buprenorphine and Tuberculosis

Topics: Antiretroviral Therapy, Highly Active; Buprenorphine; Comorbidity; Evidence-Based Medicine; Harm Reduction; HIV Infections; Humans; Incidence; Medication Adherence; Methadone; Needle Sharing; Opiate Substitution Treatment; Opioid-Related Disorders; Risk Factors; Substance Abuse, Intravenous; Tuberculosis; Unsafe Sex

Opioid agonist treatments (OAT) are widely-used, evidence-based strategies for treating opioid dependence and reducing HIV transmission. The positive benefits of OAT are strongly correlated with time spent in treatment, making retention a key indicator for program quality. This study assessed patient retention and associated factors in Ukraine, where OAT was first introduced in 2004.. Data from clinical records of 2916 patients enrolled in OAT at thirteen sites from 2005 to 2012 were entered into an electronic monitoring system. Survival analysis methods were used to determine the probability of retention and its correlates.. Twelve-month retention was 65.8%, improving from 27.7% in 2005, to 70.9% in 2011. In multivariable analyses, the correlates of retention were receiving medium and high doses of medication (compared to low doses, dropout aHR=0.57 for both medium and high doses), having not been tested for HIV and tuberculosis (compared to not being tested, dropout aHR=4.44 and 3.34, respectively), and among those who were tested-a negative TB test result (compared to receiving a positive test result, dropout aHR=0.67).. Retention in Ukrainian OAT programs, especially in recent years, is comparable to other countries. The results confirm the importance of adequate OAT dosing (≥60mg of methadone, ≥8mg of buprenorphine). Higher dosing, however, will require interventions that address negative attitudes toward OAT by patients and providers. Interruption of OAT, in the case developing tuberculosis, should incorporate continuity of OAT for TB patients through integrated care delivery systems.

Topics: Adult; Buprenorphine; Cohort Studies; Delivery of Health Care, Integrated; Dose-Response Relationship, Drug; Female; HIV Infections; Humans; Male; Methadone; Multivariate Analysis; Opiate Substitution Treatment; Opioid-Related Disorders; Patient Compliance; Patient Dropouts; Retrospective Studies; Tuberculosis; Ukraine

Buprenorphine's availability in primary care settings offers increased access to treatment and linkage to primary care for opioid-dependent patients. Currently, tuberculin skin testing (TST) is recommended for patients enrolling in methadone maintenance treatment (MMT), but not for those enrolling in buprenorphine maintenance treatment (BMT).. To compare TST screening results in enrollees in BMT and MMT programs and assess the correlates of TST positivity among these subjects.. A cross-sectional analysis of a retrospective cohort study was conducted to compare concurrent TST results among contemporaneously matched groups of MMT and BMT patients in the same community.. TST positivity was approximately 9% in both MMT and BMT settings (p = .27). Increased TST positivity was associated with being Black (AOR = 3.53, CI = 1.28-9.77), Hispanic (AOR = 3.11, CI = 1.12-8.60), and having higher education (AOR = 3.01, CI = 1.20-7.53).. These results confirm a similar high prevalence of TST positivity in opioid-dependent patients enrolling in MMT and BMT programs. Racial and ethnic health disparities remain associated with TST positivity, yet a relationship between higher education and tuberculosis requires further investigation.. These data suggest the importance of incorporating TST screening in emerging BMT programs as a mechanism to provide increased detection and treatment of tuberculosis infection in opioid-dependent patient populations.

Topics: Adult; Buprenorphine; Female; Humans; Male; Methadone; Opioid-Related Disorders; Policy Making; Prevalence; Tuberculin Test; Tuberculosis

Drug abuse is on the rise. Drug addiction lowers the general immunity of the body. Tuberculosis is known to be one of the major infectious diseases with a high incidence among drug addicts. Treatment of drug addicts suffering from tuberculosis is a challenge to the treating physician.. An interventional prospective study which involved free de-addiction drugs and motivation along with free anti tubercular drugs under Revised National Tuberculosis Programme was undertaken among drug addicts. Sixty drug addicts suffering from tuberculosis, registered under RNTCP in SPM marg TB Clinic (Pili Kothi) between 2002-2007 and treated under DOTS along with de-addiction treatment by an NGO (Sharan) formed the study sample.. Objectives of the study were: a) To study the profile of drug addicts with tuberculosis, b) To assess the success results of DOTS in drug addicts with tuberculosis (along with de-addiction treatment).. Extensive counselling for de-addiction and motivation of the study patients along with nutritional food supplements improved the compliance and adherence to treatment with equal success rates as in non-addict tuberculosis patients. The overall success rate in drug addicts was 83.3%. The default rate of 3.3% and failure rate of just 1.7% among study group were also within the permissible range of RNTCP (< 4%).. DOTS along with supplementary intervention was observed to be quite effective in drug addicts with TB.

Topics: Adolescent; Adult; Antitubercular Agents; Buprenorphine; Directly Observed Therapy; Drug Users; Humans; India; Male; Middle Aged; Motivation; Narcotic Antagonists; Patient Compliance; Prospective Studies; Substance-Related Disorders; Treatment Outcome; Tuberculosis; Young Adult