What Predicts the Successful Completion of Addiction Treatment?

Bushauna A Freeman-Dr. Metzger

SUMR PROGRAM 2016Philadelphia, PAAugust 17, 2016

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

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)

Heroin• Heroin is one of the most commonly

abused opioids

• Heroin usually appears as a white or brown powder that is used intravenously

• Studies estimate that approximately 23% of all individuals who use heroin become dependent on it

Source: National Institute on Drug Abuse

ADDICTION = CHRONIC MEDICAL CONDITION

1. Biological aspect

2. Behavioral aspect

• Opioid use disorder requires attention to both--medication assisted treatment (MAT)

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

JAIDS, 2015

USE OF (SUBOXONE) IN THE HPTN 058 STUDY

HPTN 058 Study Design

Opiate injectorsrecruited from

communities (4)and screened

Short-Term ArmSuboxone detox for 3 wks., Then at 6 months if needed;

plus 1 year counseling

Long-Term Arm

1 year of SuboxoneAdministration and

one year ofcounseling;Referral to

local resources

HIV testing and counseling

Every 6 months

Year 02

If not eligible, referredto local resources and terminated from study

HPTN 058: STUDY DESIGN

Enrollment SitesSites

Chiang Mai, Thailand

Urumuqi, Xinjiang

Heng County, Guangxi

Nanning, Guangxi

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

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

HPTN 058 Study

Inclusion CriteriaLT-MAT

Age At least 18 yrs. of age - 41+ yrs.

Gender Male/Female

Marital Status Married, or living with partner;Single, Divorced, Widowed

Education Status None to 9+ yrs.

HPTN 058 Study

Baseline Drug Use Characteristics

Long Term- MedicationAssisted 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

HPTN 058 Study

Common Factors that Inhibit Treatment Completion

• Age

• Gender

• Education

• Employment

• Poly Drug Use

• Sexual Risk Actions

What factors were actually associated with medication and counseling

completion?

AgeMedication Completion Counseling Completion

0

10

20

30

40

50

60

70

80

18-28 29-34 35-40 41+ Total

AgeRangeIntervals

Incomplete

Completed

(p<.05)

0

10

20

30

40

50

60

70

80

18-28 29-34 35-40 41+ Total

AgeRangeIntervals

Incomplete

Completed

(p<.005)

Complete Adherence = attending 12 Weeks, 9 months counseling sessions; all medication visits

GenderMedication Completion Counseling Completion

Complete Adherence = attending 12 Weeks, 9 months counseling sessions; all medication visits

(p=NS)

0

10

20

30

40

50

60

70

Male Female Total

Gender

Incomplete

Completed

(p=NS)

0

10

20

30

40

50

60

70

Male Female Total

Gender

Incomplete

Completed

EmploymentMedication Completion Counseling Completion

0

10

20

30

40

50

60

70

No Job Regular Employment

Total

Employment Status

Incomplete

Completed

(p<.05)

Complete Adherence = attending 12 Weeks, 9 months counseling sessions; all medication visits

0

10

20

30

40

50

60

70

No Job Regular Employment

Total

Employment Status

Incomplete

Completed

(p=NS)

Education Status

Medication Completion Counseling Completion

(p<.005)

Complete Adherence = attending 12 Weeks, 9 months counseling sessions; all medication visits

0

10

20

30

40

50

60

70

80

NoEducation 1-8yrs. 9ormoreyrs. Total

YearsofSchooling

Incomplete

Completed

(p<.001)

0

10

20

30

40

50

60

70

80

NoEducation 1-8yrs. 9ormoreyrs. Total

YearsofSchooling

Incomplete

Completed

Poly Drug Use

Medication Completion Counseling Completion

0

10

20

30

40

50

60

70

OneDrug TwoormoreDrugs Total

#ofDrugsAbused

Incomplete

Completed

0

10

20

30

40

50

60

70

OneDrug TwoormoreDrugs Total

#ofDrugsAbused

Incomplete

Completed

(p=NS)(p=NS)

Complete Adherence = attending 12 Weeks, 9 months counseling sessions; all medication visits

Sexual Risk Actions

Medication Completion Counseling Completion

0

10

20

30

40

50

60

70

Yes No Total

Sexu

al P

ract

ices

in th

e pa

st m

onth

Vaginal/Anal Sex?

Incomplete

Completed

(p=NS)

0

10

20

30

40

50

60

70

Yes No Total

Sexu

al P

ract

ices

in th

e pa

st m

onth

Vaginal/Anal Sex?

Incomplete

Completed

(p=NS)

Complete Adherence = attending 12 Weeks, 9 months counseling sessions; all medication visits

Counseling Completion by Medication Completion

0

10

20

30

40

50

60

70

80

90

100

SomeSessions AllSessions Total

Med

icat

ion

Visit

s Rat

e

Completion of Counseling Treatment

Incomplete

Completed

(p<.001)

Reasons for Missed VisitsTOTAL

UNABLE TO SCHEDULE WINDOW

14.7% 52.7% 51.3% 43.2% 48.1%

UNABLE TO CONTACT

36.0% 11.8% 20.9% 21.4% 18.5%

PARTICIPANTINCACERATED

31.6% 25.8% 20.0% 0.3% 19.5%

PARTICIPANTDECEASED

0.0 0.2% 0.1% 0.0% 0.1%

86.2%

RESULTS SUMMARIZED

A l l F a c t o r s

§ Age

§ Gender

§ Education

§ Employment

§ Poly Drug Use

• Sexual Risk Actions

§ Completion of Counseling sessions by completion of Medication visits

S i g n i f i c a n t F a c t o r s§ Age

§ Education

§ Completion of Counseling sessions by completion of Medication visits

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

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

Acknowledgements

• David Metzger, Ph.D., Director

• Danielle Fiore, Data Analyst

• Tiffany Dominique, BA