Employment Status Complete Adherence = attending 12 Weeks, 9 months counseling sessions; all medication visits

19 Education Status 80 Medication Completion 80 Counseling Completion 70 (p<.001) 70 (p<.005) Incomplete Completed Incomplete Completed No Education 1-8 yrs. 9 or more yrs. Total 0 No Education 1-8 yrs. 9 or more yrs. Total Years of Schooling Years of Schooling Complete Adherence = attending 12 Weeks, 9 months counseling sessions; all medication visits

20 Poly Drug Use Medication Completion (p=ns) Counseling Completion (p=ns) Incomplete Completed 40 Incomplete Completed One Drug Two or more Drugs Total 0 One Drug Two or more Drugs Total # of Drugs Abused # of Drugs Abused Complete Adherence = attending 12 Weeks, 9 months counseling sessions; all medication visits

21 Sexual Risk Actions Medication Completion Counseling Completion (p=ns) 60 (p=ns) Sexual Practices in the past month Incomplete Completed Sexual Practices in the past month Incomplete Completed 0 Yes No Total 0 Yes No Total Vaginal/Anal Sex? Vaginal/Anal Sex? Complete Adherence = attending 12 Weeks, 9 months counseling sessions; all medication visits

22 Counseling Completion by Medication Completion (p<.001) 80 Medication Visits Rate Incomplete Completed Some Sessions All Sessions Total Completion of Counseling Treatment

23 Reasons for Missed Visits TOTAL UNABLE TO SCHEDULE WINDOW UNABLE TO CONTACT PARTICIPANT INCACERATED PARTICIPANT DECEASED 14.7% 52.7% 51.3% 43.2% 48.1% 36.0% 11.8% 20.9% 21.4% 18.5% 31.6% 25.8% 20.0% 0.3% 19.5% % 0.1% 0.0% 0.1% 86.2%

24 RESULTS SUMMARIZED Age Gender Education Employment All Factors Significant Factors Age Education Completion of Counseling sessions by completion of Medication visits Poly Drug Use Sexual Risk Actions Completion of Counseling sessions by completion of Medication visits

25 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

26 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

27 Acknowledgements David Metzger, Ph.D., Director Danielle Fiore, Data Analyst Tiffany Dominique, BA