Prescribing methadone in prison predicts linkage to HIV care after release from prison: A randomized and patient preference trial

Abstract

Purpose

The transition from prison is hazardous, especially for people with HIV and opioid use disorder. To determine the impact of methadone on linkage to HIV care in people with HIV and opioid use disorder, we prospectively compared those allocated to pre-release methadone or not.

Methods

A prospective, open-label trial of 310 people with HIV and opioid use disorder at Malaysia's largest prison were allocated to pre-release methadone up to 24 weeks before release or not by randomization (n = 64) or preference (n = 246); 296 were included in the final analytical sample. Directed acyclic graphing was used to theorize the relationship between pre-release methadone and post-release linkage to HIV care and identify confounding variables. An inverse probability weighted Cox proportional hazards model estimated the impact of pre-release methadone on linkage to HIV care through 360 days after release.

Results

Overall, 218 (73.6 %) of 296 study participants initiated methadone before release. Receiving pre-release methadone significantly predicted linkage to HIV care at all time points through 360 days (aHR = 1.87; 95 % CI 1.15–2.85) after release. The corresponding numbers needed to treat with pre-release methadone for one increased linkage to HIV care at 30 and 360 days were 14 (95 % CI 9.2–62.4) and 5 (95 % CI 3.4–22.0), respectively.

Conclusions

While treatment with methadone should be available to everyone with opioid use disorder, it should especially be included as part of an HIV treatment-as-prevention strategy for people in prisons, especially by the time of release. It can optimize HIV treatment outcomes by jumpstarting the HIV treatment cascade.